Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)

Clarke, Carl E; Patel, Smitaa; Ives, Natalie; Rick, Caroline E; Woolley, Rebecca; Wheatley, Keith; Walker, Marion F; Zhu, Shihua; Kandiyali, Rebecca; Yao, Guiqing; Sackley, Catherine M; on behalf of the PD REHAB Collaborative Group

doi:10.3310/hta20630

Cited by 110Parkinson's Disease Mechanisms and TreatmentsOccupational Therapy Practice and ResearchBalance, Gait, and Falls Prevention

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Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)

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Clarke, Carl E, Patel, Smitaa, Ives, Natalie, Rick, Caroline E, Woolley, Rebecca, Wheatley, Keith, Walker, Marion F, Zhu, Shihua, Kandiyali, Rebecca, Yao, Guiqing, Sackley, Catherine M, on behalf of the PD REHAB Collaborative Group·2016·Health Technology Assessment

DOI 10.3310/hta20630PMC PMC5018686

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Abstract

Background: Cochrane reviews of physiotherapy (PT) and occupational therapy (OT) for Parkinson’s disease found insufficient evidence of effectiveness, but previous trials were methodologically flawed with small sample size and short-term follow-up. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of individualised PT and OT in Parkinson’s disease. Design: Large pragmatic randomised controlled trial. Setting: Thirty-eight neurology and geriatric medicine outpatient clinics in the UK. Participants: Seven hundred and sixty-two patients with mild to moderate Parkinson’s disease reporting limitations in activities of daily living (ADL). Intervention: Patients were randomised online to either both PT and OT NHS services ( n = 381) or no therapy ( n = 381). Therapy incorporated a patient-centred approach with individual assessment and goal setting. Main outcome measures: 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’s 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. Results: 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) –0.7 to 1.7; p = 0.4] or PDQ-39 summary index (0.007 points, 95% CI –1.5 to 1.5; p = 1.0) between groups. The EQ-5D quotient was of borderline significance in favour of therapy (–0.03, 95% CI –0.07 to –0.002; p = 0.04). 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; p = 0.005) and EQ-5D quotient (0.02, 95% CI 0.00007 to 0.03; p = 0.04) 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 –0.010 to 0.065) at a small incremental cost (£164, 95% CI –£141 to £468), resulting in an incremental cost-effectiveness ratio of under £4000 (£3493, 95% –£169,371 to £176,358). There was no difference in adverse events or serious adverse events. Conclusions: 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’s 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’s 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’s disease. Trial registration: Current Controlled Trials ISRCTN17452402. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; 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.

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Six studies used the Hoehn and Yahr staging for assessing disease severity, which varied from stage 1 to 3.
“Six studies used the Hoehn and Yahr staging for assessing disease severity (Clarke et al., 2016), which varied from stage 1 to 3.”
From A Systematic Review of Third-Wave Therapies to Reduce Distress and Improve Wellbeing and Quality of Life in People with Parkinson's Disease. (2025) · cites this paper as Clarke et al., 2016
The Statistical analysis section uses Hoehn and Yahr stage to assess disease severity, supporting that part of the citation. This paper reports one trial, not six studies, and Table 7 includes participants at stage ≥4.0, so its participants were not limited to stages 1–3. (LLM, conf=0.86)
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Analysis of Incomplete Multivariate Data
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Method
Epidemiology of Parkinson's disease
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“We conclude that NHS low-dose, patient-centred, goal-directed PT and OT do not produce immediate or long-term improvements in ADL or quality of life in mild to moderate PD. DOI: 10.3310/hta20630 HEALTH TECHNOLOGY ASSESSMENT 2016 VOL. 20 NO. 63 © Queen’s Printer and Controller of HMSO 2016.”
MethodResultInfluentialSelf-citation
Occupational therapy for independent-living older adults. A randomized controlled trial.
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The relevance of the Lewy Body to the pathogenesis of idiopathic Parkinson's disease
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Self-citation
A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease
Ashburn, A., Fazakarley, L., Ballinger, C., Pickering, R. M., Mclellan, L., & Fitton, C. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.099333 · Cited by 355
Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis
Tomlinson, C. L., Patel, S., Meek, C., Herd, C. P., Clarke, C. E., Stowe, R. L., Shah, L., Sackley, C. M., Deane, K. H., Wheatley, K., et al. (2012) · BMJ · doi:10.1136/bmj.e5004 · Cited by 343 · cited 1×
“Our Cochrane review of PT versus no intervention in PD showed that all forms of PT produced small benefits in motor function and ADL but no change in QoL.(8,9) The Cochrane review of OT found insufficient evidence about effectiveness.”
MethodSelf-citation
Physiotherapy for Parkinson's disease: a comparison of techniques
Tomlinson, C. L., Herd, C. P., Clarke, C. E., Meek, C., Patel, S., Stowe, R. L., Deane, K. H., Shah, L., Sackley, C. M., Wheatley, K., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002815.pub2 · Cited by 241 · cited 1×
“Physiotherapy versus alternative physiotherapy intervention This review was published by the trial team in The Cochrane Library.(11) Methods See review in previous section: Physiotherapy versus no or placebo intervention.”
MethodSelf-citation
Determining minimally important differences for the PDQ-39 Parkinson's disease questionnaire.
Peto, V., Jenkinson, C., & Fitzpatrick, R. (2001) · Age and Ageing · doi:10.1093/ageing/30.4.299 · Cited by 217
Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial.
Walker, M., Gladman, J., Lincoln, N. B., Siemonsma, P., & Whiteley, T. (1999) · The Lancet · doi:10.1016/s0140-6736(98)11128-5 · Cited by 198
Self-citation
Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials
Legg, L., Drummond, A., Leonardi-Bee, J., Gladman, J., Corr, S., Donkervoort, M., Edmans, J., Gilbertson, L., Jongbloed, L., Logan, P., et al. (2007) · British medical journal · doi:10.1136/bmj.39343.466863.55 · Cited by 186 · cited 1×
“This has been validated in stroke(15) and has been shown in other community OT trials to be relevant and sensitive to change.(16) We also explored the use of the Rivermead Mobility Index (RMI); the patient-completion UPDRS ADL scale; PDQ-39; European Quality of Life-5 Dimensions (EQ-5D); and Hospital Anxiety and Depre…”
MethodSelf-citation
Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study
Wade, D. T., Gage, H., Owen, C., Trend, P., Grossmith, C., & Kaye, J. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.2.158 · Cited by 176 · cited 1×
“This is similar to another community study of PT (8% loss at 6 months),(21) but higher retention than an outpatient rehabilitation study (30% loss at 6 months).(22) Delivery of OT to the control arm after the trial may have helped with retention.”
