TY - JOUR
T1 - A randomized clinical trial of burst vs. spaced physical therapy for Parkinsons disease
AU - Au, Ka Loong Kelvin
AU - Lopes, Janine Lemos Melo Lobo Jofili
AU - Kraus, Alison
AU - Patton, Kimberly
AU - Warren, Lisa
AU - Gao, Hanzhi
AU - Wong, Joshua K.
AU - Moore, Kathryn
AU - Toledo, Jon B.
AU - Stiep, Tamara
AU - Frey, Jessica
AU - Tholanikunnel, Tracy
AU - Hess, Christopher
AU - Almeida, Leonardo
AU - Ramirez-Zamora, Adolfo
AU - Okun, Michael S.
N1 - Funding Information:
Funding for this study was provided by the University of Florida 2020–2021 Moonshot Grant for “The Next Generation of Treatments for Parkinson's Disease”.
Funding Information:
Ka Loong Kelvin Au has no disclosures. Janine Lemos Melo Lobo Jofili Lopes has no disclosures. Alison Kraus has no disclosures. Kimberly Patton has no disclosures. Lisa Warren has no disclosures. Hanzhi Gao has no disclosures. Joshua K Wong's DBS research is supported by R25 NS108939. Kathryn Moore has no disclosures. Jon B Toledo has no disclosures. JBT is supported by the Edmon J. Safra Fellowship in Movement Disorders. Tamara Stiep received honorarium during participation in a formative research study with Medtronic. Jessica Frey receives support from the Dystonia Medical Research Foundation (DMRF) . Tracy Tholanikunnel has no disclosures. Christopher Hess has received grant support from the Parkinson's Foundation and has received honoraria for speaking engagements, grant reviews, and scientific reviews from The Parkinson's Foundation and UptoDate Inc. Leonardo Almeida has no disclosures. Adolfo Ramirez-Zamora has received a consulting honorarium from Signant Health, Medtronic Inc., Guidepoint consulting, and Rho Inc. Dr Ramirez-Zamora is on an advisory board for Stealth and Boston Scientific (24 months ago). He receives grant support from R01HD091658 , UH3NS109845 , 90IFRE0035 and the Parkinson's Foundation .
Funding Information:
Funding for this study was provided by the University of Florida 2020?2021 Moonshot Grant for ?The Next Generation of Treatments for Parkinson's Disease?.Ka Loong Kelvin Au has no disclosures. Janine Lemos Melo Lobo Jofili Lopes has no disclosures. Alison Kraus has no disclosures. Kimberly Patton has no disclosures. Lisa Warren has no disclosures. Hanzhi Gao has no disclosures. Joshua K Wong's DBS research is supported by R25 NS108939. Kathryn Moore has no disclosures. Jon B Toledo has no disclosures. JBT is supported by the Edmon J. Safra Fellowship in Movement Disorders. Tamara Stiep received honorarium during participation in a formative research study with Medtronic. Jessica Frey receives support from the Dystonia Medical Research Foundation (DMRF). Tracy Tholanikunnel has no disclosures. Christopher Hess has received grant support from the Parkinson's Foundation and has received honoraria for speaking engagements, grant reviews, and scientific reviews from The Parkinson's Foundation and UptoDate Inc. Leonardo Almeida has no disclosures. Adolfo Ramirez-Zamora has received a consulting honorarium from Signant Health, Medtronic Inc., Guidepoint consulting, and Rho Inc. Dr Ramirez-Zamora is on an advisory board for Stealth and Boston Scientific (24 months ago). He receives grant support from R01HD091658, UH3NS109845, 90IFRE0035 and the Parkinson's Foundation.Michael Okun serves as a consultant for the Parkinson's Foundation, and has received research grants from NIH, Parkinson's Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun's DBS research is supported by: NIH R01 NR014852 and R01NS096008. Dr. Okun is PI of the NIH R25NS108939 Training Grant. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology and JAMA Neurology. Dr. Okun has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, QuantiaMD, WebMD/Medscape, Medicus, MedNet, Einstein, MedNet, Henry Stewart, American Academy of Neurology, Movement Disorders Society and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic, Abbvie, Boston Scientific, Abbott and Allergan and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations.
