Early Parkinson’s rehab linked to longer survival, study finds
Starting Parkinson’s rehabilitation within a year of diagnosis was associated with longer survival in a recent nationwide study.
Delaying rehabilitation was linked to progressively higher mortality risk across all disability levels, including among people without functional impairment, the South Korean study found.
The researchers said the findings “indicate that the survival benefit of timely rehabilitation is not confined to the pre-disability stage; even among individuals with functional impairment, the prompt initiation of rehabilitation therapy remains meaningfully associated with improved long-term outcomes.”
Parkinson’s involves the progressive loss of dopaminergic neurons, nerve cells that produce dopamine, a signalling molecule involved in movement.
This can cause motor symptoms including tremor, slowed movement and problems with balance and walking.
Medicines can ease symptoms but do not stop the disease progressing, making rehabilitation an important part of long-term care. Guidelines recommend starting rehabilitation early, although in practice it is often delayed until people develop walking or balance problems.
Whether starting rehabilitation early can affect long-term outcomes, including survival, remains unclear.
Researchers in South Korea used national health insurance data to examine whether the timing of rehabilitation after a Parkinson’s diagnosis was associated with mortality and whether this differed by disability severity.
The study included 19,153 people with Parkinson’s. Of these, 10,393, or 54.3 per cent, began rehabilitation two years or more after diagnosis, 6,170, or 32.2 per cent, started within a year and 2,590, or 13.5 per cent, began between one and two years after diagnosis.
Those who began rehabilitation within the first year were more likely to be women and had a higher burden of coexisting conditions, including high blood pressure, abnormal levels of fatty molecules in the blood, urinary tract infections and depression, than those who started rehabilitation later.
They were also more likely to smoke and reported lower levels of physical activity.
During follow-up of up to 15 years, 11,339 participants, or 59.2 per cent, died.
After adjusting for factors including age, sex, income and other variables, people who started rehabilitation one to two years after diagnosis had a 28 per cent higher risk of death than those who started within the first year.
Those who waited at least two years had a 44 per cent higher risk.
Further survival analyses also showed significantly better survival among people who started rehabilitation within the first year of diagnosis.
After adjusting for potential confounding factors, people with mild to moderate disability when rehabilitation began had a 21 per cent higher mortality risk than those without functional impairment, while those with severe disability had a 45 per cent higher risk.
The researchers also looked at rehabilitation timing within each disability group.
Among people without disability when rehabilitation started, beginning treatment one to two years after diagnosis was associated with a 25 per cent higher mortality risk compared with starting within the first year.
Waiting at least two years was associated with a 46 per cent higher risk.
A similar pattern was found among people with mild to moderate or severe disability. In all three groups, longer delays in starting rehabilitation were consistently associated with a higher mortality risk.
The researchers noted that rehabilitation is often introduced only after functional decline has developed, describing this as a “reactive rather than proactive approach” to Parkinson’s management.
They said the findings support incorporating rehabilitation referral into routine care when Parkinson’s is diagnosed rather than waiting for gait, balance or other functional problems to develop.
“Systematic efforts to facilitate early rehabilitation referral at the time of PD diagnosis are warranted to improve long-term survival outcomes,” they wrote.