Result
Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial
Gilbertson, L., Langhorne, P., Walker, A., Allen, A., & Murray, G. (2000) · British medical journal · doi:10.1136/bmj.320.7235.603 · Cited by 170
Physiotherapy versus placebo or no intervention in Parkinson's disease
Tomlinson, C. L., Patel, S., Meek, C., Clarke, C. E., Stowe, R. L., Shah, L., Sackley, C. M., Deane, K. H., Herd, C. P., Wheatley, K., et al. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002817.pub3 · Cited by 169 · cited 3×
“Previous PT trials in PD have been relatively small (range 6–153) and with follow-up of less than 3 months.(8) It is now clear that larger and longer trials can be done in PD, and these will provide more reliable answers.”
BackgroundMethodResultSelf-citation
Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial
van Nimwegen, M., Speelman, A. D., Overeem, S., van de Warrenburg, B. P. C., Smulders, K., Dontje, M. L., Borm, G. F., BACKX, F. J. G., Bloem, B. R., Munneke, M. A. M., et al. (2013) · BMJ · doi:10.1136/bmj.f576 · Cited by 167
Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial
Munneke, M., Nijkrake, M. J., Keus, S. H. J., Kwakkel, G., Berendse, H. W., Roos, R. A. C., Borm, G. F., Adang, E., Overeem, S., & Bloem, B. R. (2009) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70327-8 · Cited by 159 · cited 1×
“Total contact time between patients and physiotherapists over 6 months in ParkNet was 15 sessions of 30 minutes, nearly double that in PD REHAB.(29) Importantly, however, the dose delivered in PD REHAB reflects what therapists routinely deliver in NHS practice.”
Background
Physiotherapy and Occupational Therapy vs No Therapy in Mild to Moderate Parkinson Disease: A Randomized Clinical Trial.
Clarke, C., Patel, S., Ives, N., Rick, C., Dowling, F., Woolley, R., Wheatley, K., Walker, M., & Sackley, C. (2016) · JAMA Neurology · doi:10.1001/jamaneurol.2015.4452 · Cited by 95
Self-citation
Occupational therapy for patients with Parkinson's disease
Dixon, L., Duncan, D. C., Johnson, P., Kirkby, L., O'Connell, H., Taylor, H. J., & Deane, K. H. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002813.pub2 · Cited by 93 · cited 2×
“The Cochrane review of OT found insufficient evidence about effectiveness.(7) The absence of any motor effect (PDQ-39 mobility domain) or response in ADL in PD REHAB is likely to be multifactorial because of the early disease stage of most of the patients, the low dose of intervention, and the lack of consistency in t…”
Background
Measuring disability after a stroke.
Ebrahim, S., Nouri, F., & Barer, D. (1985) · Journal of Epidemiology and Community Health · doi:10.1136/jech.39.1.86 · Cited by 91 · cited 1×
“The primary outcome measure was the total score on the NEADL scale at 3 months after randomisation.(15) The NEADL measures instrumental ADL which is specifically addressed by PT and OT, and addresses more complex ADL issues such as making a meal, cleaning and travelling on public transport.”
Background
Cluster Randomized Pilot Controlled Trial of an Occupational Therapy Intervention for Residents With Stroke in UK Care Homes
Sackley, C., Wade, D., Mant, D., Atkinson, J., Yudkin, P., Cardoso, K., Levin, S., Lee, V., & Reel, K. (2006) · Stroke · doi:10.1161/01.str.0000237124.20596.92 · Cited by 85
Self-citation
A Delphi Survey of Best Practice Occupational Therapy for Parkinson's Disease in the United Kingdom
Deane, K. H. O., Ellis-Hill, C., Dekker, K., Davies, P., & Clarke, C. E. (2003) · British Journal of Occupational Therapy · doi:10.1177/030802260306600603 · Cited by 68
Self-citation
The Parkinson’s Disease Questionnaire (PDQ-39): evidence for a method of imputing missing data
Jenkinson, C., Heffernan, C., Doll, H., & Fitzpatrick, R. M. (2006) · Age and Ageing · doi:10.1093/ageing/afl055 · Cited by 45
Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson's disease: the PD OT trial
Clarke, C., Furmston, A., Morgan, E., Patel, S., Sackley, C. M., Walker, M., Bryan, S., & Wheatley, K. (2008) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2007.138586 · Cited by 42 · cited 5×
“The current trial (PD REHAB) design was informed by our pilot study of OT in PD (PD OT).(10)”
MethodInfluentialSelf-citation
An exercise intervention to prevent falls in Parkinson’s: an economic evaluation
Fletcher, E., Goodwin, V., Richards, S., Campbell, J., & Taylor, R. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-426 · Cited by 38 · cited 2×
“However, as reported previously, only one other trial that included evidence on cost-effectiveness was identified.(27) It, too, showed no statistically significant difference in either costs or outcomes, so its inclusion would make little difference to the overall outcome.”
Result
Evaluating rehabilitation using cost-consequences analysis: an example in Parkinson's disease
Gage, H., Kaye, J., Owen, C., Trend, P., & Wade, D. (2006) · Clinical Rehabilitation · doi:10.1191/0269215506cr936oa · Cited by 38
Occupational Therapy in Nursing and Residential Care Settings: A Description of a Randomised Controlled Trial Intervention
Sackley, C., Atkinson, J., & Walker, M. (2004) · British Journal of Occupational Therapy · doi:10.1177/030802260406700302 · Cited by 33 · cited 1×
“The intervention was developed by combining existing evidence from our surveys of current and best-practice OT in PD(5,6) and the consensus of a group of expert occupational therapists.(13) The intervention was provided by an experienced occupational therapist and was delivered at the level of the individual.”
MethodSelf-citation
The Artistry of Judgement: A Model for Occupational Therapy Practice
Paterson, M. L., Higgs, J., & Wilcox, S. (2005) · doi:10.1177/030802260506800905 · Cited by 29
Stroke Rehabilitation: Evidence-based or evidence-tinged?
