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Khobkhun F1,2,3, Hollands PM1, Hollands K4, Ajjimaporn A2
1Liverpool John Moores University, Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool, United Kingdom, 2Mahidol University, College of Sport Science and Technology, Nakon-Pathom, Thailand, 3Mahidol University, Physical Therapy, Nakon-Pathom, Thailand, 4University of Salford, Centre for Health Sciences Research, Manchester, United Kingdom
Background: The benefits of physiotherapy interventions for improving functional performance, activities of daily life (ADL) and quality of life (QOL) in people with Parkinson's disease (PD) have been well-established. However, the mechanism through which these improvements are achieved remains unclear. Understanding how physiotherapy treatments work is important, as this will help in designing more effective, individually tailored and cost-efficient interventions. Axial rigidity is a common symptom of PD and is believed to contribute towards many mobility problems, including difficulties with the following: side lying to sitting, supine to stand, balancing, turning and walking. These problems may lead to increase risks of falling. Furthermore, it is possible that the positive effects of physiotherapy on functional performance in PD patients might be due, in part, to reductions in axial rigidity.
Purpose: A scoping review was conducted to determine whether there is sufficient high-quality evidence to investigate whether improvements in function due to exercise-based rehabilitation may be associated with reduced axial rigidity in people with PD.
Methods: A systematic search of the following databases was conducted: Cochrane Library, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, PubMed. For this study selection, articles that compared the effects of exercise-based treatment as an experimental intervention with a non-physiotherapy intervention as the control were included. The experimental interventions comprised general physiotherapy or exercises, task-specific training, dance, Tai Chi, yoga, Pilates and martial arts while the control interventions were composed of the usual care, which comprised either the impartation of education or prescription of medication only (without the inclusion of any physiotherapy programme). The synthesis method was used as a narrative to describe these articles.
Results: Two review authors (FK and MH) independently selected studies by following a set of inclusion criteria. Ninety-four studies were identified for review from the five databases that were searched. Eleven studies were eligible for inclusion, but only four of those studies explicitly focussed on physiotherapy in terms of exercise-based treatment for axial rigidity. It was found that two studies hinted at the beneficial results of exercise treatment in improving axial rigidity in people with PD at the Hoehn & Yahr stages of one to three, as evidenced by an improvement in Unified Parkinson's Disease Rating Scale (UPDRS) (in rigidity scores), axial rotation, spinal flexibility and range of motion of the neck and trunk. Furthermore, two other studies provided evidence for improvement of movement problems related to axial rigidity in PD patients, e.g. problems with maintaining functional reach, balance, gait turning and ensuring bed mobility.
Conclusion(s): The findings of this scoping review indicates that there is insufficient high-quality evidence to determine whether improvements in function due to exercise-based rehabilitation are associated with reduced axial rigidity in people with PD. Further research needs to be conducted to explore the relationship between the beneficial effects of exercise-based interventions on functional mobility and improvements in axial rigidity in people with PD.
Implications: This advocates the need for high-quality research to determine which exercise or physiotherapy intervention may be beneficial to this population and help guide physiotherapists on how to deliver this.
Keywords: Parkinson''''''''s Disease, rigidity, exercise
Funding acknowledgements: 1. Liverpool John Moores University Funding
2. Mahidol University's Academic Development Scholarship
Purpose: A scoping review was conducted to determine whether there is sufficient high-quality evidence to investigate whether improvements in function due to exercise-based rehabilitation may be associated with reduced axial rigidity in people with PD.
Methods: A systematic search of the following databases was conducted: Cochrane Library, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, PubMed. For this study selection, articles that compared the effects of exercise-based treatment as an experimental intervention with a non-physiotherapy intervention as the control were included. The experimental interventions comprised general physiotherapy or exercises, task-specific training, dance, Tai Chi, yoga, Pilates and martial arts while the control interventions were composed of the usual care, which comprised either the impartation of education or prescription of medication only (without the inclusion of any physiotherapy programme). The synthesis method was used as a narrative to describe these articles.
Results: Two review authors (FK and MH) independently selected studies by following a set of inclusion criteria. Ninety-four studies were identified for review from the five databases that were searched. Eleven studies were eligible for inclusion, but only four of those studies explicitly focussed on physiotherapy in terms of exercise-based treatment for axial rigidity. It was found that two studies hinted at the beneficial results of exercise treatment in improving axial rigidity in people with PD at the Hoehn & Yahr stages of one to three, as evidenced by an improvement in Unified Parkinson's Disease Rating Scale (UPDRS) (in rigidity scores), axial rotation, spinal flexibility and range of motion of the neck and trunk. Furthermore, two other studies provided evidence for improvement of movement problems related to axial rigidity in PD patients, e.g. problems with maintaining functional reach, balance, gait turning and ensuring bed mobility.
Conclusion(s): The findings of this scoping review indicates that there is insufficient high-quality evidence to determine whether improvements in function due to exercise-based rehabilitation are associated with reduced axial rigidity in people with PD. Further research needs to be conducted to explore the relationship between the beneficial effects of exercise-based interventions on functional mobility and improvements in axial rigidity in people with PD.
Implications: This advocates the need for high-quality research to determine which exercise or physiotherapy intervention may be beneficial to this population and help guide physiotherapists on how to deliver this.
Keywords: Parkinson''''''''s Disease, rigidity, exercise
Funding acknowledgements: 1. Liverpool John Moores University Funding
2. Mahidol University's Academic Development Scholarship
Topic: Neurology: Parkinson's disease
Ethics approval required: No
Institution: Liverpool John Moores University
Ethics committee: Liverpool John Moores University Research Ethics Committee (REC)
Reason not required: It''''''''s a scoping review (narative review)
All authors, affiliations and abstracts have been published as submitted.
