Multidisciplinary Rehabilitation for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

Author (yr.)	N	Inclusion criteria	Exclusion criteria	Intervention	Duration	Outcome measures	Result
Van der Mark et al. (2013)	IG = 51	Clinical diagnosis of PD, ability to complete the study questionnaires, written informed consent, and presence of a caregiver	Dementia (MMSE <24) and current treatment by a movement disorders specialist	Multidisciplinary team (movement disorders specialist, PD nurses, and social worker)	8 months	PDQ-39, UPDRS part III, UPDRS total, MADRS, SCOPA-PS, CSI, and daily LED (mg)	Credence to a multidisciplinary team approach
	CR = 49			Control group: care given by a general neurologist
Barboza et al. (2019)	IG = 28	Idiopathic PD, stages 1.5 to 3 on the modified H&Y scale, older than 50 yrs, and independent for walking	Other neurological, musculoskeletal, and associated disorders, as well as cognitive alterations, that interfere with movement	Motor physiotherapy with cognitive training	4 months	UPDRS (domain II), UPDRS (domain III), UPDRS (total), GDS, MMSE, MoCA, LED (mg), and PDQL	Both treatment approaches were effective for the outcomes
	CG = 26			Control group: motor PT only
Clarke et al. (2016)	IG = 381	Idiopathic PD defined by the UK Parkinson disease society brain bank criteria; self- or caregiver reported limitations in ADL	Dementia as locally defined and receipt of PT or OT for PD in the last 12 months	Physiotherapy plus occupational therapy	8 weeks	NEADL scale, PDQ-39, EQ-5D, and SF-12	No evidence to support this intervention
	CG = 381			Control group: no therapy
Ferrazzoli et al. (2017)	IG = 186	Idiopathic PD by the UK brain bank criteria, H&Y stages 2–4, and stable pharmacological treatment in the last 6 weeks	Any focal brain lesion (CT or MRI), psychosis, auditory, visual, and/or vestibular dysfunctions and other chronic diseases	Multidisciplinary intensive rehabilitation treatment (MIRT)	4 weeks	PDQ-39, UPDRS total, PDDS, TUG, BBS, STAI, BDI, LED (mg), and neurologic tests	MIRT improve QoL in short-term and long-term period
	CG = 48			Control group: no rehabilitation
Monticone et al. (2015)	IG = 33	Idiopathic PD (modified H&Y scale, 2.5–4), a decline in function assessed, older than 50 yrs, duration of more than 10 yrs, and stable drug use for more than 15 days	Dementia and other neurological diseases, systemic illness, psychiatric deficits, invasive drug treatments, and surgical interventions for PD	Multidisciplinary rehabilitative (MR) care-motor training, cognitive training, and ergonomic education	8 weeks	UPDRS part III, BBS, FIM and PDQ-39	MR improves patient conditions
	CG = 34			Control group: general physiotherapy
Sturkenboom (2012)	IG = 29	Idiopathic PD lived at home, reported difficulties in daily activities, had a nonprofessional caregiver who could assist at least twice a week	Use of occupational therapy in the last 12 months, disabling comorbidity, inability to complete questionnaires, participation in another intervention trial	Home-based occupational therapy according to the Dutch guidelines of occupational therapy	10 weeks	UPDRS III, CIRS-G, MMSE, COPM, AMPS, and ZBI	Negligible to small effects in favor of the intervention group
	CG = 14			Control group: no occupational therapy

IG: intervention group, CG: control group, PD: Parkinson’s disease, H &Y scale: Hoehn and Yahr scale, ADL: activity of daily living, MIRT: multidisciplinary intensive rehabilitation treatment, MMSE: mini-mental state examination, PDQ-39: Parkinson’s Disease Questionnaire, UPDRS: Unified Parkinson Disease Rating Scale, MADS: Montgomery Asberg Depression Scale, SCOPA-PS: Scales for Outcomes in Parkinson’s Disease Psychosocial Index, CSI: Caregiver Strain Index, LED: levodopa equivalent dose, GDS: Geriatric Depression Scale, MoCA: Montreal Cognitive Assessment, PDQL: Parkinson’s Disease Quality of Life Questionnaire, NEADL: Nottingham Extended Activities of Daily Living, EQ-5D: EuroQol-5D, SF-12: short form 12, PDDS: Parkinson’s Disease Disability Scale, TUG: Timed Up and Go Test, BBS: Berg Balance Scale, STAI: State-Trait Anxiety Inventory, BDI: Beck Depression Inventory, FIM: functional independence measure, CIRS-G: Cumulative Illness Rating Scale-Geriatrics, COPM: Canadian Occupational Performance Measure, AMPS: Assessment of Motor and Process Skills, and ZBI: Zarit Burden Inventory.