Walker, M. F. (2007) · Acta Dermato Venereologica · doi:10.2340/16501977-0063 · Cited by 29 · cited 1×
“The lack of task-related practice was also of particular concern, as this activity is a logical ‘practice makes perfect’ intervention when struggling with specific ADL and, more importantly, has been shown to be a significant factor in functional recovery in stroke rehabilitation trials.(41)”
BackgroundSelf-citation
A Survey of Current Occupational Therapy Practice for Parkinson's Disease in the United Kingdom
Deane, K. H. O., Ellis-Hill, C., Dekker, K., Davies, P., & Clarke, C. (2003) · British Journal of Occupational Therapy · doi:10.1177/030802260306600503 · Cited by 28 · cited 1×
“Therapists provide task-related training and educate patients and carers.(5,6) Evidence for physiotherapy and occupational therapy in Parkinson’s disease Cochrane reviews of PT and OT for PD found insufficient evidence of their individual effectiveness, but the trials included in the reviews were methodologically flaw…”
BackgroundSelf-citation
Updated guidelines for the management of Parkinson's disease.
Bhatia, K. P., Brooks, D. J., Burn, D. J., Clarke, C. E., Grosset, D., Macmahon, D., Playfer, J., Schapira, A., Stewart, D., & Williams, A. (2001) · Hospital Medicine · doi:10.12968/hosp.2001.62.8.1621 · Cited by 27 · cited 1×
“Current UK practice was examined through two published surveys.(25,26) 3.”
MethodSelf-citation
Occupational Therapy to Optimise Independence in Parkinson's Disease: The Designing and Recording of a Randomised Controlled Trial Intervention
Meek, C., Morgan, E. R., Walker, M. F., Furmston, A., Vinagre‐Aragón, A., Birleson, A., Kelly, V., Clarke, C. E., & Sackley, C. M. (2010) · British Journal of Occupational Therapy · doi:10.4276/030802210x12706313444027 · Cited by 18
Self-citation
MPTP(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine)誘発サルヘミパーキンソニズムにおける自発性サッケード
碓井, 貞. (1990) · doi:10.11501/3051962 · Cited by 17
Physiotherapy for Parkinson’s disease: defining evidence within a framework for intervention
Rochester, L., Nieuwboer, A., & Lord, S. (2011) · Neurodegenerative Disease Management · doi:10.2217/nmt.11.1 · Cited by 16 · cited 1×
“A recent Dutch trial of PT in Parkinson’s disease (ParkNet)(29) also showed no evidence in favour of therapy.(40) Total contact time between patients and physiotherapists over 6 months in ParkNet was 15 sessions of 30 minutes, nearly double that in PD REHAB.”
Background
1.091 A LARGE RANDOMISED TRIAL ASSESSING QUALITY OF LIFE IN PATIENTS WITH EARLY PD: RESULTS FROM PD MED EARLY
Clarke, C., Patel, S., Ives, N., Rick, C., Jenkinson, C., Wheatley, K., Williams, A., & Gray, R. (2012) · doi:10.1016/s1353-8020(11)70205-x · Cited by 4
Self-citation

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Metabolite and lipoprotein profiles reveal sex-related oxidative stress imbalance in de novo drug-naive Parkinson’s disease patients
Meoni, G., Tenori, L., Schade, S., Licari, C., Pirazzini, C., Bacalini, M. G., Garagnani, P., Turano, P., Molin, A. D., Bartoletti‐Stella, A., et al. (2022) · npj Parkinson s Disease · doi:10.1038/s41531-021-00274-8 · Cited by 30
A single determination of C-reactive protein does not suffice to declare a patient with a diagnosis of axial spondyloarthritis ‘CRP-negative’
Landewé, R., Nurminen, T., Davies, O., & Baeten, D. (2018) · Arthritis Research & Therapy · doi:10.1186/s13075-018-1707-8 · Cited by 27
Retinal Alterations Predict Early Prodromal Signs of Neurodegenerative Disease
Casciano, F., Zauli, E., Celeghini, C., Caruso, L., Gonelli, A., Zauli, G., & Pignatelli, A. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25031689 · Cited by 34
“In addition, at least one of the following symptoms must be present: muscular rigidity, rest tremor with the frequency of 4–6 Hz, and postural instability not associated with visual, vestibular, cerebellar, or proprioceptive dysfunctions [228].”
Background
Parkinsonism: A Rare Adverse Effect of Valproic Acid
Muralidharan, A., Rahman, J., Banerjee, D., Mohammed, A. R. H., & Malik, B. H. (2020) · Cureus · doi:10.7759/cureus.8782 · Cited by 32
Standardized Care Pathways as a Means to Improve Patient Safety.
Lancaster, E. M., & Wick, E. (2021) · Surgical Clinics of North America · doi:10.1016/j.suc.2020.08.011 · Cited by 22
Early Detection of Parkinson’s Disease Using AI Techniques and Image Analysis
Ianculescu, M., Petean, C., Săndulescu, V., Alexandru, A., & Vasilevschi, A. (2024) · Diagnostics · doi:10.3390/diagnostics14232615 · Cited by 18
“As examined using the UDPRS, on the Hoehn and Yahr Modified Scale [18], none of the PD patients were assessed to be in a late stage of the disease.”
Comprehensive review of statistical methods for analysing patient-reported outcomes (PROs) used as primary outcomes in randomised controlled trials (RCTs) published by the UK’s Health Technology Assessment (HTA) journal (1997–2020)
Qian, Y., Walters, S. J., Jacques, R., & Flight, L. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-051673 · Cited by 25
Metabolomic analysis of serum using proton NMR in 6-OHDA experimental PD model and patients with PD.
Kumari, S., Kumaran, S., Goyal, V., Bose, S., Jain, S., Dwivedi, S., Srivastava, A., & Jagannathan, N. (2020) · Neurochemistry International · doi:10.1016/j.neuint.2020.104670 · Cited by 17
'Mind the gap' - a scoping review of long term, physical, self-management in Parkinson's.
Hulbert, S., & Goodwin, V. (2019) · Physiotherapy · doi:10.1016/j.physio.2019.12.003 · Cited by 17
Age Matters: Objective Gait Assessment in Early Parkinson's Disease Using an RGB-D Camera
Ospina, B. E. M., Chaparro, J. A. V., Paredes, J. D. A., Castaño-Pino, Y. J., Navarro, A., & Orozco, J. L. (2019) · Parkinson's Disease · doi:10.1155/2019/5050182 · Cited by 17
“PD diagnosis was made by the movement disorder specialist at the institution following the UK Parkinson’s Disease Society Brain Bank diagnostic criteria [18].”
