Effectiveness of Intensive Inpatient Rehabilitation Treatment on Disease Progression in Parkinsonian Patients: A Randomized Controlled Trial With 1-Year Follow-up
Open accessAbstract
BACKGROUND: Rehabilitation treatments have acute beneficial effects in Parkinson's disease (PD) patients, but whether the effects persist over time is unclear. OBJECTIVE: To assess whether an intensive rehabilitation treatment (IRT) is effective in improving motor performance compared with a control group in a 12-month follow-up, to investigate whether a second cycle administered after 1 year has the same efficacy as the first treatment, and to determine whether IRT reduces the need for increasing levodopa dosage. METHODS: A total of 50 PD patients were randomly assigned to 2 groups; 25 participants had 4 weeks of inpatient physical therapy that included treadmill and stabilometric platform training. At discharge, these patients were invited to continue doing the learned exercises. After 12 months, the same treatment was repeated. The control group of 25 patients received only pharmacological treatment and was invited to practice generic physical exercise at home. The rating scales used for the clinical evaluation were the Unified Parkinson's Disease Rating Scale Sections II and III (UPDRS II and III) and total (UPDRS tot). RESULTS: The authors found that the beneficial effects of IRT persisted over time. A second rehabilitation cycle administered after 1 year was as effective as the first treatment. At the end of the study, daily medication dosage was reduced in treated patients, whereas it was significantly increased in control patients. CONCLUSION: These findings suggest that the natural worsening of symptoms associated with PD can be effectively counteracted by a properly designed IRT.
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Immediate and long-term retention of gait improvements have been reported following cessation of treadmill exercise.
“Both immediate (upon completion of training 4 to 12 weeks) and long-term retention (lasting several months) of gait improvements have been reported following cessation of treadmill exercise 24, 28, 29.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [29]
Benefits of increased movement amplitude and speed in gait appear to transfer to increased amplitude and speed of finger and foot tapping.
“For example, the benefits of increased movement amplitude and speed in gait (stride length and velocity) appear to transfer to increased amplitude and speed of finger and foot tapping 28, 29.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [29]
Benefits of treadmill training transfer to improvements in Unified Parkinson's Disease Rating Scale motor score.
“Interestingly benefits of treadmill training, a largely lower extremity task, have also been shown to transfer to improvements in the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [29]
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“Moreover, 6-month and 1-year follow-up scores on the UPDRSIII (clinical motor examination) were better than the admission scores although the therapy had been discontinued several months prior (9).”
BackgroundFrazzitta, G., Bossio, F., Maestri, R., Palamara, G., Bera, R., & Ferrazzoli, D. (2015) · BioMed Research International · doi:10.1155/2015/878472 · Cited by 21 · see citing works
Ortelli, P., Ferrazzoli, D., Bera, R., Caremani, L., Giladi, N., Maestri, R., & Frazzitta, G. (2018) · Journal of Parkinson s Disease · doi:10.3233/jpd-171247 · Cited by 21 · see citing works
Frazzitta, G., Bertotti, G., Morelli, M., Riboldazzi, G., Pelosin, E., Balbi, P., Boveri, N., Comi, C., Turla, M., Leva, S., et al. (2012) · Neurorehabilitation · doi:10.3233/nre-2012-0758 · Cited by 21 · see citing works
Multi-Modal Rehabilitation Therapy in Parkinson's Disease and Related Disorders
Saluja, A., Goyal, V., & Dhamija, R. (2022) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_164_22 · Cited by 16 · see citing works
Cui, W., Li, D., Yue, L., & Xie, J. (2023) · Journal of Neurology · doi:10.1007/s00415-023-11887-9 · Cited by 24 · see citing works
“Comprehensive rehabilitation approaches such as intensive rehabilitation therapy and multimodal rehabilitation therapy [74, 75] that combine pharmacological and non-pharmacological treatments are also crucial.”
BackgroundFocused and Sustained Attention Is Modified by a Goal-Based Rehabilitation in Parkinsonian Patients
Ferrazzoli, D., Ortelli, P., Maestri, R., Bera, R., Gargantini, R., Palamara, G., Zarucchi, M., Giladi, N., & Frazzitta, G. (2017) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2017.00056 · Cited by 19 · see citing works
Meloni, M., Saibene, F. L., Tella, S. D., Cesare, M. D., Borgnis, F., Nemni, R., & Baglio, F. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.626041 · Cited by 18 · see citing works
Does Cognitive Impairment Affect Rehabilitation Outcome in Parkinson’s Disease?
