{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:06:43Z","timestamp":1791558403493,"version":"4.3.4"},"reference-count":44,"publisher":"National Institute for Health and Care Research","issue":"63","license":[{"start":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T00:00:00Z","timestamp":1470009600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["07\/01\/07"],"award-info":[{"award-number":["07\/01\/07"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cochrane reviews of physiotherapy (PT) and occupational therapy (OT) for Parkinson\u2019s disease found insufficient evidence of effectiveness, but previous trials were methodologically flawed with small sample size and short-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the clinical effectiveness and cost-effectiveness of individualised PT and OT in Parkinson\u2019s disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Large pragmatic randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Thirty-eight neurology and geriatric medicine outpatient clinics in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Seven hundred and sixty-two patients with mild to moderate Parkinson\u2019s disease reporting limitations in activities of daily living (ADL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>\n                      Patients were randomised online to either both PT and OT NHS services (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009381) or no therapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009381). Therapy incorporated a patient-centred approach with individual assessment and goal setting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was instrumental ADL measured by the patient-completed Nottingham Extended Activities of Daily Living (NEADL) scale at 3 months after randomisation. Secondary outcomes were health-related quality of life [Parkinson\u2019s Disease Questionnaire-39 (PDQ-39); European Quality of Life-5 Dimensions (EQ-5D)], adverse events, resource use and carer quality of life (Short Form questionnaire-12 items). Outcomes were assessed before randomisation and at 3, 9 and 15 months after randomisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 92% of the participants in each group were available at the primary time point of 3 months, but there was no difference in NEADL total score [difference 0.5 points, 95% confidence interval (CI) \u20130.7 to 1.7;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.4] or PDQ-39 summary index (0.007 points, 95% CI \u20131.5 to 1.5;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.0) between groups. The EQ-5D quotient was of borderline significance in favour of therapy (\u20130.03, 95% CI \u20130.07 to \u20130.002;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Contact time with therapists was for a median of four visits of 58 minutes each over 8 weeks (mean dose 232 minutes). Repeated measures analysis including all time points showed no difference in NEADL total score, but PDQ-39 summary index (curves diverging at 1.6 points per annum, 95% CI 0.47 to 2.62;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and EQ-5D quotient (0.02, 95% CI 0.00007 to 0.03;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) showed significant but small differences in favour of the therapy arm. Cost-effective analysis showed that therapy was associated with a slight but not significant gain in quality-adjusted life-years (0.027, 95% CI \u20130.010 to 0.065) at a small incremental cost (\u00a3164, 95% CI \u2013\u00a3141 to \u00a3468), resulting in an incremental cost-effectiveness ratio of under \u00a34000 (\u00a33493, 95% \u2013\u00a3169,371 to \u00a3176,358). There was no difference in adverse events or serious adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NHS PT and OT did not produce immediate or long-term clinically meaningful improvements in ADL or quality of life in patients with mild to moderate Parkinson\u2019s disease. This evidence does not support the use of low-dose, patient-centred, goal-directed PT and OT in patients in the early stages of Parkinson\u2019s disease. Future research should include the development and testing of more structured and intensive PT and OT programmes in patients with all stages of Parkinson\u2019s disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-10\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Current Controlled Trials ISRCTN17452402.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-11\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>\n                      This project was funded by the NIHR Health Technology Assessment programme and will be published in full in\n                      <jats:italic>Health Technology Assessment<\/jats:italic>\n                      ; Vol. 20, No. 63. See the NIHR Journals Library website for further project information. The Birmingham Clinical Trials Unit, University of Birmingham, received support from the UK Department of Health up to March 2012. Catherine Sackley was supported by a NIHR senior investigator award, Collaboration for Leadership in Applied Health Research and Care East of England and West Midlands Strategic Health Authority Clinical Academic Training award.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/hta20630","type":"journal-article","created":{"date-parts":[[2016,8,31]],"date-time":"2016-08-31T13:21:44Z","timestamp":1472649704000},"page":"1-96","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":91,"title":["Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson\u2019s disease: a large pragmatic randomised controlled trial (PD REHAB)"],"prefix":"10.3310","volume":"20","clinical-trial-number":[{"clinical-trial-number":"isrctn17452402","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Carl E","family":"Clarke","sequence":"first","affiliation":[{"name":"Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"},{"name":"Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smitaa","family":"Patel","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Ives","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline E","family":"Rick","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Woolley","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Wheatley","sequence":"additional","affiliation":[{"name":"Cancer Research UK Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion F","family":"Walker","sequence":"additional","affiliation":[{"name":"Rehabilitation and Ageing, Queen\u2019s Medical Centre, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Primary Care Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Kandiyali","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiqing","family":"Yao","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M","family":"Sackley","sequence":"additional","affiliation":[{"name":"University of East Anglia, Norwich, UK"},{"name":"Academic Department of Physiotherapy, Faculty of Life Sciences and Medicine, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the PD REHAB Collaborative Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2016,8]]},"reference":[{"key":"key20160822131513724_ref1-bib1","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/S1474-4422(06)70471-9","article-title":"Epidemiology of Parkinson\u2019s disease","volume":"5","author":"de Lau","year":"2006","journal-title":"Lancet Neurol"},{"key":"key20160822131513724_ref1-bib2","volume-title":"National Institute for Health and Clinical Excellence (NICE) Guidelines \u2013 Parkinson\u2019s Disease: Diagnosis and Management in Primary and Secondary Care","author":"National Collaborating Centre for Chronic Conditions","year":"2006"},{"key":"key20160822131513724_ref1-bib3","volume-title":"Evaluation of Physiotherapy in Parkinson\u2019s Disease: Project Update. 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