Method
Multi-Modal Rehabilitation Therapy in Parkinson's Disease and Related Disorders
Saluja, A., Goyal, V., & Dhamija, R. K. (2022) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_164_22 · Cited by 25
“99].[64] A recent systematic review including 10 studies (1343 PD patients) found that a few studies showed an improvement in perceived occupational performance and upper limb function with OT.”
Background
The effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson’s disease
Oğuz, S., Ertürk, G., Polat, M., & Apaydin, H. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2028325 · Cited by 16
Falls Self-Management Interventions for People with Parkinson’s Disease: A Systematic Review
Owen, C. L., Ibrahim, K., Dennison, L., & Roberts, H. C. (2019) · Journal of Parkinson s Disease · doi:10.3233/jpd-181524 · Cited by 17
“large RCTs of occupational therapy; in these stud83 ies the majority of participants had mild-moderate 84 PD, the very group in whom rehabilitative inter85 ventions have been proposed to be more effective 86 [14, 17, 18].”
Background
Impact of frailty and sex-related differences on postural control and gait in older adults with Parkinson's Disease.
Dallaire, M., Houde-Thibeault, A., Bouchard-Tremblay, J., Wotto, E. A., Côté, S., Oliveira, C. S., Ngomo, S., & da Silva, R. D. (2024) · Experimental Gerontology · doi:10.1016/j.exger.2024.112360 · Cited by 14
“We used the London Brain Bank ’ s inclusion criteria and classified as stages 1 to 3 (mild to moderate) according to the modified Hoehn & Yahr scale (Hoehn and Yahr, 1967; Clarke et al., 2016).”
Method
Detraining Slows and Maintenance Training Over 6 Years Halts Parkinsonian Symptoms-Progression
Hortobágyi, T., Sipos, D., Borbély, G., Áfra, G., Reichardt-Varga, E., Sántha, G., Nieboer, W., Tamási, K., & Tollár, J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.737726 · Cited by 18
“These changes in turn exceed the changes in M-EDL after very low-intensity physical and occupational therapy (48).”
Result
Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial
Hommel, A., Meinders, M., Weerkamp, N., Richinger, C., Schmotz, C., Lorenzl, S., Dodel, R., Coelho, M., Ferreira, J., Tison, F., et al. (2020) · Journal of Parkinson's Disease · doi:10.3233/jpd-202033 · Cited by 14
“Several other studies on complex multidisciplinary interventions in PD failed to show an impact on ADL-measures, indicating that these outcomes may not be sensitive enough to capture relevant change in these situations [39–42].”
Moderate Frequency Resistance and Balance Training Do Not Improve Freezing of Gait in Parkinson's Disease: A Pilot Study
Schlenstedt, C., Paschen, S., Seuthe, J., Raethjen, J., Berg, D., Maetzler, W., & Deuschl, G. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.01084 · Cited by 14
A Systematic Review of tACS Effects on Cognitive Functioning in Older Adults Across the Healthy to Dementia Spectrum
Kraft, J. D., & Hampstead, B. (2023) · Neuropsychology Review · doi:10.1007/s11065-023-09621-3 · Cited by 13
“Participants were recruited from a specialty clinic and met UK Brain Bank criteria (Clarke et al., 2016).”
Economic Evaluation in Neurological Physiotherapy: A Systematic Review
García-Álvarez, D., Sempere‐Rubio, N., & Faubel, R. (2021) · Brain Sciences · doi:10.3390/brainsci11020265 · Cited by 17
“This makes it possible to analyze the association of the costs of the intervention with measurements of the effects of the intervention, such as patient-reported health outcomes (PROs), among which we find HRQL, daily life activities, or variables related to the healthcare system like readmissions avoided [30] or days…”
BackgroundMethodInfluential
Classification of GBA1 variants and their impact on Parkinson’s disease: an in silico score analysis
Lanore, A., Tesson, C., Basset, A., Lejeune, F., Cogan, G., Mangone, G., Sambin, S., Bertille, N., Anheim, M., Arnulf, I., et al. (2025) · npj Parkinson s Disease · doi:10.1038/s41531-025-01060-6 · Cited by 9
Oscillatory EEG-TMS Reactivity in Parkinson Disease
Formaggio, E., Tonellato, M., Antonini, A., Castiglia, L., Gallo, L., Manganotti, P., Masiero, S., & Felice, A. D. (2021) · Journal of clinical neurophysiology · doi:10.1097/wnp.0000000000000881 · Cited by 12
Quickcard-Based Approach to Guiding Specific Nonpharmacological Treatments in a German Parkinson’s Network
Kerkemeyer, L., Achtert, K., Claus, I., Happe, S., Overbeck, J., Kleen, N., Palesch, A., Schmuck, C., Krouß, S., Perick, J., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9072272 · Cited by 12
Blood Neurofilament Light Chain in Parkinson’s Disease: Comparability between Parkinson’s Progression Markers Initiative (PPMI) and Asian Cohorts
Chen, J., Chan, L., Chung, C., Bamodu, O. A., & Hong, C. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10215085 · Cited by 15
“The diagnosis of PD was based on the UK Parkinson’s Disease Society Brain Bank Diagnostic Criteria [31].”
Method
Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial
Xin, Y., Ashburn, A., Pickering, R. M., Seymour, K. C., Hulbert, S., Fitton, C., Kunkel, D., Marian, I. R., Roberts, H. C., Lamb, S. E., et al. (2020) · BMC Neurology · doi:10.1186/s12883-020-01852-8 · Cited by 13
Risk of Parkinson disease in stroke patients: A nationwide cohort study in South Korea
Choi, H. L., Ahn, J. H., Chang, W. H., Jung, W., Kim, B., Han, K., Youn, J., & Shin, D. (2024) · European Journal of Neurology · doi:10.1111/ene.16194 · Cited by 10
“Patients diagnosed with PD were identified with code V124, which is specified by criteria comparable to the UK Parkinson's Disease Society Brain Bank Diagnostic Criteria [ 29 ], and the diagnosis is confirmed by a neurologist or neurosurgeon.”
