Barriers and Facilitators in Physical Rehabilitation for Parkinson's Disease in the Arabian World

Parkinson’s disease (PD) is a neurodegenerative disorder that, over time, leads to increased difficulties in various aspects of daily living and mobility, including walking, transfer, and balance. The main form of treatment for PD is pharmacological (mainly dopamine replacement medications) and surgical; however, it should be noted that a number of problems have been identified with these forms of treatment. For example, phramacological treatment is often insufficient to improve nondopaminergic symptoms, such as lack of balance control, resulting falls, and freezing of gait, which all have become increasingly recognized as prevalent and as contributing factors to morbidity in the PD population. As a result, physical rehabilitation therapies have been introduced as an adjunct to medication use so as to enable patients with PD to maintain their maximum level of independence. The benefits of physical rehabilitation in PD is well documented. In a recent systematic review, brief exposure to various forms of physical rehabilitation in patients with PD produced significant positive effects on motor symptoms, including walking speed, balance, and freezing of gait. In addition, preclinical evidence in PD animal models have demononstrated that physical training may alter the course of the disease and directly alter the neurodegenerative process. In spite of the growing recognition that physical rehabilitation may provide health benefit for people with PD, it is being recognized that there are barriers to participation. The available evidence, however, is largely based on information obtained from the developed countries, where cultural, economic, and health care structure differs in significant ways from those in the developing countries. There is very limited reported literature from the developing world about life experiences, challenges, and the provision of rehabilitation services for patients with PD, especially from the Arabian world. Therefore, consensus views of specialists working routinely with PD in Arab countries are being reported here in an attempt to categorize the barriers to physical rehabilitation in patients with PD from the Arabian world. The Arabian world consists of 22 countries, including Egypt, Algeria, Tunisia, Morocco, Libya, Somalia, Mauritania, Djibouti, Sudan, Yemen, Oman, Qatar, Bahrain, Kuwait, Saudi Arabia, and United Arab Emirates, as well as Iraq, Syria, Lebanon, and Jordan, which share a lot of similarities in cultural and social aspects. All of these countries are developing countries in which this article is discussing the possible barriers for people with PD to get engaged in physical rehabilitation programs.