Ferrazzoli, D., Ortelli, P., Maestri, R., Bera, R., Giladi, N., Ghilardi, M. F., Pezzoli, G., & Frazzitta, G. (2016) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2016.00192 · Cited by 18 · see citing works
Berardi, A., Napoli, G. D., Ernesto, M., Fabbrini, G., Conte, A., Ferrazzano, G., Viselli, F., & Galeoto, G. (2022) · Healthcare · doi:10.3390/healthcare10030561 · Cited by 17 · see citing works
Exercícios terapêuticos domiciliares na doença de Parkinson: uma revisão integrativa
Gondim, I. T. G. D. O., Lins, C. C. D. S. A., & Coriolano, M. D. G. W. D. S. (2016) · Revista Brasileira de Geriatria e Gerontologia · doi:10.1590/1809-98232016019.150040 · Cited by 17 · see citing works
Asymmetric Dopaminergic Degeneration and Attentional Resources in Parkinson’s Disease
Ortelli, P., Ferrazzoli, D., Zarucchi, M., Maestri, R., & Frazzitta, G. (2018) · Frontiers in Neuroscience · doi:10.3389/fnins.2018.00972 · Cited by 17 · see citing works
Meng, L., Wang, D., Shi, Y., Li, Z., Zhang, J., Lu, H., Zhu, X., & Ming, D. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1252610 · Cited by 16 · see citing works
“The intervention has also been regarded as a complementary option for PD management (Frazzitta et al., 2011; Bloem et al., 2015).”
BackgroundLowry, K. A., Woods, T., Malone, A., Krajek, A. C., Smiley‐Oyen, A. L., & Swearingen, J. V. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2020.1774948 · Cited by 15 · see citing works
Cohen, M., Herman, T., Ganz, N., Badichi, I., Gurevich, T., & Hausdorff, J. M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20053806 · Cited by 14 · see citing works
“These positive benefits in the clinic are in line with previously reported studies [1,3,5].”
BackgroundResultRate of motor progression in Parkinson’s disease: a systematic review and meta-analysis
Pauwels, A., Phan, A. L. G., Ding, C., Phan, T. G., & Kempster, P. A. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1452741 · Cited by 14 · see citing works
Zarucchi, A., Vismara, L., Frazzitta, G., Mauro, A., Priano, L., Maestri, R., Bergna, A., & Tarantino, A. G. (2020) · Neurorehabilitation · doi:10.3233/nre-203068 · Cited by 14 · see citing works
Effectiveness of an intensive rehabilitation treatment on different Parkinson's disease subtypes
Frazzitta, G., Abbruzzese, G., Bertotti, G., Boveri, N., Pezzoli, G., & Maestri, R. (2013) · Neurorehabilitation · doi:10.3233/nre-130959 · Cited by 13 · see citing works
Occupational Therapy for Parkinsonian Patients: A Retrospective Study
Franciotta, M., Maestri, R., Ortelli, P., Ferrazzoli, D., Mastalli, F., & Frazzitta, G. (2019) · Parkinson s Disease · doi:10.1155/2019/4561830 · Cited by 13 · see citing works
Ferrazzoli, D., Ortelli, P., Riboldazzi, G., Maestri, R., & Frazzitta, G. (2018) · Journal of Neurology · doi:10.1007/s00415-018-8792-0 · Cited by 12 · see citing works
Rehabilitation in movement disorders: From basic mechanisms to clinical strategies
Ferrazzoli, D., Ortelli, P., Iansek, R., & Volpe, D. (2022) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819410-2.00019-9 · Cited by 12 · see citing works
Frazzitta, G., Morelli, M., Bertotti, G., Felicetti, G., Pezzoli, G., & Maestri, R. (2012) · Parkinson s Disease · doi:10.1155/2012/910454 · Cited by 12 · see citing works
Ziegler, K., Messner, M., Paulig, M., Starrost, K., Reuschenbach, B., Fietzek, U. M., & Ceballos-Baumann, A. (2022) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13578 · Cited by 11 · see citing works
Goudy, L., Rigby, B. R., Silliman-French, L. M., & Becker, K. A. (2019) · Adapted Physical Activity Quarterly · doi:10.1123/apaq.2019-0008 · Cited by 11 · see citing works
Physical Exercise as Intervention in Parkinsonism
Archer, T., & Fredriksson, A. (2014) · Springer eBooks · doi:10.1007/978-1-4614-5836-4_105 · Cited by 10 · see citing works
Quality of life predicts rehabilitation prognosis in Parkinson's disease patients
Meng, D., Jin, Z., Chen, K., Yu, X., Wang, Y., Du, W., Wei, J., Xi, J., & Fang, B. (2022) · Brain and Behavior · doi:10.1002/brb3.2579 · Cited by 10 · see citing works