Method
The Potential Role of Fecal Microbiota Transplantation in Parkinson’s Disease: A Systematic Literature Review
Vongsavath, T., Laeeq, T., Tun, K. M., & Hong, A. S. (2023) · Applied Microbiology · doi:10.3390/applmicrobiol3030067 · Cited by 13
A systematic review and meta-analysis of safety and efficacy of safinamide for motor fluctuations in patients with Parkinson's disease
Ahmed, M. A. A. (2019) · F1000Research · doi:10.12688/f1000research.21372.1 · Cited by 9
Associations Between Gut Microbiota Composition and Impulse Control Disorders in Parkinson’s Disease
Lin, S., Lin, R.-J., Chu, C.-L., Chen, Y., & Fu, S. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26136146 · Cited by 9
Rapid Voluntary Blinking as a Clinical Marker of Parkinson’s Disease
Francis, M., Zirra, A., Haque, T., Gallagher, D., Budu, C., Lees, A. J., Schrag, A., Noyce, A., & Simonet, C. (2024) · Journal of Parkinson's Disease · doi:10.3233/jpd-240005 · Cited by 8
Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson’s Disease
Rafferty, M. R., Foster, E. R., Roberts, A. C., Smaller, K., Johnson, L. L., & Lawson, R. (2024) · Journal of Parkinson's Disease · doi:10.3233/jpd-230267 · Cited by 8
Health-related quality of life changes after the merging yoga and occupational therapy for Parkinson's disease program: A mixed-methods study.
Swink, L., Fruhauf, C. A., Atler, K., Fling, B., Klinedinst, T. C., & Schmid, A. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2020.101156 · Cited by 8
The effect of subthalamic deep brain stimulation on autonomic dysfunction in Parkinson’s disease: clinical and electrophysiological evaluation
Yavaşoğlu, N. G., & Çomoğlu, S. S. (2021) · Neurological Research · doi:10.1080/01616412.2021.1942409 · Cited by 6
Multilingual Validation of the First French Version of Munich Dysphagia Test—Parkinson's Disease (MDT-PD) in the Luxembourg Parkinson's Study
Simons, J., Vaillant, M., Hipp, G., Pavelka, L., Stute, L., Pauly, C., & Krüger, R. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.01180 · Cited by 7
“To be included in the study, all subjects must meet either the UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria (10, 11) for PD or the criteria defined for the respective atypical forms of parkinsonism, including progressive supranuclear palsy (PSP) (12, 13), multiple system atrophy (MSA) (12), c…”
Intervention development and treatment success in UK health technology assessment funded trials of physical rehabilitation: a mixed methods analysis
Goodwin, V. A., Hill, J. J., Fullam, J., Finning, K., Pentecost, C., & Richards, D. A. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026289 · Cited by 8
A soft magnetoelastic ball for self-powered Parkinson’s disease diagnosis
Tat, T., Xu, J. H., Xiao, X., Chen, S., Duan, Z., Zhao, X., Chen, J., Yin, J., & Chen, J. (2025) · Cell Biomaterials · doi:10.1016/j.celbio.2025.100243 · Cited by 7
“…PD rating scales —the Unified Parkinson Disease Rating Scale (UPDRS), with the Movement Disorder Society (MDS)-UPDRS as the newest revision 9 ; Hoehn and Yahr stages 10 ; and the Schwab and England rating of the activities of daily living scale 11 —rely heavily on patients’ subjective inputs.”
Plasma and urinary metabolomic signatures differentiate genetic and idiopathic Parkinson's disease.
Cotrin, J. C., dos Santos, G. C., Cadaxo, A. S., Pereira, J. S., Spitz, M., de Rosso, A. L. Z., Veras, R. P., Valente, A. P., Pimentel, M. M. G., & Santos-Rebouças, C. (2025) · Brain Research · doi:10.1016/j.brainres.2025.149625 · Cited by 6
GATA3 as a Blood-Based RNA Biomarker for Idiopathic Parkinson’s Disease
Acharya, S., Lumley, A., Zhang, L., Vausort, M., & Devaux, Y. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241210040 · Cited by 6
“Briefly, patients above the age of 18 years that fulfilled the United Kingdom Parkinson’s Disease Society (UK-PDS) Brain Bank Clinical Diagnostic Criteria were included in the iPD sample group of the study [39].”
Method
Perceptions of people with Parkinson’s and their caregivers of falling and falls-related healthcare services- a qualitative study
Owen, C., Gaulton, C., Roberts, H., & Dennison, L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276588 · Cited by 6
Clinicians’ view on the management of oral health in Parkinson’s disease patients: a qualitative study
Verhoeff, M., Thymi, M., Brandwijk, A. N., Heres, M. S., Koutris, M., Berendse, H., van Dijk, K. V., & Lobbezoo, F. (2023) · BDJ Open · doi:10.1038/s41405-023-00144-w · Cited by 5
“, physiotherapeutic options, although the effectiveness of such options has not yet been fully demonstrated [26, 27].”
Background
The effects of Pilates training on abdominal muscle thickness and core endurance in patients with Parkinson’s disease: a single-blind controlled clinical study
Göz, E., Özyürek, S., Aktar, B., Çolakoğlu, B., & Balcı, B. (2023) · Turkish Journal of Medical Sciences · doi:10.55730/1300-0144.5663 · Cited by 5
“Therefore, usually, a therapeutic exercise approach is followed to supplement the pharmacological and surgical treatments in order to increase the functional abilities of patients with PD and to reduce the likelihood of any secondary complications they may develop [2,3].”
Background
Orofacial myofunctional assessment and quality of life of individuals with Parkinson's disease.
de Araújo, S. R. S., Castelo, P., Said, A. D. V., Fernandes, J., Neves, C. R., Diaféria, G., & Bommarito, S. (2022) · Special Care in Dentistry: managing special patients, settings, and situations · doi:10.1111/scd.12787 · Cited by 5
Perceived exercise habits of individuals with Parkinson’s disease living in the community
Lockwich, J., Schwartzkopf-Phifer, K., Skubik-Peplaski, C., Andreatta, R. D., & Kitzman, P. H. (2021) · Clinical Parkinsonism & Related Disorders · doi:10.1016/j.prdoa.2021.100127 · Cited by 7
“Luckily, exercise targeting improving cadence has been identified as a key variable to improving propulsion gait deficits in PD [8].”
Background
Parkinson Disease and Occupational and Environmental Exposure to Pesticides in a Region of Intense Agribusiness Activity in Brazil: A Case-Control Study.
