PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2014

Clinical Scenario

We are DPT students who will come into contact patients with idiopathic Parkinson’s Disease (PD) in our future practices. This patient population is at increased risk for falls. We observed exercise interventions used to decrease fall risk in our clinical settings. We would like to know if exercise interventions can reduce fall risk specifically in patients with Parkinson’s disease.

Clinical Question

Do exercise programs focused on balance and strength training reduce fall risk in patients with Parkinson’s disease?

Clinical Bottom Line

Based on the studies done by Allen et al., Ashburn et al., and Goodwin et al. there are mixed results as to whether exercise programs including strength and balance training significantly reduce fall risk for individuals with PD. Allen et al. found no effect of exercise on fall risk using the PD risk assessment, but they did find a significant decrease in fall risk based on the 5 times sit-to-stand assessment. Ashburn et al. and Goodwin et al. both found participation in an exercise program did not significantly reduce number of fallers or number of falls respectively. Using a subgroup analysis based on disease severity, Ashburn et al. reported the exercise group had significantly fewer repeat fallers among participants in the less severe disease stage. Other than the fair internal validity and use of subjects from countries outside the United States the studies were generalizable to those in our patient population who are independent ambulators and who have no cognitive deficits. All subjects had idiopathic PD and treatments were feasible and cost effective. More research needs to be done to determine the effectiveness of exercise in reducing fall risk for patients with PD. Future research should include larger study populations for adequate power, assess exercise effectiveness in different disease stages, determine if there is a difference in effectiveness between individual, group therapy, or home exercise, and explore differences between different exercise protocols.

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