Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. Wearable Sensor-Based Biofeedback Training for Balance and Gait in Parkinson Disease: A Pilot Randomized Controlled Trial. Comparing the effects of hydrotherapy and land-based therapy on balance in patients with Parkinson’s disease: a randomized controlled pilot study Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease: a quasi-randomized pilot trial. In-patient multidisciplinary rehabilitation for Parkinson's disease: A randomized controlled trial. Promotion of physical activity and fitness in sedentary patients with Parkinson’s disease: randomised controlled trial Does Integrative Medicine Enhance Balance in Aging Adults? Proof of Concept for the Benefit of Electroacupuncture Therapy in Parkinson's Disease Tango for treatment of motor and non-motor manifestations in Parkinson's disease: a randomized control study. Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: a randomized controlled pilot study Working on asymmetry in Parkinson’s disease: randomized, controlled pilot study Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson's disease: a randomized controlled trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care. Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. Virtual Reality–Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson’s Disease
Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice OBJECTIVES To analyze the feasibility and efficacy of a novel system ( Gamepad [ GAMing Experience in PArkinson 's Disease ] ) for biofeedback rehabilitation of balance and gait in Parkinson disease ( PD ) . DESIGN R and omized controlled trial . SETTING Clinical rehabilitation gym . PARTICIPANTS Subjects with PD ( N=42 ) were r and omized into experimental and physiotherapy without biofeedback groups . INTERVENTIONS Both groups underwent 20 sessions of training for balance and gait . The experimental group performed tailored functional tasks using Gamepad . The system , based on wearable inertial sensors , provided users with real-time visual and acoustic feedback about their movement during the exercises . The physiotherapy group underwent individually structured physiotherapy without feedback . MAIN OUTCOME MEASURES Assessment s were performed by a blinded examiner preintervention , postintervention , and at 1-month follow-up . Primary outcomes were the Berg Balance Scale ( BBS ) and 10-m walk test ( 10MWT ) . Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Question naire . RESULTS Gamepad was well accepted by participants . Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining ( experimental group-physiotherapy without biofeedback group : mean , 2.3±3.4 points ; P=.047 ) and at follow-up ( experimental group-physiotherapy without biofeedback group : mean , 2.7±3.3 points ; P=.018 ) . Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group ( experimental group-physiotherapy without biofeedback group : -1.6±1.5 mm ; P=.003 ) . No significant between-group differences were found in the other outcomes . CONCLUSIONS Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month . After training , 10MWT data were comparable between groups . Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical setting s , to enhance gait improvements , and to increase transfer of training effects to real-life context Objective : Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinson ’s disease and the effectiveness of this treatment on balance parameters in comparison to a traditional l and -based physical therapy . Design : A r and omized single-blind controlled trial . Setting : Out patients . Subjects : Thirty-four patients with Parkinson ’s disease in Hoehn-Yahr stage 2.5–3 . Intervention : Group 1 hydrotherapy treatment , group 2 l and -based rehabilitation treatment . The two groups underwent the same rehabilitation period ( 60 minutes of treatment , five days a week for two months ) . Main measures : The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes , using a stabilometric platform . Secondary outcome measures were Unified Parkinson ’s Disease Rating Scale II and III , Timed Up and Go Test , Berg Balance Scale , Activities-specific Balance Confidence Scale , Falls Efficacy Scale , Falls diary and Parkinson ’s Disease Question naire-39 . Results : Hydrotherapy treatment proved to be feasible and safe . Patients in both groups had a significant improvement in all outcome variables . There was a better improvement in patients who underwent hydrotherapy than in patients treated with l and -based therapy in the centre of pressure sway area closed eyes ( mean SD change : 45.4 SD64.9 vs. 6.9 SD45.3 , p = 0.05 ) , Berg Balance Scale ( 51.2 SD3.1 vs. 6.0 SD3.1 , p = 0.005 ) , Activities-specific Balance Confidence Scale ( 16.8 SD10.6 vs. 4.1 SD5.4 , p = 0.0001 ) , Falls Efficacy Scale ( −5.9 SD4.8 vs. −1.9 SD1.4 , p = 0.003 ) , Parkinson ’s Disease Quetionnaire-39 ( −18.4 SD12.9 vs. −8.0 SD7.0 , p = 0.006 ) and falls diary ( −2.4 SD2.2 vs. −0.4 SD0.5 , p = 0.001 ) . Conclusion : Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease OBJECTIVE To examine the effectiveness of dance on motor functions , cognitive functions , and