Introduction

Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 44 in 2025, we had International Course in Spain, A Coruna, in the Faculty of Physiotherapy at University of Coruña about EBP. The program was opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields. More than 30 physiotherapy students and 9 teachers from six universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Czech Republic, CERRFF and École D´Assas, France, and Escola de Santa María de O Porto, Portugal), actively participated this week and shared experiential group dynamics and social activities. The students collaborated and wrote articles on a range of topics, including evidence-based neurology, respiratory and musculoskeletal disorders, geriatric and pediatric care, as well as sports injuries and related issues. This article introduces the neurological group’s work.

Background

Lee Silverman Voice Treatment (LSVT) BIG is a novel and emerging therapeutic technique in Parkinson’s disease treatment. It involves a series of progressive, high-effort, high-amplitude, exaggerated and functionally incorporated movement patterns that are performed either in repetitions or held. This includes held seated reaching patterns, repetitive step and reach patterns, functional patterns (such as sit-to-standing), and “BIG” walking. The specific aim of LSVT BIG is in amplifying otherwise bradykinetic and hypokinetic movement stereotypes that are characteristic of Parkinson’s disease.

Significant evidence exists and continues to emerge about LSVT BIG’s effectiveness in terms of strictly motor outcomes in Parkinson’s disease; less of such on the topic of its effect on quality of life-related outcomes. Such is an important aspect of Parkinson’s disease for understanding and treating the pathology, as demonstrated by a national survey by the American Academy of Neurology in 2020, finding 25.9 percent of surveyees with Parkinson’s reporting a quality of life score (according to McGill Quality of Life Subscore) of five or less on a scale out of ten (Rodriguez-Blazquez et al., 2020). Considering the psychosomatic implications of Parkinson’s, such as pain, psychological health, fatigue, and said factors’ bearing on quality of life outcomes, this mini review seeks to explore LSVT BIG’s effectiveness beyond motor outcomes and into that of quality of life.

Methods

To search for articles, we first defined a PICO question. The eligibility criteria were as follows: Population; patients with Parkinson’s disease. Intervention; LSVT-BIG treatment program. Control; standard physical therapy or usual care. Outcome; quality of life. Study type; randomized controlled trials (RCTs). Based on this question, the following keywords were determined: “LSVT BIG”, “Quality of Life” (QoL), “Parkinson’s disease” and “Physical Therapy”. Each reviewer searched using these terms in the electronic databases PubMed, PEDro, and SpringerLink.

Results

In total, five articles were identified. Three of them were already included in a previous systematic review focusing on physical exercise for people with Parkinson’s disease. Two articles were more recent and therefore considered more relevant for our review. Furthermore, one article from the previous review was also selected, as it was highly relevant to our research question. Each reviewer extracted data from one article and assessed its quality using the PEDro scale. The three articles included in our review are summarized below.

The study by Schaible et al. (2021) investigated the effects of different physiotherapy interventions on quality of life in 44 patients with Parkinson’s disease. Participants were randomized into three groups: LSVT-BIG (n=14), intensive personalized physiotherapy (n=15), and conventional physiotherapy (n=12). The LSVT BIG and intensive groups attended one-hour sessions four times per week over four weeks, whereas the conventional group attended the same number of sessions but spread over eight weeks with two sessions per week. At post-intervention, all groups showed improvements in quality of life as measured by the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39); however, no significant differences between the groups were found. The study was rated 7 out of 10 on the PEDro scale, with limitations including lack of patient and therapist blinding and allocation concealment.

The study by Aytutuldu et al. (2024) compared the effects of LSVT BIG and the more conventional Progressive Structured Mobility Training (PSMT) program. 32 participants with Parkinson’s disease were randomly assigned to either group. Both groups participated in four 60-minute sessions per week over a four-week period. QoL and functional mobility outcomes were evaluated using the Activity-Specific Balance Confidence Scale–Short Form (ABC-SF), Parkinson’s Activity Scale (PAS), and PDQ-39. The study found the LSVT BIG group to have shown significant improvements in balance confidence and functional activity performance compared to the PSMT group. However, no significant difference was observed between groups for overall QoL. The study was rated PEDro score of 7/10, with its main limitations being a lack of blinding of therapists and assessors, unspecified means of patient blinding, and the absence of results over the course of treatment administration.

