Physical Therapy Underused in Parkinson’sJune 27, 2016
Patients with Parkinson's disease aren't taking advantage of the physical, occupational, and speech therapy available to them, researchers reported here.
Only about 11% of Parkinson's patients on Medicare had claims for physical or occupational therapy and only about 12% had claims for speech therapy, Michelle Fullard, MD, of the University of Pennsylvania, and colleagues reported at the Movement Disorders Society meeting
"This is very positive support for something that many feel is a problem, that allied healthcare is highly underutilized," Peter Schmidt, PhD, of the National Parkinson Foundation, who wasn't involved in the study, told MedPage Today.
Multiple studies have demonstrated the efficacy of physical, occupational, and speech therapy -- collectively known as allied healthcare -- in Parkinson's disease. Physical therapy, for instance, has been shown in randomized controlled trials to improve motor function and independence and reduce falls in this population, the researchers said.
But no study has yet examined allied healthcare utilization among Parkinson's patients in the U.S. So Fullard and colleagues conducted a cross-sectional study using Medicare claims data from 2007 to 2009, totaling 742,846 Medicare beneficiaries with Parkinson's.
The researchers found that there were several factors that were associated with use of allied healthcare. Race was one such factor, with Asian Americans having the highest likelihood of use (adjusted odds ratio 1.52 for physical/occupational therapy, 1.45 for speech therapy, compared with white patients) while African Americans had the lowest (aOR 0.67 for physical/occupational therapy, 0.67 for speech therapy).
Parkinson's patients who were under the care of a neurologist care had increased utilization of allied healthcare. Those who had at least one neurologist visit per year had a higher likelihood of receiving an evaluation for physical/occupational therapy (aOR 1.31) and speech therapy (aOR 1.52) compared with those who hadn't seen a neurologist.
Fullard and colleagues also found lower rates of allied healthcare use were more common in states with reduced availability of allied healthcare providers. The researchers called for further research in order to identify the barriers to these therapies for Parkinson's patients.
Schmidt noted that one such barrier is a therapy cap that limits patients to about a month's worth of occupational therapy, and a similar month's worth of combined physical and speech therapy.
"In order to get patients beyond a month of physical, occupational, or speech therapy, you have to ask for an exception, and the physician has to fill out paperwork, which creates an administrative burden," he said.
Schmidt added that there are sufficient data to show that physical therapy in the long run benefits patients with Parkinson's – even if that just means a slower degradation of their condition.
"Occupational and physical therapy can help patients with being able to exercise, and we know that's one of the most effective ways to reverse the course of Parkinson's," he said. "We've also shown that the earlier you get it, particularly with physical therapy, the more effective it is later in the disease."