mental symptoms of Parkinson 's disease ( PD ) . DESIGN This study employed a quasi-r and omised , between-group design . SETTING Dance , PD exercise , and all assessment s were performed in community halls in different regions of Japan . PARTICIPANTS Forty-six mild-moderate PD patients participated . INTERVENTION Six PD patient associations that agreed to participate in the study were r and omly assigned to a dance group , PD exercise group , or non-intervention group . The dance and PD exercise groups performed one 60-min session per week for 12 weeks . Control group patients continued with their normal lives . All groups were assessed before and after the intervention . MAIN OUTCOME MEASURES We used the Timed Up- and -Go Test ( TUG ) and Berg Balance Scale ( BBS ) to assess motor function , the Frontal Assessment Battery at bedside ( FAB ) and Mental Rotation Task ( MRT ) to assess cognitive function , and the Apathy Scale ( AS ) and Self-rating Depression Scale ( SDS ) to assess mental symptoms of PD . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) was used for general assessment of PD . RESULTS When comparing results before and after intervention , the dance group showed a large effect in TUG time ( ES=0.65 , p=0.006 ) , TUG step number ( ES=0.66 , p=0.005 ) , BBS ( ES=0.75 , p=0.001 ) , FAB ( ES=0.77 , p=0.001 ) , MRT response time ( ES=0.79 , p<0.001 ) , AS ( ES=0.78 , p<0.001 ) , SDS ( ES=0.66 , p=0.006 ) and UPDRS ( ES=0.88 , p<0.001 ) . CONCLUSIONS Dance was effective in improving motor function , cognitive function , and mental symptoms in PD patients . General symptoms in PD also improved . Dance is an effective method for rehabilitation in PD patients PURPOSE This study was undertaken to evaluate the effects of an inpatient 2-month multidisciplinary rehabilitative program of task-oriented exercises , cognitive-behavioral training , and occupational therapy on motor impairment , activities of daily living , and quality of life ( QoL ) in subjects with long- duration Parkinson 's disease ( PD ) . METHODS Subjects were r and omly selected for an experimental ( multidisciplinary rehabilitative care ) and a control group ( general physiotherapy ) and were assessed before treatment , after 8 weeks ( post-treatment ) , and 12 months after the end of treatment . Medications were not adjusted during training . Outcome measures were the Movement Disorder Society Unified Parkinson 's Disease Rating Scale , Part III ( primary outcome ) , the Berg Balance Scale , the Functional Independence Measure , and the 39-Parkinson 's Disease Question naire . A linear mixed model for repeated measures was used for each outcome . RESULTS Seventy subjects with PD ( 46 females ; mean age , 74 ± 7 years ; mean disease duration , 15 ± 3 years , modified Hoehn & Yahr stage , 2.5 - 4 ) were r and omized , 64 completed the study ( experimental = 32 ; control = 32 ) . A significant effect of time , group , and time by group interaction were noted for all outcomes . The primary outcome showed a between-group difference in favor of the experimental group of 25 points after training , which was maintained at follow-up . After training , the Berg Balance Scale score of the experimental group was greater than 43.5 , a value previously identified as a cutoff between fallers and nonfallers for subjects with PD . CONCLUSION Our findings suggest that multidisciplinary rehabilitative care is useful in changing the course of motor impairment , balance , activities of daily living , and QoL. The effects lasted for at least 1 y after the intervention Objective To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson ’s disease . Design Multicentre r and omised controlled trial . Setting 32 community hospitals in the Netherl and s , collaborating in a nationwide network ( ParkinsonNet ) . Participants 586 sedentary patients with idiopathic Parkinson ’s disease aged between 40 and 75 years with mild to moderate disease severity ( Hoehn and Yahr stage ≤3 ) . Intervention Patients were r and omly assigned to the ParkFit programme or a matched general physiotherapy intervention . ParkFit is a multifaceted behavioural change programme , design ed specifically to achieve an enduring increase in the level of physical activity ( coaches using motivational strategies ; ambulatory feedback ) . Main outcome measures The primary endpoint was the level of physical activity , measured every six months with a st and ardised seven day recall ( LASA physical activity question naire — LAPAQ ) . Secondary endpoints included two other measures of physical activity ( activity diary and ambulatory activity monitor ) , quality of life ( Parkinson ’s disease question naire — PDQ-39 ) , and fitness ( six minute walk test ) . Results 540 ( 92.2 % ) patients completed the primary outcome . During follow-up , overall time spent on physical activities ( LAPAQ ) was comparable between the groups ( adjusted group difference 7 % , 95 % confidence interval −3 to 17 % ; P=0.19 ) . Analyses of three secondary outcomes indicated increased physical activity in ParkFit patients , as suggested by the activity diary ( difference 30 % ; P<0.001 ) , the activity monitor ( difference 12 % ; P<0.001 ) , and the six minute walk test ( difference 4.8 m ; P=0.05 ) . PDQ-39 did not differ between ParkFit patients and controls ( difference −0.9 points ; P=0.14 ) . The number of fallers was comparable between ParkFit patients ( 184/299 ; 62 % ) and controls ( 191/287 ; 67 % ) . Conclusions The ParkFit behavioural change programme did not increase overall physical activity , as measured with the LAPAQ . The analysis of the secondary endpoints justifies further work into the possible merits of behavioural change programmes to increase physical activities in daily life in Parkinson ’s disease . Trial registration Clinical trials NCT00748488 Background : Postural balance and potentially fall risk increases among older adults living with neurological diseases , especially Parkinson 's disease ( PD ) . Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance , interest is growing in evaluating alternative PD therapies . Objective : The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture ( EA ) as an alternative therapy . Methods : 15 aging adults ( 71.2 ± 6.3 years ) with idiopathic PD and 44 healthy age-matched participants ( 74.6 ± 6.5 years ) were recruited . The PD participants were r and omly assigned ( at a ratio of 2:1 ) to an intervention ( n = 10 ) or to a control group ( n = 5 ) . The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks , while the control group received a sham treatment . Outcomes were assessed at baseline and after the final therapy . Measurements included balance assessment , specifically the ratio of medial-lateral ( ML ) center-of-gravity ( COG ) sway to anterior-posterior ( AP ) sway ( COGML/AP ) and ankle/hip sway during eyes-open , eyes-closed , and eyes-open dual-task trials , the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , as well as quality of life , concerns for fall , and pain question naires . Results : No difference was observed for the assessed parameters between the intervention and the control group at baseline . After treatment , an improvement in balance performance was observed in the intervention group . Compared with the healthy population , PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance . Following EA therapy , COGML/AP sway was reduced by 31 % and ankle/hip sway increased by 46 % in the different conditions ( p = 0.02 for the dual-task condition ) . The clinical rating revealed an overall improvement ( p < 0.01 ) in mentation , behavior , and mood ( UPDRS part I , 49 % ) , activities of daily living ( UPDRS part II , 46 % ) , and motor examination ( UPDRS part III , 40 % ) . There was a significant reduction ( p < 0.02 ) in the specific items regarding UPDRS fall status ( 67 % ) and rigidity ( 48 % ) . Changes were small and nonsignificant in the controls ( p > 0.29 ) . Conclusions : This pilot study demonstrates improvement in rigidity and balance following EA . These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD OBJECTIVE To determine effects of  Argentine tango  on  motor and non-motor manifestations of Parkinson 's disease . DESIGN R and omized control trial . PARTICIPANTS Forty patients with idiopathic Parkinson 's disease . SETTING Movement disorder clinic and dance studio . INTERVENTION Two r and omized groups : group ( N=18 ) with 24 partnered tango classes , and control self-directed exercise group ( N=15 ) . MAIN OUTCOMES MEASURES The primary outcome was overall motor severity . Secondary outcomes included other motor measures , balance , cognition , fatigue , apathy , depression and quality of life . RESULTS On the primary intention-to-treat analysis there was no difference in motor severity between groups MDS-UPDRS-3 ( 1.6 vs.1.2-point reduction , p=0.85 ) . Patient-rated clinical global impression of change did not differ ( p=0.33 ) , however examiner rating improved in favor of tango ( p=0.02 ) . Mini-BESTest improved in the tango group compared to controls ( 0.7±2.2 vs. -2.7±5.9 , p=0.032 ) . Among individual items , tango improved in both simple TUG time ( -1.3±1.6s vs. 0.1±2.3 , p=0.042 ) and TUG Dual Task score ( 0.4±0.9 vs. -0.2±0.4 , p=0.012 ) , with borderline improvement in walk with pivot turns ( 0.2±0.5 vs. -0.1±0.5 , p=0.066 ) . MoCa ( 0.4±1.6 vs. -0.6±1.5 , p=0.080 ) and FSS ( -3.6±10.5 vs. 2.5±6.2 , p=0.057 ) showed a non-significant trend toward improvement in the tango group . Tango participants found the activity more enjoyable ( p<0.001 ) and felt more " overall " treatment satisfaction ( p<0.001 ) . We found no significant differences in other outcomes or adverse events . CONCLUSION Argentine tango can improve balance , and functional mobility , and may have modest benefits upon cognition and fatigue in Parkinson 's disease . These findings must be confirmed in longer-term trials explicitly powered for cognition and fatigue Objective : To compare the efficacy of two physiotherapy protocol s ( water-based vs. non-water-based ) on postural deformities of patients with Parkinson ’s disease . Design : A single blind , r and omized controlled pilot study . Setting : Inpatient ( Rehabilitative Department ) . Participants : A total of 30 patients with idiopathic Parkinson ’s