What non-pharmacological interventions are effective in managing symptoms of parkinsonism in primary care?

Effective non-pharmacological interventions for managing symptoms of parkinsonism in primary care include:

• Parkinson's disease nurse specialist support: Regular access to clinical monitoring, medicine adjustment, ongoing support, and reliable information for patients and carers is recommended to manage symptoms effectively.
• Physiotherapy and physical activity: Referral to a physiotherapist experienced in Parkinson's disease for assessment, education, advice, and Parkinson's disease-specific physiotherapy is advised, especially for those with balance or motor function problems.
• Occupational therapy: Early referral to an occupational therapist with Parkinson's expertise for assessment, education, and advice on motor and non-motor symptoms is beneficial. Parkinson's disease-specific occupational therapy should be offered to those having difficulties with activities of daily living.
• Speech and language therapy: Referral for assessment and advice is recommended early in the disease. Speech and language therapy should be offered to those with communication, swallowing, or saliva control problems, including strategies like expiratory muscle strength training and attention to effort therapies.
• Nutrition advice: Referral to a dietitian for specialist advice is suggested, including discussion of protein redistribution diets for those on levodopa experiencing motor fluctuations and advice to avoid reducing total daily protein intake. Vitamin D supplementation is also advised.
• Alexander Technique: Consideration of the Alexander Technique may help people experiencing balance or motor function problems.

These interventions aim to improve motor and non-motor symptoms, enhance quality of life, and support daily functioning in people with Parkinson's disease managed in primary care settings ¹.