Silvestre, G. C. S. B., Ferreira, M., de Figueiredo, S. E. F. M. R., da Silva, C. A. L., Siqueira, H., & da Silva, A. M. C. (2020) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002043 · Cited by 5
“Copyrig ORIGINAL ARTICLE Parkinson Disease and Occupational and Environmental Exposure to Pesticides in a Region of Intense Agribusiness Activity in Brazil A Case–Control Study Grasiela Cristina Silva Botelho Silvestre, MSc, Marcelo José Monteiro Ferreira, PhD, Sue Ellen Ferreira Modesto Rey de Figueiredo, PhD, Crist…”
MethodInfluential
Automated Stage Discrimination of Parkinson’s Disease
Aharonson, V., Seedat, N., Israeli-korn, S., Hassin-Baer, S., Postema, M., & Yahalom, G. (2020) · BIO Integration · doi:10.15212/bioi-2020-0006 · Cited by 5
A Systematic Review of Third-Wave Therapies to Reduce Distress and Improve Wellbeing and Quality of Life in People with Parkinson's Disease.
Christodoulou, D., Reeves, S., Carvalho, N. P., Stellman, J., & Gould, R. L. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2511957 · Cited by 4
“Six studies used the Hoehn and Yahr staging for assessing disease severity (Clarke et al., 2016), which varied from stage 1 to 3.”
Post-Physical Therapy 4-Month In-Home Dynamic Standing Protocol Maintains Physical Therapy Gains and Improves Mobility, Balance Confidence, Fear of Falling and Quality of Life in Parkinson’s Disease: A Randomized Controlled Examiner-Blinded Feasibility Clinical Trial
Boas, M. V. E., Pongmala, C., Biddix, A., Griggs, A., Luker, A. T., Carli, G., Marušič, U., & Bohnen, N. (2024) · Journal of Frailty, Sarcopenia and Falls · doi:10.22540/jfsf-09-267 · Cited by 4
“While Clarke et al. 34 reported no clinically meaningful improvements in activities of daily living or quality of life (QoL) post-PT over the longer term (i.e., 3, 9 and 15 months), Mak et al. 35 conclude in their systematic review and meta-analysis that long term physical therapy is beneficial for motor symptoms and…”
Can Corticomuscular Coherence Differentiate between REM Sleep Behavior Disorder with or without Parkinsonism?
Choi, G. S., Yun, J. Y., Hwang, S., Kim, S. E., Kim, J., Im, C., & Lee, H. W. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235585 · Cited by 5
“PD and DLB were clinically diagnosed by an expert neurologist according to the diagnostic criteria of the United Kingdom PD Society Brain Bank [28] and the diagnostic criteria of the DLB Consortium [29].”
Method
Future Perspectives: Assessment Tools and Rehabilitation in the New Age
Gilmore, G., & Jog, M. (2017) · Springer eBooks · doi:10.1007/978-3-319-46062-8_10 · Cited by 4
Interventions for promoting physical activity in people with newly diagnosed Parkinson’s disease: scoping review
Gilby, J., Kent, B., Lozano, R. K., & Marsden, J. F. (2025) · Systematic Reviews · doi:10.1186/s13643-025-02892-2 · Cited by 5
“In their large randomized controlled trial with 15-month follow-up, Clarke et al. found a small but significant difference in the summary index of the PDQ-39 between therapy and control groups (see Table 2), but no motor effect was observed in the PDQ-39 mobility domain [57].”
Influential
Exploring the Impact of Robotic Hand Rehabilitation on Functional Recovery in Parkinson’s Disease: A Randomized Controlled Trial
Raciti, L., Latella, D., Raciti, G., Sorbera, C., Bonanno, M., Ciatto, L., Andronaco, G., Quartarone, A., Lorenzo, G. D., & Calabrò, R. S. (2025) · Brain Science · doi:10.3390/brainsci15060644 · Cited by 3
Efficacy and safety of glucagon-like peptide-1 receptor agonists in Parkinson’s disease: A systematic review and meta-analysis
Singh, M. P., Balasundaram, M. K., & Singh, A. (2025) · Journal of Neurosciences in Rural Practice · doi:10.25259/jnrp_393_2024 · Cited by 2
Acceptability and feasibility randomised controlled trial of a digital mental health intervention for people with Parkinson’s (PACT): trial protocol
Pinto, C., Brown, J., Hurt, C. S., Cubí‐Mollá, P., Chowdhury, S., McCracken, L. M., Norton, S., Volpato, R., Stumpf, S., & Bogosian, A. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01594-9 · Cited by 5
“The PD REHAB Healthcare Usage Questionnaire [37] will be administered to participants in the intervention and control groups at both baseline and endpoints.”
Effects of a sequential square mat walking training program Fisior® on improving physical performance in older adults with Parkinson's disease: A pilot study.
Alegre-Tamariz, J., Runzer-Colmenares, F. M., Bermejo-Franco, A., & Parodi, J. (2024) · Geriatric Nursing · doi:10.1016/j.gerinurse.2024.09.021 · Cited by 3
Regulatory miR-SNP rs4636297A > G in miR-126 is linked to increased risk of rigidity feature in patients with Parkinson’s disease
Pooshani, S., Azadmehr, A., Saadat, P., Sepidarkish, M., & Daraei, A. (2024) · International Journal of Neuroscience · doi:10.1080/00207454.2024.2398571 · Cited by 3
“According to the criteria of hoehn and Yahr staging scale [66] describing the level of Parkinson’s clinical disability, the patients under study were in stages 1.5, 2, 2.5, 3, 4, and 5, with rates of 17, 27, 18, 23,10 and 5%, respectively.”
Influential
Dietary quality and the gut microbiome in early-stage Parkinson’s disease patients
Yoon, H. J., Kang, W., Jo, S., Hwang, Y., Lee, J.-H., Chung, S., & Park, Y. (2023) · Nutritional neuroscience · doi:10.1080/1028415x.2023.2253025 · Cited by 3
“PD was diagnosed according to the U.K. Parkinson ’ s Disease Society Brain Bank clinical diagnostic criteria [14].”
