Objective: To assess current practices for timing of physical therapy (PT) in Parkinson’s disease (PD).

Background: Most persons with Parkinson disease (PD) face increasing mobility deficits which profoundly impact quality of life and healthcare utilization. Physical therapy (PT) is commonly used in conjunction with pharmacotherapy to mitigate the symptoms of PD. Typically, PT for neurological disorders is prescribed as a ‘burst’ of short-term, closely spaced visits over 6-12 weeks. Recent research suggests patients with PD may maintain better mobility when receiving ‘spaced’ PT sessions over 6 months or longer compared to the same number of visits delivered in the traditional ‘burst’ schedule [1]; however, current practices for timing of PT in patients with PD remain unknown.

Method: We conducted two online surveys of a network of experienced PD clinical trial sites in the United States and Canada from November 2022 to January 2023. We defined burst PT as sessions spread over 6-12 weeks and spaced PT as sessions spread over 6 months or longer.

Results: A total of 71 (45.2%) sites completed the first survey. Sixty-five (91.5%) sites had patients completing burst PT and 37 (52.1%) had patients completing spaced PT. When asked about accepted clinical practices for treating patients with PD, 67 (94.4%) sites indicated burst PT was accepted and 62 (87.3%) indicated spaced PT was accepted. Two sessions per week was the most common timing of PT in 36 (50.7%) sites, followed by one session per week among 19 (26.8%) sites. A total of 84 (53.5%) sites completed the second survey. A total of 22 (26.2%) sites endorsed that their providers usually specified a time period for PT to start and stop when writing a prescription, 48 (57.1%) sites indicated their providers typically waited for the physical therapist to request to continue sessions after the first 12 sessions are completed, and 17 (20.2%) sites indicated it is typically their provider’s intention that PT is continued for 12 months.

Conclusion: While most patients with PD receive burst PT, spaced PT is another widely-used approach and accepted in clinical practice. In addition to the potential benefits for maintaining mobility, a spaced regimen may also present a less burdensome approach to PT for patients and caregivers. Future research should investigate the impact of spaced vs. burst PT on outcomes such as mobility, quality of life, and caregiver strain.

References: 1. Au KLK, Lopes JLMLJ, Kraus A, et al. A randomized clinical trial of burst vs. spaced physical therapy for Parkinsons disease. Parkinsonism Relat Disord. 2022;97:57-62. doi:10.1016/j.parkreldis.2022.02.021

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MDS Abstracts - https://www.mdsabstracts.org/abstract/current-practices-for-timing-of-physical-therapy-in-parkinsons-disease-burst-vs-spaced/