Clinical relevance of rehabilitation programs for Parkinson's disease. I: Non-symptom-specific therapeutic approaches.

The idiopathic Parkinson syndrome (IPS) affects multiple structures of the central nervous system and exhibits a broad variety of clinical symptoms that are only partially treatable by pharmacological treatment. Therefore, non-pharmacological approaches are highly warranted. The aim of this study was to identify, categorize and rate studies on rehabilitative therapeutic approaches for IPS regarding not only study design and statistics, but also clinical relevance. For reasons of homogeneity, only studies applying a rehabilitative program targeting three or more symptoms were included and studies treating isolated symptoms were excluded. Study design and statistics were rated by using an established rating system. To evaluate clinical relevance a rating system was developed considering effectiveness, everyday life relevance, long-term effect, therapy frequency and setting, duration of the therapy units, effects on quality of life, and assessment. Applying this rating system to 17 studies, we found four studies with a Level I of statistical quality and four studies with high clinically relevant information. This novel method of analysing may help to gain valuable data from studies that may lack strong methodology, and may help to promote further research.