Method
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
Measuring Value: Cost-Effectiveness Analysis for Occupational Therapy
Morrow, C., & Simpson, K. (2021) · American Journal of Occupational Therapy · doi:10.5014/ajot.2022.049086 · Cited by 3
“Although some economic evaluations have been reported for rehabilitation (B € urge et al., 2016; Chiatti & Iwarsson, 2014; Clarke et al., 2016; Fern (cid:2) andez-de-Las-Pe ~ nas et al., 2019; Rahja et al., 2018; Schene et al., 2007), a recent assessment of reporting quality for economic…”
Effect of patient education interventions on non-motor symptoms and disease outcomes in parkinson’s disease: a systematic review
Doeselaer, L. V., Colman, K., Crosiers, D., & Dijkstra, F. (2025) · Acta Neurologica Belgica · doi:10.1007/s13760-025-02900-1 · Cited by 2
Blood α‐Synuclein Separates Parkinson's Disease from Dementia with Lewy Bodies
Kannarkat, G. T., Zack, R., Skrinak, R. T., Morley, J. F., Davila‐Rivera, R., Arezoumandan, S., Dorfman, K., Luk, K. C., Wolk, D. A., Weintraub, D. A., et al. (2025) · Annals of Neurology · doi:10.1002/ana.27288 · Cited by 8
“6,7 However, cognitive impairment, which develops in over 70% of individuals with PD later in the disease course, and characterized as mild cognitive impairment (PD-MCI) or progressing to dementia (PDD), may be the most detrimental to quality of life.”
Parkinson's Elevated: improving healthspan
McKee, K. E., Rafferty, M. R., Sakata, T., Hedges, D. M., Griffith, G. J., Bingham, M., Obradovich, S. A., Francis, M., & Corcos, D. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1529075 · Cited by 2
Functional Connectivity and Volumetrics Improve Outcome Prediction for Deep Brain Stimulation in Parkinson's Disease
Younce, J. R., Norris, S., Ushe, M., & Perlmutter, J. (2025) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70108 · Cited by 2
“To be included, participants must have met UK Brain Bank criteria 33 for diagnosis of idiopathic PD, placement of bilateral STN DBS between 2007 and 2017 (re ﬂ ecting time period when this series of pre-DBS research MRI scans were collected), and adequate clinical and MRI data for analysis.”
Exploring social, cultural and environmental factors that influence attitudes to exercise among people with Parkinson’s disease: A qualitative study
Baron, F., & Bogosian, A. (2024) · Journal of Health Psychology · doi:10.1177/13591053241296647 · Cited by 2
“Theevidence from pragmatic exercise-based studies is less positive, with three large therapist-led UK trials yielding small or non-significant effects (Ashburn et al., 2019; Clarke et al., 2016; Goodwin et al., 2011).”
Cross-Sectional Study Comparing Activities of Daily Living Using Barthel Index Within a Geriatric Population Having Non-Communicable Diseases
Harale, M., Oommen, A. B., Faruqi, A. A., Mundada, M., Pancholi, T., Yammanuru, B., Yekkaluru, S., Reddy, R. H., & Gupta, A. D. (2024) · Cureus · doi:10.7759/cureus.65046 · Cited by 2
Relationship of Vitamin D Deficiency with Non-Motor Functions of Parkinson’s disease
Khan, M., Mouri, U. K., Islam, M. R., Rahman, T., Rahman, A., & Ahmed, J. (2024) · Bangladesh Journal of Medicine · doi:10.3329/bjm.v35i2.72400 · Cited by 2
“Adult patients e”18 years of age who fulfilled the criteria for Parkinson’s disease based on the British Brain Bank criteria 9 were included the study.”
Method
Cost-Effectiveness Analyses of Non-Pharmacological and Non-Surgical Interventions in Idiopathic Parkinson’s Disease: A Systematic Review
Hartmann-Nardin, D., Stock, S., Kalbe, E., & Folkerts, A.-K. (2024) · Journal of Parkinson's Disease · doi:10.3233/jpd-230213 · Cited by 2
Association of serum uric acid and non-motor symptoms in Parkinson's disease: A cross-sectional study from a movement disorders clinic in Lagos, Nigeria
Odeniyi, O., Ojo, O., Odeniyi, I., & Okubadejo, N. (2022) · Journal of Clinical Sciences · doi:10.4103/jcls.jcls_29_22 · Cited by 2
Effects of Focal Muscle Vibration on Static and Dynamic Balance in Patients with Parkinson’s Disease: Preliminary Results of a Retrospective Study
Ferrara, P. E., Casa, E. D., Calciano, R., Ricciardi, D., Tassi, L., Cutaia, A., Lama, E., Lombardo, C., Fusco, A., Ferriero, G., et al. (2026) · Medicina · doi:10.3390/medicina62020300 · Cited by 1
Anxiety-related gut microbiota alterations in Parkinson’s disease: distinct associations compared to healthy individuals
Lin, S.-H., Lin, R.-J., Chan, K., Chu, C.-L., Chen, Y.-L., & Fu, S.-C. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1594152 · Cited by 1
L’évaluation économique en physiothérapie ou comment en avoir pour son argent
Gagnon, R., Hébert, L., Guertin, J., Berthelot, S., Desmeules, F., & Perreault, K. (2022) · Physiotherapy Canada · doi:10.3138/ptc-2022-0079 · Cited by 1
Structured guideline-based physiotherapy reduces difficulties in activities of daily living in Parkinson’s disease
Medijainen, K., Pääsuke, M., Lukmann, A., & Taba, P. (2021) · NeuroRehabilitation (Reading, MA) · doi:10.3233/nre-210181 · Cited by 1
Functional improvement related to enrolment in a Parkinson’s disease rehabilitation program
Chow, B., Feloiu, F., Berardocco, A., Ceglie, D., & Nesathurai, S. (2020) · Neurorehabilitation · doi:10.3233/nre-203218 · Cited by 1
“However, one randomized controlled trial did not support combined PT and OT for mild to moderate PD, due to a lack of immediate or long-term clinically meaningful improvements in QOL and ADL performance (Clarke et al., 2016).”
How Much Allied Health Therapy Care Is Enough? An Evidence Scan.
Twizeyemariya, A., Grimmer, K., & Milanese, S. (2020) · Physiotherapy Canada. Physiothérapie Canada · doi:10.3138/ptc-2018-0019 · Cited by 1
MUTATION ANALYSIS OF DJ-1 GENE IN VIETNAMESE PARKINSON’S DISEASE PATIENTS
Giang, H., Nguyen, H. D., Nguyen, T. T. H., Vũ, N. X., & Võ, T. (2018) · Vietnam Journal of Biotechnology · doi:10.15625/1811-4989/15/4/13399 · Cited by 1
“The diagnosis of PD was based on published criteria (Clarke et al., 2016).”