The study by YoungSeok and DeokJu (2022) investigated the effects of LSVT BIG intervention on hand function, activities of daily living, psychological function and quality of life in patients with Parkinson’s disease. The study was completed with 14 patients, randomly allocated to an intervention (n=7) and a control (n=7) group. The intervention group received 40 minutes of task-based LSVT BIG program plus 30 minutes of conventional occupational therapy, while the control group received 30 minutes of conventional occupational treatment plus 40 minutes of relaxation training and stretching. Both programs were conducted five times per week for four weeks. After this intervention, the quality of life was assessed using the PDQ-39 questionnaire. The intervention group showed significant improvement across all QoL domains, whereas the control group did not reach statistical significance in the social function domain. The study scored 6 points on the PEDro scale, with the main limitations being a lack of blinding among subjects, therapists, and assessors.

Conclusion

One study found no significant differences in the PDQ-39 quality of life measure and was limited by the lack of blinding. Another study reported improvements in balance confidence and functional ambulation but no changes in PDQ-39, and it lacked long-term follow-up. A third study observed social improvements among participants but was constrained by a small sample size and a short intervention period.

Ultimately, we conclude that the effect of LSVT BIG treatment on quality of life outcomes in individuals with Parkinson’s disease is not significant. Though, considering the limitations of the research, further studies with improved methodological quality, including more thorough blinding procedures, larger sample sizes, extended intervention periods and long-term follow-ups, are recommended to clarify these findings.

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Authors:

Aapo Kuokkanen, physiotherapy student, Savonia, University of Applied Sciences, Kuopio, Finland

Eliška Coufalová, physiotherapy student, Charles University, Czech Republic

Vincent Leone-Ganado, physiotherapy student, Charles University, Czech Republic

Dagmar Pavlu, PT. Assoc. Prof. Charles University, Czech Republic.

Ivana Vláčilová, PhD., PT. Charles University, Czech Republic.

Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland.

Veronica Robles García, PhD. PT. OT. Associate Professor, University of A Coruña, A Coruña, Spain.

Zeltia Naia Entonado, PhD. PT. University of A Coruña, A Coruña, Spain.

María Vilanova Pereira, PhD., PT. University of A Coruña, A Coruña, Spain.

Adrien Pallot, PT, MSc, Lecturer at École D´Assas, France.

Aurel Bellaïche, PT, Lecturer at CEERRF, France.

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References:

Choi, Y., & Kim, D. (2022). Effects of Task-Based LSVT-BIG Intervention on Hand Function, Activity of Daily Living, Psychological Function, and Quality of Life in Parkinson’s Disease: A Randomized Control Trial. Occupational therapy international, 2022, 1700306. https://doi.org/10.1155/2022/1700306

Ernst, M., Folkerts, A. K., Gollan, R., Lieker, E., Caro-Valenzuela, J., Adams, A., Cryns, N., Monsef, I., Dresen, A., Roheger, M., Eggers, C., Skoetz, N., & Kalbe, E. (2024). Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis. The Cochrane database of systematic reviews, 4(4), CD013856. https://doi.org/10.1002/14651858.CD013856.pub3

Kaya Aytutuldu, G., Ersoz Huseyinsinoglu, B., Karagoz Sakalli, N., Sen, A., & Yeldan, I. (2024). LSVT® BIG versus progressive structured mobility training through synchronous telerehabilitation in Parkinson’s disease: A randomized controlled trial. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 45(7), 3163–3172. https://doi.org/10.1007/s10072-024-07322-0

Rodriguez-Blazquez, C., Forjaz, M. J., Lizcano, E., Martínez-Martín, P., & the International Parkinson and Movement Disorder Society Non-Motor Study Group. (2020). Symptom burden among individuals with Parkinson disease: A national survey. Neurology and Therapy, 9(1), 135–148. https://doi.org/10.1007/s40120-020-00193-1

Schaible, F., Maier, F., Buchwitz, T. M., Schwartz, F., Hoock, M., Schönau, E., Libuda, M., Hordt, A., van Eimeren, T., Timmermann, L., & Eggers, C. (2021). Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson’s disease: a randomized controlled study comparing three exercise models. Therapeutic advances in neurological disorders, 14, 1756286420986744. https://doi.org/10.1177/1756286420986744