Physiotherapy in Parkinson's disease patients: Recommendations for clinical practice

Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease with a prevalence of 0.3% of the whole population in industrialized countries. Currently only symptomatic treatment options comprising pharmacological and surgical therapies as well as adjunct rehabilitative interventions are available. Increasing evidence from a wide range of clinical and experimental studies suggests that regular exercise and physical fitness favourably influence progression of symptoms. Physical therapy plays an important role in the management of Parkinson's disease providing strategies to improve physical capacity and to overcome pharmaco-resistant motor symptoms such as complex disturbances of gait, balance, and posture at different stages of the disease. Although physical therapy provides clinically meaningful benefits for Parkinson's disease patients, referral rates are often suboptimal for several reasons. Regional differences in availability of experienced therapists and specific training programmes affect administration of physical therapy together with health economic regulations und limitations.Physicians thus need to cooperate with regional allied health professionals to implement strategies and treatment programmes that are tailored to meet the capabilities, deficits, and personal preferences of individual PD patients. Evidence from numerous studies suggests that these efforts are worthwhile.