Method
The Attitudes of Physiotherapy Students Toward Occupational Medicine
Prendushi, H. (2016) · doi:10.19044/esj.2016.v12n36p39 · Cited by 1
“Moreover, for 93.1% of students the topic of work disability is an interesting subject of study (Svendsen, Christiansen, Haahr, Andrea & Frost, 2014; Clarke et al., 2016), as well as for 90.3% of the students the occupational diseases are interesting to study (Murtezani, 2012; Brattig, Schablon,…”
BackgroundInfluential
Improvement in quality of life in Parkinson's disease after an inpatient rehabilitation program
de Almeida, P. N. S., Souza, N., Macedo, R. C., & Oliveira, J. (2026) · Heliyon · doi:10.1016/j.heliyon.2026.e45534
Analysis of the effectiveness of subthalamic nucleus deep brain stimulation in patients with advanced parkinson’s disease: one-year follow-up from ukrainian experience
Mykhailovska, N., Zinkevych, I. P., & Kostiuk, K. (2026) · Ukrainian Neurosurgical Journal · doi:10.25305/unj.366965
Multimodal balance training with rhythmical auditory cueing in Huntington's disease: A pilot randomized controlled trial.
Capato, T. T. C., Nonnekes, J., Ramjith, J., Barbosa, E. R., Inthout, J., & Bloem, B. (2026) · Journal of Huntington's Disease · doi:10.1177/18796397261468393
Reliability and convergent validity of the 6-minute pegboard and ring test in people with Parkinson’s disease: a cross-sectional study
Gürdal, R., Polat, H., Horata, E. T., & Tuncer, İ. A. (2026) · Acta Neurologica Belgica · doi:10.1007/s13760-026-03159-w
Single-lead ECG during paced breathing enables multidimensional assessment of Parkinson's disease
Deng, L., Tong, X.-W., Yao, Y., Wang, K.-X., Zheng, H., Peng, C.-K., & Cui, X. (2026) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2026.110067
Microstructural alterations of the thalamo-striatal system in parkinson’s disease with dementia: a diffusion tensor imaging study
Soliman, R., Hamed, A., Hassanein, S. M. A., Taher, A., Mahmoud, M., Korayem, M., & Khedr, E. (2026) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1186/s43055-026-01792-2
“A total of 25 patients with PD were recruited from the neurology outpatients clinic during the period from 2023 to 2024, following the diagnostic criteria established by the UK Parkinson’s Disease Society Brain Bank [16].”
Exercise, exerkines, and muscle–brain crosstalk in Parkinson's disease
Páez-García, S., Alvarado, E., Cuevas, A., Valverde, L., Salinas, E., O'Hara-Veintimilla, K., Rodríguez-Oroz, M., & Borda, M. G. (2026) · Neuroprotection · doi:10.1002/nep3.70032
Relationship between dietary habits and gut metabolome profile in Parkinson's disease: a case–control study
Ekmekci, H., Aydemir, F. H. Y., Sivrikaya, A., Özgüncü, C., Ildız, Ö. F., & Topkafa, M. (2026) · Nutritional neuroscience · doi:10.1080/1028415x.2026.2628828
“PD diagnosis was strictly based on the United Kingdom Brain Bank criteria [15].”
Understanding dopaminergic dose reduction following STN-DBS: mediation analysis
Lanore, A., Houot, M., Basset, A., Bendetowicz, D., Menon, P., Bardinet, É., Fernández-Vidal, S., Cornillault, J., Karachi, C., Navarro, S., et al. (2026) · BMJ Neurology Open · doi:10.1136/bmjno-2025-001427
Aktivierende Therapien bei Morbus Parkinson
Stalter, J., & Witt, K. (2024) · DNP – Die Neurologie & Psychiatrie · doi:10.1007/s15202-024-6307-7
Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson’s disease. A single-subject design
Lockwich, J., Kitzman, P. H., Skubik-Peplaski, C., Andreatta, R. D., & Schwartzkopf-Phifer, K. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2388873
“…safe option for individuals with PD to practice intensity based and walking in multiple studies with little adverse reactions or dropouts reported [39–43]. treadmill practice utilizes both visual and verbal cuing to improve gait abnormalities that are present with stepping practice that provides…”

Authors: Clarke, C. E., Patel, S., Ives, N., Rick, C. E., Woolley, R., Wheatley, K., Walker, M. F., Zhu, S., Kandiyali, R., Yao, G., Sackley, C. M., & on behalf of the PD REHAB Collaborative Group
Affiliations: Sandwell & West Birmingham Hospitals NHS Trust (GB)
University of Birmingham (GB)
Cancer Research UK Clinical Trials Unit (GB)
University of Nottingham (GB)
University of Southampton (GB)
University of East Anglia (GB)
Corresponding author: Clarke, Carl E
ORCID: Clarke, Carl E
Patel, Smitaa
Ives, Natalie
Rick, Caroline E
Woolley, Rebecca
Wheatley, Keith
Walker, Marion F
Zhu, Shihua
Kandiyali, Rebecca
Yao, Guiqing
Sackley, Catherine M
Venue: Health Technology Assessment
Publisher: National Institute for Health and Care Research
Published: 2016-08
Volume: 20
Issue: 63
Pages: 1-96
ISSN: 1366-5278 (ISSN-L)
2046-4924
DOI: 10.3310/hta20630
PMC: PMC5018686
OpenAlex: W2508437487
Cited by: 110
References: 52
Citations by year: 2026: 10 · 2025: 19 · 2024: 16 · 2023: 6 · 2022: 9 · 2021: 13 · 2020: 13 · 2019: 11 · 2018: 8 · 2017: 1 · 2016: 4
FWCI: 6.02
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm (unspecified)
Locations: Health Technology Assessment (publishedVersion, cc-by)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
ePrints Soton (University of Southampton) (submittedVersion)
Figshare (submittedVersion)
Research Portal (King's College London) (submittedVersion, other-oa)
Leicester Research Archive (University of Leicester) (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Bristol Research (University of Bristol) (submittedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Warwick Research Archive Portal (University of Warwick) (submittedVersion)
Funders: Health Technology Assessment programme (07/01/07)
Topics: Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords: Parkinson's disease, physiotherapy, occupational therapy, instrumental activities of daily living, health-related quality of life, cost-effectiveness, personalized treatment, patient-centered care, caregiver quality of life, resource utilization (health care), PDQ-39, EQ-5D, adverse events
MeSH terms: Activities of Daily Living, Adult, Age Factors, Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, United Kingdom, Humans, Male, Middle Aged, Occupational Therapy, Parkinson Disease, Quality of Life, Severity of Illness Index, State Medicine, Technology Assessment, Biomedical, Quality-Adjusted Life Years, Physical Therapy Modalities

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Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)

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