Doctoral defence: Kadri Medijainen “Effects of disease-specific physiotherapy on functional performance in patients with mild-to-moderate Parkinson’s disease“

On October 5 at 14.00 Kadri Medijainen will defend her doctoral thesis “Effects of disease-specific physiotherapy on functional performance in patients with mild-to-moderate Parkinson’s disease“.

Supervisors:
Professor Pille Taba, University of Tartu
Professor emerita Mati Pääsuke, University of Tartu
Lecturer Aet Lukmann, University of Tartu

Oponent:
Senior Associate Professor John Brincks, VIA University College (Denmark)

Summary:
Physiotherapy is used as a supporting treatment alongside dopaminergic drugs to control symptoms of patients with Parkinson’s disease (PD). The role of a physiotherapist in treatment of patients with PD is to increase the physical activity, handling the motor symptoms and to prevent the secondary symptoms through use of various physiotherapeutic interventions. The positive effect of several types of exercise has been confirmed. However, several interventions that have proved effective in studies are not feasible in everyday clinical environment, mainly due to time and other constraints. Besides, there is an explicit conflict between the single-domain intervention and the patient-specific physiotherapy principle that is growing in prominence. Studies that investigate and confirm the effects of physiotherapy intervention, simultaneously providing the recommendations of physiotherapy guidelines are lacking.

In this doctoral study, the effects of a physiotherapeutic intervention combining core areas of physiotherapy guidelines on walking (including the presence of freezing episodes) and self-reported limitations to activities of daily living were studied. In addition to that, the effect of instructions from the physiotherapist on the walking speed of patients with PD was analysed.

As the main outcomes, it can be noted that an 8-week PD-specific group physiotherapy intervention can increase the speed of gait initiation, improve proximal joint mobility, reduce the level of self-reported freezing episodes and limitations to activities of daily living. The results also emphasize the importance of thorough evaluation of gait in patients with PD. As the gait speed is strongly dependent on the instructions given, physiotherapists need to use uniform instructions. In gait assessments, the patient’s gender needs to be considered, especially if the gait speed is not controlled for height. Male PD patients not only walk faster due to having a longer stride, but they are also able to increase the speed of walking more when instructed.

The study adds to knowledge of the essence of PD-specific physiotherapy and has a practical value to physiotherapists to improve the life of patients with PD. In conclusion, the study emphasizes the efficiency of the disease-specific physiotherapy, highlights the important aspects of physiotherapeutic gait assessment of patients with PD, and anticipates that referral rates to physiotherapy for Estonian patients diagnosed with PD would increase.