disease . Interventions : Participants were r and omly assigned to one of two eight-week treatment groups : Water-based ( n = 15 ) or non-water-based physiotherapy exercises ( n = 15 ) . Outcome measures : Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk ( evaluated by means of a posturographic system ) were used as primary outcomes . Unified Parkinson Disease Rating Scale section III , Time Up and Go Test , Berg Balance Scale , Activities-specific Balance Confidence , Falls Efficacy Scale and the Parkinson ’s disease quality of life question naire ( 39 items ) were the secondary outcomes . All outcomes were assessed at baseline , at the end of training and eight weeks after treatment . Patients were always tested at the time of their optimal antiparkinsonian medication ( ‘ on ’ phase ) . Results : After the treatment , only Parkinson ’s disease subjects r and omized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion ( water-based group : −65.2 ° ; non-water-based group : + 1.7 ° ) and dorsal flexion ( water-based group : −22.5 ° ; non-water-based group : −6.5 ° ) and lateral inclination of the trunk ( water-based group : −2.3 ° ; non-water-based group : + 0.3 ° ) . Both groups presented significant improvements in the secondary clinical outcomes without between-group differences . Conclusion : Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson ’s disease Abstract Posture , gait and balance problems are very disabling symptoms in Parkinson ’s disease ( PD ) . An increased stride-to-stri de variability , reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait . These features predispose to freezing of gait ( FOG ) , which often leads to falls . The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG , thus preventing falls .  Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program ( performed twice a week ) by means of the motor part of the Unified Parkinson ’s Disease Rating Scale ( UPDRS-III ) , Gait and Falls Question naire , Tinetti balance and gait scale , Short Physical Performance Battery ( SPPB ) , European Quality of Life question naire . Patients were r and omly assigned to three treatment arms : ( 1 ) worst side improvement ; ( 2 ) best side improvement ; ( 3 ) st and ard therapy . All study arms showed a significant improvement of the Tinetti and SPPB scores . BSI led to a greater improvement than ST in terms of UPDRS-III ( p = 0.01 ) ; Tinetti total score ( p = 0.05 ) and Tinetti gait subscore ( p = 0.01 ) . Our study confirms the efficacy of physical therapy in the treatment of PD and , more importantly , suggests that specific intervention tailored on individual feature ( e.g. , asymmetry of motor condition ) might be even more effective than st and ard rehabilitative programs BACKGROUND There is a lack of evidence about the most effective strategy for training gait in mild to moderate Parkinson 's disease . The aim of this study was to compare the effects of robotic gait training versus equal intensity treadmill training and conventional physiotherapy on walking ability in patients with mild to moderate Parkinson 's disease . METHODS Sixty patients with mild to moderate Parkinson 's disease ( Hoehn & Yahr stage 3 ) were r and omly assigned into three groups . All patients received twelve , 45-min treatment sessions , three days a week , for four consecutive weeks . The Robotic Gait Training group ( n = 20 ) underwent robot-assisted gait training . The Treadmill Training group ( n = 20 ) performed equal intensity treadmill training without body-weight support . The Physical Therapy group ( n = 20 ) underwent conventional gait therapy according to the proprioceptive neuromuscular facilitation concept . Patients were evaluated before , after and 3 months post-treatment . Primary outcomes were the following timed tasks : 10-m walking test , 6-min walking test . RESULTS No statistically significant difference was found on the primary outcome measures between the Robotic Gait Training group and the Treadmill Training group at the after treatment evaluation . A statistically significant improvement was found after treatment on the primary outcomes in favor of the Robotic Gait Training group and Treadmill Training group compared to the Physical Therapy group . Findings were confirmed at the 3-month follow-up evaluation . CONCLUSIONS Our findings support the hypothesis that robotic gait training is not superior to equal intensity treadmill training for improving walking ability in patients with mild to moderate Parkinson 's disease BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To examine the feasibility of a r and omized controlled study design and to explore the benefits of a set dancing intervention compared with usual care . DESIGN R and omized controlled design , with participants r and omized to Irish set dance classes or a usual care group .  