Forty-four studies (n=1,974) reported in 51 papers were included in the review. Of these, 18 had a randomised controlled trial (RCT) design, 16 were controlled trials and 10 were observational studies.
All 25 physiotherapy studies reported at least one statistically significant positive outcome. Of the 4 RCTs that provided follow-up data, only two showed lasting improvements after 6 weeks of follow-up (motor score improved after physiotherapy with cueing compared with no cueing; self-assessed disability and attitude to self improved with Alexander Technique compared with massage or no intervention).
Two of the 4 identified occupational therapy studies showed positive effects of the treatment. Of the 2 RCTs with positive effects, one showed maintained improvement after 6 or 12 months for akathesia, functional status and bradykinesia.
All 10 identified speech and language intervention studies showed at least one positive outcome after treatment. Both of the 2 RCTs with follow-up showed maintained improvement 3 months after treatment (prosadic improvement for speech and language therapy, intelligibility improved after therapy plus visual reinforcement; dysarthria improvement after treatment for dysarthria).
All 5 identified psychological, educational and multidisciplinary intervention studies showed improvements for several assessed outcomes. One of the 2 identified RCTs with follow-up assessment showed maintained improvement (improved general health and psychological well-being after tailored patient education on exercise, diet and side-effects compared with no intervention). Another study evaluating a multidisciplinary approach with physical, occupational and speech therapy, specialist nurse, social and group support, and education showed that treated patients and carers had statistically significant worse general and mental health 6 months after the intervention than untreated controls.