J Neurol (2004) 251 : 680–687 DOI 10.1007/s00415-004-0402-7 ORIGINAL COMMUNICATION Samyra H. J. Keus Bastiaan R. Bloem Dagmar Verbaan Pieter A. de Jonge Marnix Hofman Bob J. van Hilten Marten Munneke Physiotherapy in Parkinson’s disease: utilisation and patient satisfaction JON 1402 Introduction Despite advances in the pharmacotherapeutic and neu- rosurgical management, the majority of patients with Parkinson’s disease (PD) become progressively dis- abled. Dopaminergic medication is effective in decreas- ing bradykinesia and rigidity, but has far less influence on gait impairment, postural instability and falls [5, 11, 19]. Moreover, long-term use of dopaminergic medica- tion may paradoxically cause adverse events, e. g. dyskinesias, freezing related to motor fluctuations, and orthostatic hypotension [9]. Consequently, the tendency to fall might aggravate and quality of life might be threatened [34]. Neurosurgical interventions are promising,but patients with marked dopa-resistant mo- bility deficits appear to be unsuitable candidates for surgery [1, 29]. Patients can also be referred to a physiotherapist.The purpose of physiotherapy is to improve or maintain the Received: 11 September 2003 Received in revised form: 11 December 2003 Accepted: 19 January 2004 S. H. J. Keus · D.Verbaan · P. A. de Jonge · M. Hofman · M. Munneke Dept. of Physical & Occupational Therapy Leiden University Medical Center Leiden, The Netherlands B. J. van Hilten Dept. of Neurology Leiden University Medical Center Leiden, The Netherlands B. R. Bloem, M. D., Ph. D. () · M. Munneke University Medical Centre St Radboud Dept. of Neurology (326) P. O. Box 9101 6500 HB Nijmegen, The Netherlands Tel.: +31-24/361-5202 Fax: +31-24/354-1122 E-Mail: b.bloem@neuro.umcn.nl ■ Abstract To examine the quality and quantity of physiotherapy care in Parkinson’s disease (PD) in the Netherlands, postal questionnaires were sent to 300 PD patients. Pa- tients who had received treatment by a physiotherapist at some stage during the previous year were asked to give approval to contact their therapist. Subsequently, postal questionnaires were sent to 129 physiotherapists who had recently treated the patients that were iden- tified in the first stage of the study. Completed questionnaires were re- turned by 235 patients and 99 ther- apists. Sixty percent of patients were currently treated by a physio- therapist, most of them for more than six months. Ninety-five pa- tients had serious problems within at least one of the four core areas of physiotherapy practice in PD (pos- ture, balance, gait, transfers) and were therefore regarded as requir- ing referral to physiotherapy.Yet, 41% of them received no treatment at the time of enquiry. On the other hand, 75 patients had no serious problems within these core areas, yet half of them currently received treatment. The main goals for treatment were improvement of gait, general physical condition, posture or balance. Treatment mainly comprised active exercises. 60% of patients were treated by therapists without specific interest or education in PD. Most patients were presently satisfied with the treatment, but 11 % had previously changed to another therapist be- cause of dissatisfaction. In the Netherlands, referral rates of PD patients to physiotherapy are high and treatment duration is lengthy. Referral seems, to some extent, ar- bitrary. Scientific evidence for the effectiveness of physiotherapy in PD remains limited. ■ Key words Parkinson’s disease · questionnaires · referral · physical therapy · activities of daily living