Zhang, H., Hou, T.-T., Jin, Z., Zhang, T., Wang, Y.-H., Cheng, Z.-H., Liu, Y.-H., Fang, J., Yan, H., Zhen, Y., et al. (2024) · Trials · doi:10.1186/s13063-024-08045-5 · Cited by 10 · see citing works
Effect of Treadmill Walking on Leg Muscle Activation in Parkinson's Disease
Bello, O., Márquez, G., & Fernández‐del‐Olmo, M. (2018) · Rejuvenation Research · doi:10.1089/rej.2018.2084 · Cited by 10 · see citing works
Steendam-Oldekamp, E., & van Laar, T. (2024) · Journal of Parkinson s Disease · doi:10.3233/jpd-230271 · Cited by 9 · see citing works
“…including the German PD-Multimodel Complex Treatment (MCT) model [14–17], the Italian Multidisciplinary Intensive Rehabilitation Treatment concept [18–22], the Dutch inpatient rehabilitation program at Parkinson Expertise Centers (Point for Parkinson), and the Hamburg Parkinson Day-Clinic,…”
BackgroundScherbaum, R., Höllerhage, M., Klebe, S., Riederer, P., Müller, T., Schröter, N., Weise, D., Woitalla, D., & Tönges, L. (2025) · Journal of Neural Transmission · doi:10.1007/s00702-025-02963-7 · Cited by 9 · see citing works
“In general, inpatient multidisciplinary therapies improved motor symptoms, everyday functions, and quality of life in four international randomized controlled trials (Monticone et al. 2015; Ferrazzoli et al. 2018; Marumoto et al. 2019; Frazzitta et al. 2012).”
An equation to calculate UPDRS motor severity for online and rural assessments of Parkinson's
Sangarapillai, K., Norman, B. M., & Almeida, Q. J. (2021) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2021.11.028 · Cited by 9 · see citing works
Effects of rTMS and intensive rehabilitation in Parkinson’s Disease on learning and retention
Marchesi, G., Albanese, G. A., Ferrazzoli, D., George, S., Ricci, S., Tatti, E., Rocco, A. D., Quartarone, A., Frazzitta, G., & Ghilardi, M. F. (2019) · International Conference on Rehabilitation Robotics · doi:10.1109/icorr.2019.8779471 · Cited by 8 · see citing works
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Multidisziplinäre Komplextherapie der Parkinson-Krankheit
Scherbaum, R., & Tönges, L. (2024) · Der Nervenarzt · doi:10.1007/s00115-024-01666-w · Cited by 7 · see citing works
Baldassarre, I., Rotondo, R., Piccardi, L., Leonardi, L., Lanni, D., Gaglione, M., Stocchi, F., Fini, M., Goffredo, M., Padua, E., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133884 · Cited by 7 · see citing works
“…that a multidisciplinary rehabilitation program (physical therapy, occupational therapy, and speech therapy) significatively improved cognitive performance in the early–moderate PD stages [20], and it appears to improve the QoL in patients with PD in both the short-term and long-term [17,18,20].”
BackgroundJi, X., Lu, D., Yang, Q., Xiao, L., Wang, J., & Wang, G. (2022) · Computational and Mathematical Methods in Medicine · doi:10.1155/2022/3393191 · Cited by 7 · see citing works
“Although the multidisciplinary therapy included in the literature mainly consisted of physical therapy, it also had some visual and auditory guidance training to improve gait and posture [24, 26].”
MethodResultCardini, R., Gervasoni, E., Giannoni‐Luza, S., Cavalca, A., Piva, A., Cattaneo, D., Pelosin, E., Bocci, T., Marceglia, S. R. F., Priori, A., et al. (2026) · npj Parkinson s Disease · doi:10.1038/s41531-026-01326-7 · Cited by 5 · see citing works
Neuropsychiatric Treatments for Parkinson's Disease: Nonpharmacological Approaches
Mathur, N., Bhatt, H., & Lidstone, S. C. (2022) · Seminars in Neurology · doi:10.1055/s-0041-1742266 · Cited by 5 · see citing works
Disexecutive Functions and Depression in Patients with Parkinson Disease
Pierobon, A., Giardini, A., Maestri, R., Farina, C., Callegari, S., Torlaschi, V., Bertotti, G., Majani, G., & Frazzitta, G. (2014) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000092 · Cited by 5 · see citing works
Specialized Allied Health Care for Parkinson’s Disease: State of the Art and Future Directions
Sturkenboom, I. H. W. M., Talebi, A. H., Maas, B. R., de Vries, N. M., Darweesh, S. K. L., & Kalf, J. G. (2024) · Journal of Parkinson s Disease · doi:10.3233/jpd-230307 · Cited by 4 · see citing works
“67 , 68 , 70 , 71 , 73 , 74 Thus, three trials showed no improvement.”
