Effectiveness of a Goal-Based Intensive Rehabilitation in Parkinsonian Patients in Advanced Stages of Disease

Article type: Research Article

Authors: Ortelli, Paola^{a; 1} | Ferrazzoli, Davide^{a; 1; *} | Bera, Rossana^a | Caremani, Luca^a | Giladi, Nir^b | Maestri, Roberto^c | Frazzitta, Giuseppe^a

Affiliations: [a] Department of Parkinson’s disease, Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” Hospital, Gravedona ed Uniti, Como, Italy | [b] Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Centre, Sieratzki Chair in Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, Tel-Aviv, Israel | [c] Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Montescano, Pavia, Italy

Correspondence: [*] Correspondence to: Davide Ferrazzoli, MD; Department of Parkinson’s disease, Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” Hospital, via Pelascini, 3, Gravedona ed Uniti (CO), 22015 Italy. Tel.: +39 331 8643163; Fax: +39 0344 85896; E-mail: davideferrazzoli@gmail.com.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Parkinsonian patients in advanced stages of disease suffer from many motor and non-motor symptoms, whose responsiveness to dopamine replacement therapy and deep brain stimulation is poor. It is necessary to find complementary strategies in order to improve the clinical conditions of patients in advanced Parkinson’s disease (PD) stages. Objective:We aimed to understand whether an inpatient, motor-cognitive, multidisciplinary, aerobic, intensive and goal-based rehabilitation treatment (MIRT), specifically designed for PD, is effective for patients in advanced stages of disease. Methods:638 Parkinsonian patients, hospitalized to undergo a 4-week MIRT, were retrospectively identified. According to the Hoehn & Yahr (H&Y) scale, 496 were in H&Y stage 3 and 142 in H&Y stage 4-5. Outcome measures included: Unified Parkinson’s Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Six Minute Walk Test (6MWT), and Parkinson’s Disease Disability Scale (PDDS). Results:At baseline all measures, except UPDRS IV, significantly worsened passing from H&Y stage 3 to H&Y stage 4-5 (p≤0.002 all). After rehabilitation all outcome measures significantly improved in both groups of patients (p < 0.0001 all). Comparing the amount of improvement in the two groups, significant differences were observed only for the changes in BBS and TUG (both p < 0.0001 after adjustment), with a better improvement in the H&Y stage 4-5 group. Conclusions:A multidisciplinary, motor-cognitive, intensive and goal-based rehabilitation treatment, such as MIRT, could be an effective complementary treatment in PD patients in advanced stages of disease.

Keywords: Advanced stages of disease, multidisciplinary treatment, Parkinson’s disease, rehabilitation

DOI: 10.3233/JPD-171247

Journal: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 113-119, 2018