Physiotherapy reimbursement
Document for submission to the health insurance company

A contribution by Andreas Becker


Complaints keep coming because the cash registers cost of the PT do not want to take over in Parkinson's disease. I have created a document over the months that some of the patients have had success with.

The document can be downloaded and is freely available.

Just let us know if you have any additions.

Indication for carrying out physiotherapy
Patients with Parkinson's syndromes

For submission to the health insurance company

Erika Musterfrau, born on January 01.01.1965st, 2020, has been in my treatment since XNUMX.
Musterfrau has been suffering from idiopathic Parkinson's syndrome at Hoehn & Yahr for 10 years
stage 3
Parkinson's disease is the second most common disease after Alzheimer's dementia the second most common progressive
neurodegenerative disease affecting older adults. The prevalence will be in the next
years to increase significantly. As a result of pathophysiological loss or degeneration of
dopaminergic neurons in the substantia nigra of the midbrain and neuronal development
Lewy bodies is the idiopathic Parkinson's disease associated with risk factors such as aging,
Family history, pesticide exposure, and environmental chemicals associated. The Ultimate Cause
of neurodegeneration is still unknown.
Characterized by motor and non-motor symptoms, Parkinson's patients show
classically resting tremor, stiffness, bradykinesia and balance disorders. The
Parkinson's disease can also be caused by neurobehavioural disorders such as depression or anxiety,
cognitive impairment and autonomic dysfunction. In the last decades
have evolved medical-pharmacological therapies and innovative surgical interventions like that
Deep brain stimulation (THS) widely spread. A definitive disease modifying Therapy stands
however off. Knowledge of strategies to promote optimal patient quality of life
with Parkinson's disease is of utmost importance to caregivers, healthcare providers and patients themselves
To improve the quality of life, in addition to medical, socio-medical, nursing,
pharmacological and surgical intervention, the therapeutic treatments are decisive.
There has been sufficient evidence for this for more than a decade and in the current literature.
An analysis was carried out in the Evidence-Based Medicine Committee of the Movement Disorder Society (MDS).
of 143 motor symptom intervention studies. Here it became clear
noted that in addition to medication, the continuation of physiotherapy as clinically useful
Is evaluated. It was also explicitly mentioned that there were no conclusions in the examined
Studies exist that show prevention or delay in motor complications
let. (Fox, et al., 2018)
In the European Physiotherapy Guideline for Parkinson's Disease: Implications for Neurologists is to
read that physical therapy has a positive impact on functional activities such as gait,
has transfer and balance. This paper provides very practical guidance for clinicians who
working with Parkinson's patients and providing physiotherapy treatments for their patients
prescribe. (Domingos, et al., 2018)
In a 2020 meta-analysis, the effectiveness became more conventional and newer
of physiotherapeutic interventions for Parkinson's patients. This meta-analysis provides
a comprehensive overview of the evidence for the effectiveness of various
physiotherapeutic interventions in the treatment of Parkinson's disease, allowing clinicians and
Patients make an evidence-based decision for specific treatment modalities
In this meta-analysis, 191 studies with 7998 participants were analyzed. Here were
conventional physiotherapy, resistance training, treadmill training, strategy training, dance,
Martial arts, aerobic exercise, hydrotherapy, balance and gait training, dual tasking,
Exergaming and Nordic Walking examined. For the systematic evaluation of the methodical
Quality, the GRADE approach (Grading of Recommendations, Assessment, Development and
evaluation) used.
Conventional physiotherapy significantly improved motor symptoms and gait
and the quality of life. Strength training improved gait. Treadmill training improves gait.
Strategy training improved balance and gait. Dancing, Nordic walking, balance and
Gait training as well as martial arts improved motor symptoms, balance and
gait pattern. Exergaming improved balance and quality of life. hydrotherapy
improves balance. Finally, dual-task training didn't improve any of them
examined results significantly. (Radder, et al., 2020)
All of these treatment interventions are known to have only temporary positive effects. On
Based on these findings, patients with Parkinson's are encouraged to exercise
continue to improve or maintain their physical abilities. (Mak & Wong-Yu,
Effects of exercise training on balance and walking ability and falls
Comparison to no intervention and placebo intervention were compared in this meta-analysis.
