A randomized clinical trial of burst vs. spaced physical therapy for Parkinsons disease

Ka Loong Kelvin Au, Janine Lemos Melo Lobo Jofili Lopes, Alison Kraus, Kimberly Patton, Lisa Warren, Hanzhi Gao, Joshua K. Wong, Kathryn Moore, Jon B. Toledo, Tamara Stiep, Jessica Frey, Tracy Tholanikunnel, Christopher Hess, Leonardo Almeida, Adolfo Ramirez-Zamora, Michael S. Okun

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Introduction: The optimal timing for physical therapy (PT) delivery in Parkinson's disease (PD) is unknown. Our objective was to determine whether spacing physical therapy visits over a longer period of time is beneficial for maintenance of physical function in PD. Methods: A single center, single-blinded, randomized controlled trial of PD participants. Participants (n = 30) were randomized to either burst (two PT sessions weekly for 6 weeks) or spaced (one PT session every 2 weeks for 6 months) PT. 11 participants in each arm completed the study and were analyzed. The primary outcome measure was the Timed Up and Go (TUG) test at baseline and 6 months. The burst group had an additional outcome measure timepoint at the completion of PT at 6 weeks. Results: Neither group achieved a minimal clinically significant benefit in the TUG score (3.5s) at 6 months. The spaced PT TUG scores were maintained when comparing baseline (7.8 ± 1.5s) and 6 month timepoints (7.8 ± 2.6s, p = 0.594). The burst group TUG scores comparing baseline (9.8 ± 3.8s) to 6 weeks (9.1 ± 3.0s) also was maintained (p = 0.365). The burst group worsened, however, when measuring the period from 6 weeks to 6 months (12.1 ± 7.6s, p = 0.034). Conclusions: The spaced PT group had stability of the TUG mobility measure at 6 months, while the burst group had a significant worsening once PT was discontinued after 6 weeks. It is feasible to test these approaches in a future larger comparative effectiveness study.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalParkinsonism and Related Disorders
StatePublished - Apr 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Ltd


  • Burst physical therapy
  • Parkinson's disease
  • Physical therapy
  • Spaced physical therapy
  • Timed Up and Go


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