Objective: To determine the safety, feasibility, and preliminary efficacy of physical therapy (PT) for people with Parkinson disease (PD) who have deep brain stimulation (DBS).

Background: DBS in people with PD provides inconsistent benefit for postural instability and gait difficulty. PT may be a useful intervention for improving postural stability and gait in people with DBS. However, the safety, feasibility, and preliminary efficacy of PT for people with PD with DBS remains unknown. We hypothesized that PT would be safe, feasible, and effective in improving postural stability and gait in this population.

Method: Twenty-nine participants (mean age: 64.9 ± 6.9; 72% male; mean MDS-UPDRS III: 33.2 ± 11.4) with PD and at least one year after subthalamic nucleus (STN) DBS were randomly assigned to either PT or no intervention. Those receiving PT (n=15) attended one-hour sessions twice weekly for eight weeks. The PT included exercises focused on improving postural stability and gait. Those assigned to no intervention (n=14) went about their daily lives as usual. Safety was measured by collecting information related to adverse events during the intervention sessions. Feasibility was measured as the percentage of sessions attended out of the total possible number of sessions. Efficacy measures were collected at pre- and post-intervention. Postural stability was measured using the Balance Evaluation Systems Test (BESTest). Gait velocity was measured using the GAITRite instrumented mat. Repeated measures ANOVAs with group and time as factors were utilized to determine the presence of main effects of group and time and group x time interactions (α=.05). Age was included as a covariate in the model because it differed between groups at baseline.

Results: Physical therapy was safe as there were no serious adverse events during the intervention sessions. Physical therapy was feasible as participants attended on average 93% of sessions (range: 81-100%). After controlling for age, there were group x time interactions for postural stability (F=5.86; p=.023) and gait (F=4.64; p=.041) with the PT group demonstrating improvement while the control group did not change.

Conclusion: Physical therapy is safe, feasible, and may be effective for improving postural stability and gait among people living with PD and STN-DBS. Our results suggest further study of the efficacy of physical therapy for this population is warranted.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/physical-therapy-and-deep-brain-stimulation-in-parkinson-disease-a-pilot-randomized-controlled-trial/