SETTING Community based . PARTICIPANTS Individuals with idiopathic Parkinson disease ( PD ) ( N=90 ) . INTERVENTIONS The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes , 3 times per week . The usual care group continued with their usual care and daily activities . MAIN OUTCOME MEASURES The primary outcome was feasibility , determined by recruitment rates , success of r and omization and allocation procedures , attrition , adherence , safety , willingness of participants to be r and omized , re source availability , and cost . Secondary outcomes were motor function ( motor section of the Unified Parkinson 's Disease Rating Scale ) , quality of life ( Parkinson 's Disease Question naire-39 ) , functional endurance ( 6-min walk test ) , and balance ( mini-BESTest ) . RESULTS Ninety participants were r and omized ( 45 per group ) . There were no adverse effects or re source constraints . Although adherence to the dancing program was 93.5 % , there was > 40 % attrition in each group . Postintervention , the dance group had greater nonsignificant gains in quality of life than the usual care group . There was a meaningful deterioration in endurance in the usual care group . There were no meaningful changes in other outcomes . The exit question naire showed participants enjoyed the classes and would like to continue participation . CONCLUSIONS For people with mild to moderately severe PD , set dancing is feasible and enjoyable and may improve quality of life OBJECTIVE To investigate the role of conventional gait training and partial weight-supported treadmill gait training ( PWSTT ) in improving the balance of patients with Parkinson disease ( PD ) . DESIGN Prospect i ve r and omized controlled design . SETTING National-level university tertiary hospital for mental health and neurosciences . PATIENTS Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic . METHODOLOGY The patients were r and omly assigned into 3 equal groups : ( 1 ) a control group that only received a stable dosage of dopaminomimetic drugs ; ( 2 ) a conventional gait training ( CGT ) group that received a stable dosage of dopaminomimetic drugs and conventional gait training ; and ( 3 ) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20 % of body weight . The sessions for the CGT and PWSTT groups were provided for 30 minutes per day , 4 days per week , for 4 weeks ( 16 sessions ) . OUTCOME MEASURES The Unified Parkinson Disease Rating Scale ( UPDRS ) motor score , dynamic posturography , Berg Balance Scale , and Tinetti performance-oriented mobility assessment ( POMA ) were used as main outcome measures . RESULTS A significant interaction effect was observed in the UPDRS motor score , mediolateral index , Berg Balance Scale , limits of stability ( LOS ) total score , POMA gait score , and balance score . Post-hoc analysis showed that in comparison with the control group , the PWSTT group had a significantly better UPDRS motor score , balance indices , LOS in 8 directions , POMA gait , and balance score . The CGT group had a significantly better POMA gait score compared with control subjects . Compared with the CGT group , the PWSTT group had a significantly better UPDRS motor score , mediolateral index , POMA gait score , and LOS total score . CONCLUSION PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD Background . Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson ’s disease ( PD ) . However , programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established . Objective . To examine the effects of virtual reality – based exercise on obstacle crossing performance and dynamic balance in participants with PD . Methods . Thirty-six participants with a diagnosis of PD ( Hoehn and Yahr score ranging 1 to 3 ) were r and omly assigned to one of three groups . In the exercise groups , participants received virtual reality – based Wii Fit exercise ( VRWii group ) or traditional exercise ( TE group ) for 45 minutes , followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks . Participants in the control group received no structured exercise program . Primary outcomes included obstacle crossing performance ( crossing velocity , stride length , and vertical toe obstacle clearance ) and dynamic balance ( maximal excursion , movement velocity , and directional control measured by the limits-of-stability test ) . Secondary outcomes included sensory organization test ( SOT ) , Parkinson ’s Disease Question naire ( PDQ39 ) , fall efficacy scale ( FES-I ) , and timed up and go test ( TUG ) . All outcomes were assessed at baseline , after training , and at 1-month follow-up . Results . The VRWii group showed greater improvement in obstacle crossing velocity , crossing stride length , dynamic balance , SOT , TUG , FES-I , and PDQ39 than the control group . VRWii training also result ed in greater improvement in movement velocity of limits-of-stability test than TE training . Conclusions . VRWii training significantly improved obstacle crossing performance and dynamic balance , supporting implementation of VRWii training in participants with PD
Parkinson ’s disease ( PD ) represents the second most common neurodegenerative disease .
Currently , conventional physical therapy is complemented by additional physical interventions with recreational components , improving different motor conditions in people with PD .
This review aims to evaluate the effectiveness of additional physical interventions to conventional physical therapy in Parkinson ’s disease .