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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Tori Anne Yetter
Abstract
Introduction: Parkinson’s Disease is a neurodegenerative, movement disorder that affects the nervous system and is associated with motor symptoms of tremor, rigidity and bradykinesia as well as non-motor symptoms including depression, anxiety and fatigue. There is no cure for this disease, so the method of treatment is to slow progression of disease and reduce symptoms. The mainstay of treatment currently is Levodopa, most commonly in combination with Carbidopa known as Sinemet. This drug is associated with improved motor control, but without a cure the medication is needed long term. When used for an extended amount of time, as most patients with Parkinson’s will need, there is decreased efficacy of the drug, leading to more symptoms and increased falls. This problem is an indication for adjunct or new treatment. Therefore, this review analyzes the use of hydrotherapy exercise training (I) for more efficacy in improving balance and improving quality of life (O) in patients diagnosed with mild to moderate Parkinson’s Disease (P), when compared to the standard treatment of Levodopa (C).
Methods: A literature search was completed through PubMed and Clinical Key in November 2018. Six articles were selected based on their study design, sample population and relevance to the research question. The results and relevance were then compared to analyze the material.
Results: Based on the evidence collected from the literature review, there was a statistically significant improvement in both balance and quality of life when receiving either Levodopa or hydrotherapy for patients with Parkinson’s Disease. Unfortunately, due to the lack of direct comparison there was not significant enough evidence to state that hydrotherapy was more efficient than Levodopa for symptom management of the disease. Three studies compared balance measures and quality of life measures of patients on and off Levodopa and the other three studies compared the same measures in patients that participated in hydrotherapy. All of the studies found that in the on phase there is more significant improvement in balance and ability to live with the disease, therefore improving the quality of life. Overall, each of the studies showed that treatment, whether Levodopa or hydrotherapy, elicited improvement in life of patients with Parkinson’s Disease, but each treatment was not significant enough to allow the patient to live symptom free.
Discussion: Significantpositive results for each method of treatment were found within the articles, proving that both Levodopa and hydrotherapy are effective symptom management, but there was a significant limitation due to no data directly comparing the two therapies in order to determine the superior method of management. Most of the studies had similar inclusion criteria in order to establish similar patient populations, but the sample sizes were small decreasing the strength and validity of the study. As a result, theefficacy comparison of Levodopa and hydrotherapy cannot be determineddespite positive findings. Further study of the topic shouldbe completed.
Conclusion: Both Levodopa and hydrotherapy are effective methods of symptom management for patients with mild to moderate Parkinson’s Disease. Physicians and providers should not choose hydrotherapy as the primary method of symptom management as a result of this research, but hydrotherapy should be used more frequently as adjunct therapy until further research is done. Future study is necessary to further research this topic in order to compare pharmacologic and physiologic symptom management of Parkinson’s Disease.
Recommended Citation
Tomko, Grace, "Efficacy of Hydrotherapy Exercise Training Compared to Levodopa in Improving Balance and Improving Quality of Life in Patients with Mild to Moderate Parkinson’s Disease" (2020). Capstone Showcase. 30.
https://scholarworks.arcadia.edu/showcase/2020/pa/30
Additional Files
Grace Tomko Poster .pdf (14293 kB)Grace Tomko Additional Poster References.docx (13 kB)
Efficacy of Hydrotherapy Exercise Training Compared to Levodopa in Improving Balance and Improving Quality of Life in Patients with Mild to Moderate Parkinson’s Disease
Introduction: Parkinson’s Disease is a neurodegenerative, movement disorder that affects the nervous system and is associated with motor symptoms of tremor, rigidity and bradykinesia as well as non-motor symptoms including depression, anxiety and fatigue. There is no cure for this disease, so the method of treatment is to slow progression of disease and reduce symptoms. The mainstay of treatment currently is Levodopa, most commonly in combination with Carbidopa known as Sinemet. This drug is associated with improved motor control, but without a cure the medication is needed long term. When used for an extended amount of time, as most patients with Parkinson’s will need, there is decreased efficacy of the drug, leading to more symptoms and increased falls. This problem is an indication for adjunct or new treatment. Therefore, this review analyzes the use of hydrotherapy exercise training (I) for more efficacy in improving balance and improving quality of life (O) in patients diagnosed with mild to moderate Parkinson’s Disease (P), when compared to the standard treatment of Levodopa (C).
Methods: A literature search was completed through PubMed and Clinical Key in November 2018. Six articles were selected based on their study design, sample population and relevance to the research question. The results and relevance were then compared to analyze the material.
Results: Based on the evidence collected from the literature review, there was a statistically significant improvement in both balance and quality of life when receiving either Levodopa or hydrotherapy for patients with Parkinson’s Disease. Unfortunately, due to the lack of direct comparison there was not significant enough evidence to state that hydrotherapy was more efficient than Levodopa for symptom management of the disease. Three studies compared balance measures and quality of life measures of patients on and off Levodopa and the other three studies compared the same measures in patients that participated in hydrotherapy. All of the studies found that in the on phase there is more significant improvement in balance and ability to live with the disease, therefore improving the quality of life. Overall, each of the studies showed that treatment, whether Levodopa or hydrotherapy, elicited improvement in life of patients with Parkinson’s Disease, but each treatment was not significant enough to allow the patient to live symptom free.
Discussion: Significantpositive results for each method of treatment were found within the articles, proving that both Levodopa and hydrotherapy are effective symptom management, but there was a significant limitation due to no data directly comparing the two therapies in order to determine the superior method of management. Most of the studies had similar inclusion criteria in order to establish similar patient populations, but the sample sizes were small decreasing the strength and validity of the study. As a result, theefficacy comparison of Levodopa and hydrotherapy cannot be determineddespite positive findings. Further study of the topic shouldbe completed.
Conclusion: Both Levodopa and hydrotherapy are effective methods of symptom management for patients with mild to moderate Parkinson’s Disease. Physicians and providers should not choose hydrotherapy as the primary method of symptom management as a result of this research, but hydrotherapy should be used more frequently as adjunct therapy until further research is done. Future study is necessary to further research this topic in order to compare pharmacologic and physiologic symptom management of Parkinson’s Disease.