Effectiveness of an intensive rehabilitation treatment on different Parkinson's disease subtypes

Abstract

Parkinsonian patients can be classified in two main subgroups: tremor dominant and akinetic-rigid. The aim of this study was to evaluate whether intensive rehabilitation treatment has the same efficacy in the two subtypes. Patients were classified according to tremor: 65 patients with absence of tremor in "on" and "off" state were assigned to Group_1 and 65 patients with tremor were assigned to Group_2. All patients underwent a 4-week intensive multidisciplinary rehabilitation treatment. The primary outcome measures were: the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, UPDRS akinetic-rigid score and UPDRS tremor score. The secondary outcome measures were: the Berg Balance Scale, 6-minute walking test, self-assessment Parkinson's Disease Disability Scale, Abnormal Involuntary Movement Scale, Freezing of Gait Questionnaire. Patients in Group_1 tended to be more affected than patients in Group_2 by dyskinesias (45% vs 29% p = 0.069) and freezing (46% vs 29%, p = 0.046). Levodopa-equivalent dosages were higher in Group_1 (802 vs 670 mg/day, p = 0.008). Considering the effect of rehabilitation, an homogeneous improvement was observed in all variables in both groups of patients (p < 0.0001). Intensive rehabilitation treatment is effective in improving motor performance in both groups. The anatomical and biochemical differences existing between the two subgroups appear to not determine different clinical outcomes.