Funding Information:
Michael Okun serves as a consultant for the Parkinson's Foundation, and has received research grants from NIH , Parkinson's Foundation , the Michael J. Fox Foundation , the Parkinson Alliance , Smallwood Foundation , the Bachmann-Strauss Foundation , the Tourette Syndrome Association , and the UF Foundation . Dr. Okun's DBS research is supported by: NIH R01 NR014852 and R01NS096008 . Dr. Okun is PI of the NIH R25NS108939 Training Grant. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology and JAMA Neurology. Dr. Okun has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, QuantiaMD, WebMD/Medscape, Medicus, MedNet, Einstein, MedNet, Henry Stewart, American Academy of Neurology, Movement Disorders Society and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic , Abbvie , Boston Scientific , Abbott and Allergan and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/4
Y1 - 2022/4
N2 - Introduction: The optimal timing for physical therapy (PT) delivery in Parkinson's disease (PD) is unknown. Our objective was to determine whether spacing physical therapy visits over a longer period of time is beneficial for maintenance of physical function in PD. Methods: A single center, single-blinded, randomized controlled trial of PD participants. Participants (n = 30) were randomized to either burst (two PT sessions weekly for 6 weeks) or spaced (one PT session every 2 weeks for 6 months) PT. 11 participants in each arm completed the study and were analyzed. The primary outcome measure was the Timed Up and Go (TUG) test at baseline and 6 months. The burst group had an additional outcome measure timepoint at the completion of PT at 6 weeks. Results: Neither group achieved a minimal clinically significant benefit in the TUG score (3.5s) at 6 months. The spaced PT TUG scores were maintained when comparing baseline (7.8 ± 1.5s) and 6 month timepoints (7.8 ± 2.6s, p = 0.594). The burst group TUG scores comparing baseline (9.8 ± 3.8s) to 6 weeks (9.1 ± 3.0s) also was maintained (p = 0.365). The burst group worsened, however, when measuring the period from 6 weeks to 6 months (12.1 ± 7.6s, p = 0.034). Conclusions: The spaced PT group had stability of the TUG mobility measure at 6 months, while the burst group had a significant worsening once PT was discontinued after 6 weeks. It is feasible to test these approaches in a future larger comparative effectiveness study.
AB - Introduction: The optimal timing for physical therapy (PT) delivery in Parkinson's disease (PD) is unknown. Our objective was to determine whether spacing physical therapy visits over a longer period of time is beneficial for maintenance of physical function in PD. Methods: A single center, single-blinded, randomized controlled trial of PD participants. Participants (n = 30) were randomized to either burst (two PT sessions weekly for 6 weeks) or spaced (one PT session every 2 weeks for 6 months) PT. 11 participants in each arm completed the study and were analyzed. The primary outcome measure was the Timed Up and Go (TUG) test at baseline and 6 months. The burst group had an additional outcome measure timepoint at the completion of PT at 6 weeks. Results: Neither group achieved a minimal clinically significant benefit in the TUG score (3.5s) at 6 months. The spaced PT TUG scores were maintained when comparing baseline (7.8 ± 1.5s) and 6 month timepoints (7.8 ± 2.6s, p = 0.594). The burst group TUG scores comparing baseline (9.8 ± 3.8s) to 6 weeks (9.1 ± 3.0s) also was maintained (p = 0.365). The burst group worsened, however, when measuring the period from 6 weeks to 6 months (12.1 ± 7.6s, p = 0.034). Conclusions: The spaced PT group had stability of the TUG mobility measure at 6 months, while the burst group had a significant worsening once PT was discontinued after 6 weeks. It is feasible to test these approaches in a future larger comparative effectiveness study.
KW - Burst physical therapy
KW - Parkinson's disease
KW - Physical therapy
KW - Spaced physical therapy
KW - Timed Up and Go
UR - http://www.scopus.com/inward/record.url?scp=85126687133&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126687133&partnerID=8YFLogxK
U2 - 10.1016/j.parkreldis.2022.02.021
DO - 10.1016/j.parkreldis.2022.02.021
M3 - Article
C2 - 35325665
AN - SCOPUS:85126687133
SN - 1353-8020
VL - 97
SP - 57
EP - 62
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
ER -