The results showed positive effects of training interventions on the improvement of
balance and gait performance and reducing the rate of falls in people with
Parkinson's disease. (Shen, Wong, & Mak, 2016)
In a systematic review to assess the physical therapy evidence in the
Intervention of patients with freezing of Gait (FOG), 20 randomized trials were analyzed.
Visual and auditory cues and treadmill training are effective interventions for FOG and
Gait disorders in Parkinson's patients (evidence level A - according to the European Federation of
Neurological Societies). (Rutz & Benninger, 2020)
There are also systematic studies on quality of life, performance and falls
outpatients in Hoehn&Yahr stages I-IV with complementary therapies. So are dancing
Water exercises and robotic gait training for some patients with Parkinson’s
effective complement to medical treatment. (Alves Da Rocha, McClelland, & Morris, 2015)
Cognitive and gait disorders are two debilitating symptoms present in Parkinson's disease
(PD) occur. Importantly, in Parkinson's there is a relationship between cognitive and gait deficits
persists, suggesting that dependence on cognition is increased in order to increase gait deficits
compensate, and/or a deterioration in cognition and gait together
mechanisms might have. Rehabilitation strategies that target one factor could
Leading the improvement of the other and offering a unique opportunity to both at the same time
treat. Gold standard medicines alleviate these deficits in some cases with considerable amounts
Side effects, reflecting the importance of investigating adjunctive therapies such as exercise
intervention quality of
strength of
Aerobic Exercise High ⧫⧫⧫⧫ Physical therapists should use moderate to high intensity
perform aerobic exercise to improve VO2,
reduce the severity of motor disease and
the functional outcomes in individuals with
improve Parkinson's disease
Resistance Training High ⧫⧫⧫⧫ Physiotherapists should do resistance training,
to reduce the severity of motor disease
and strength, power, non-motor symptoms, functional
Outcomes and quality of life in people with
improve Parkinson's disease.
Balance Training ⧫⧫⧫⧫ Physiotherapists should develop intervention programs for the
Implement balance training to
Reduce impairments in postural control
and the balance and gait results, mobility,
balance and quality of life
improve individuals with Parkinson's disease
Stretching Exercise Low ⧫⧫◊◊ Physiotherapists can perform stretching exercises
to measure the ROM (Range of Motion) in individuals with
improve Parkinson's disease
External Cueing High ⧫⧫⧫⧫ Physiotherapists should implement external cueing,
about the severity of the motor disease and that
Reduce gait freezing and gait results
improve in people with Parkinson's disease
Group Training High ⧫⧫⧫⧫ Physical therapists should use community-based exercise
recommend to increase the severity of motor disease
decrease and non-motor symptoms, functional
Outcomes and quality of life in people with
improve Parkinson's disease
Gait Training High ⧫⧫⧫⧫ Physiotherapists should conduct gait training to increase the
Reduce severity of motor disease and
Stride length, gait speed, mobility and
balance in individuals with Parkinson's disease
task specific
High ⧫⧫⧫⧫ Physical therapists should have task-specific training
implement to task specific
Impairment grades and functional outcomes for
improve individuals with Parkinson's disease
behavior modifying
High ⧫⧫⧫◊ Physiotherapists should consider approaches to behavior change
implement to physical activity and
Quality of life in people with Parkinson's disease
Integrated Care High ⧫⧫⧫⧫ Physiotherapy services should be within
of an integrated care approach
reduce the severity of motor disease and
the quality of life of people with Parkinson's disease
Telerehabilitation Moderate ⧫⧫◊◊ Physiotherapy services can be via
Telerehabilitation can be provided to help balance
improve individuals with Parkinson's disease
Table 1 Presenting evidence from Physical Therapist Management of Parkinson's Disease: A Clinical Practice
Guideline From the American Physical Therapy Association
Mrs. Mustermann has been suffering from idiopathic Parkinson's syndrome for 10 years. It doesn't exist
only currently, but also in the future an urgent medical indication for the implementation of
Physiotherapy, in the case of swallowing disorders also speech therapy, in order to participate in mobility,
Self-sufficiency, social life, communication and the activities of daily living
and thus to ensure the quality of life. Secondary medical expenses such as increasing need for
Drugs with their side effects, the danger of polypharmacy and avoidance of them
Falls and their consequences can be reduced in this way.
Model city, January 01.01.2023st, XNUMX
dr medical John Doe
Chief Physician of the Department of Neurology
forest clinic

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