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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2015; 25(01): 11-18
DOI: 10.1055/s-0034-1395653
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Neue physiotherapeutische Behandlungsmethoden beim Morbus Parkinson – was ist gesichert?

New Physiotherapy Interventions in Parkinsonʼs Disease – What is the Evidence?
G. Küther
1   Medizinische Hochschule, Klinik für Rehabilitationsmedizin, Hannover
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Publication History

eingereicht 21 July 2014

akzeptiert 14 November 2014

Publication Date:
10 February 2015 (online)

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Zusammenfassung

Einleitung: Zur physiotherapeutischen Behandlung der Parkinson-Erkrankung wurde im letzten Jahrzehnt eine steigende Zahl randomisiert kontrollierter Studien mit innovativen neuen Ansätzen publiziert. Dies belegen auch aktuelle Metaanalysen, die eine zunehmend breitere Basis für die Bewertung ihrer klinischen Wirkungen bilden. Allerdings weisen diese Analysen einige Unterschiede im Hinblick auf die Studienauswahl sowie die Bewertung der klinischen Effekte auf. Die vorliegende Übersicht hat daher zum Ziel, eine aktualisierte Zusammenfassung der Evidenz der Wirkungen der einzelnen Verfahren und ihrer klinischen Anwendung zu liefern.

Methode: Eine elektronische Suche nach Metaanalysen, die zwischen Januar 2000 und März 2014 erschienen sind, wurde in den Datenbanken MEDLINE, PubMed und Google Scholar durchgeführt.

Ergebnisse: Es konnten 8 Metaanalysen identifiziert werden. Mit Ia Evidenz ist die Wirkung für die Trainings- und Tanztherapie sowie die Behandlung mit externen Reizen (Cues) belegt. Auch die Laufbandtherapie erreichte Ia Niveau, allerdings findet sich eine abweichende Bewertung in 2 Metaanalysen mit unterschiedlichen Auswahlkriterien für die einbezogenen Studien. Die Wirkung von Tai-Chi bzw. Qigong Übungen und der LSVT-BIG-Therapie ist auf Ib Niveau belegt, positive Wirkungen eines repetitiven Trainings von Ausfallschritten werden auf IIb Niveau berichtet. Keine nachhaltigen Wirkungen konnten bei der Ganzkörper-Vibrationstherapie nachgewiesen werden. Nur auf 3 Studien stützen sich Befunde über positive Effekte der konventionellen Physiotherapie in Bezug auf die Flexibilität sowie motorische und ADL Funktionen. Die Effektstärken wurden insgesamt als gering bis moderat mit Werte bis 0,56 eingeschätzt. Nahezu alle behandelten Patienten befanden sich in einem noch wenig fortgeschritten Stadium ihrer Erkrankung (entsprechend Hoehn und Yahr Stufe 2–3). Grundsätzliche Probleme für eine Bewertung waren variable Inhalte, Intensitäten und eine unterschiedliche Dauer der geprüften Behandlungen sowie der Einschluss von Kontrollgruppen mit aber auch ohne eine Therapie.

Schlussfolgerung: Die neuen physiotherapeutischen Konzepte bieten einen vielversprechenden neuen Ansatz für die Behandlung von Parkinson Patienten. Die besten therapeutischen Wirkungen sind bei der Bradykinese und posturalen Instabilität zu erwarten, sodass die geprüften Methoden als komplementäre Therapieformen zur Behandlung von Symptomen anzusehen sind, die nicht ausreichend durch eine medikamentöse oder operative Behandlung zu bessern sind. Anhand der bisher publizierten Studien lässt sich noch kein optimales, einheitliches Physiotherapiekonzept angeben.

Abstract

Introduction: In the last decade, an increasing number of randomized-controlled trials dealing with innovative new physiotherapeutic approaches for the treatment of Parkinson´s disease have been published. Recent meta-analyses reflect this development by providing a much broader basis to evaluate their clinical effects. However, some discrepancies exist between these reports when regarding the selection of clinical trials and the estimation of therapeutic effects. The purpose of this review is to present an updated compilation of available evidence for beneficial effects of the different therapies and their clinical application.

Methods: An electronic search was performed in the databases Medline, PubMed, and Google Scholar for meta-analyses, published between January 2000 and March 2014.

Results: 8 meta-analyses could be identified. Level Ia evidence can be found for the efficacy of exercise, dance and cueing therapy. Also treadmill training reached level Ia evidence, although there are some discrepancies between 2 meta-analyses with different criteria for study selection. Tai Chi/Qigong and LSTV-BIG therapy reached Ib level, positive effects of a repetitive training of compensatory steps could be demonstrated on IIb level. No long lasting effect could be ascertained for whole-body vibration therapy. Positive effects of conventional physiotherapy on flexibility, and motor- and ADL functions are reported in only 3 studies. Effects sizes were always low to moderate, reaching up to 0.56. Almost all patients tested were in less advanced stages of their disease (i. e., Hoehn Yahr 2–3). General problems for an evaluation are a variable content, intensity and duration of tested treatments, as well as control groups with and without any therapy.

Conclusion: The new physiotherapeutic concepts offer a promising new approach for treating symptoms of Parkinsonʼs disease. Best effects can be expected in the treatment of bradykinesia and postural instability, so that the tested methods can be considered as a complementary approach to treat symptoms not sufficiently ameliorated by drug therapy or surgical intervention. Considering all published studies, a “best practice” concept is not yet available.

Schlüsselwörter

Physiotherapie - Parkinson-Erkrankung - Evidenz

Key words

physiotherapy - Parkinsonʼs Disease - evidence
 

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