Exercise Training and Rehabilitation of the Brain in Parkinson´s Disease
Al-Jarrah, M. D. (2013) · Clinical Medicine Research · doi:10.11648/j.cmr.20130202.12 · Cited by 4 · see citing works
Ortelli, P., Maestri, R., Zarucchi, M., Cian, V., Urso, E., Giacomello, F., Ferrazzoli, D., & Frazzitta, G. (2017) · Journal of Clinical Movement Disorders · doi:10.1186/s40734-017-0059-x · Cited by 4 · see citing works
Harris, C., Ignatowicz, A., & Lasserson, D. S. (2019) · International Journal of Clinical Practice · doi:10.1111/ijcp.13462 · Cited by 4 · see citing works
A rehabilitation system for upper limbs in Adult Patients using video games
Chacha, F., Bermeo, J. P., & Huerta, M. (2017) · IEEE Central America and Panama Convention (CONCAPAN) · doi:10.1109/concapan.2017.8278510 · Cited by 3 · see citing works
Shin, S., & Lee, Y. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1546672 · Cited by 2 · see citing works
Hasani, M., Sidiropoulou, I., Christakou, Α., Marazioti, A., Konitsiotis, S., & Lyros, E. (2026) · NeuroSci · doi:10.3390/neurosci7020042 · Cited by 2 · see citing works
Readinger, J. L., Eastlack, M., von Nieda, K., Kantak, S. S., & Sawyer, K. L. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1952667 · Cited by 2 · see citing works
“…of life than usual care or moderate to low challenge exercises (Allen, Sherrington, Paul, and Canning, 2011; Conradsson et al., 2015; Ebersbach et al., 2010; Fisher et al., 2008; Frazzitta et al., 2012; Landers et al., 2019a; Schenkman et al., 2018; Sparrow et al., 2016; Van der Kolk et al., 2019).”
BackgroundResultMoondra, P., Rubin, L., McCrossin, M., Persaud, A., Rocco, A. D., Quartarone, A., & Ghilardi, M. F. (2024) · Biomedicines · doi:10.3390/biomedicines12081658 · Cited by 2 · see citing works
“These results are the first ones coming from a U.S. center and provide an initial validation in the U.S. of previous European findings, mostly from randomized controlled trials and other studies [16–23,26 ,27 ].”
BackgroundResultBae, S., Hong, I., & Baek, M. S. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1428972 · Cited by 2 · see citing works
Multimodale Therapieangebote bei der Parkinson-Krankheit
Ziegler, K., Fietzek, U. M., & Ceballos-Baumann, A. (2025) · Nervenheilkunde · doi:10.1055/a-2449-1461 · Cited by 2 · see citing works
Rehabilitation and Parkinson’s Disease: A Happy Marriage!
Frazzitta, G. (2013) · International Journal of Physical Medicine & Rehabilitation · doi:10.4172/2329-9096.1000109 · Cited by 2 · see citing works
Evaluation and delivery of ambulatory rehabilitation for people with Parkinson's disease
Goodwin, L. S., & Lan, L. (2014) · Reviews in Clinical Gerontology · doi:10.1017/s0959259813000257 · Cited by 2 · see citing works
- Authors
- Frazzitta, G., Bertotti, G., Riboldazzi, G., Turla, M., Uccellini, D., Boveri, N., Guaglio, G., Perini, M., Comi, C., Balbi, P., & Maestri, R.
- Affiliations
- Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy
- “Le Terrazze” Hospital, Cunardo, Italy
- Valle Camonica Hospital, Esine, Italy
- Tradate Hospital, Tradate, Italy
- Azienda Ospedaliera Sant’Antonio Abate di Gallarate (IT)
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Venue
- Neurorehabilitation and neural repair
- Publisher
- SAGE Publications
- Published
- 2011-08-15
- Volume
- 26
- Issue
- 2
- Pages
- 144-150
- ISSN
- 0888-4390 (ISSN-L)
- 1545-9683
- 1552-6844
- OpenAlex
- W2017404241
- Cited by
- 116
- References
- 37
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 16 · 2023: 6 · 2022: 10 · 2021: 7 · 2020: 8 · 2019: 10 · 2018: 7 · 2017: 8 · 2016: 5 · 2015: 4 · 2014: 10 · 2013: 9 · 2012: 6
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurorehabilitation and neural repair (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- Parkinson's disease, motor performance, treadmill training, home-based exercise, levodopa dosage, disease progression, long-term treatment efficacy
- MeSH terms
- Acoustic Stimulation, Activities of Daily Living, Aged, Antiparkinson Agents, Critical Care, Cues, Exercise Test, Female, Follow-Up Studies, Humans, Levodopa, Male, Parkinson Disease, Photic Stimulation, Pilot Projects, Treatment Outcome, Disease Progression, Statistics, Nonparametric, Physical Therapy Modalities
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