Secondly there is lack of the suitable outcome measure that patient centered and are valid for PD. This hinders the reliability and validity of the obtained results from the measurement that have been examined and recorded. Even though putting up and evaluating better outcome measures is expensive venture and time consuming, is vital for enhancing proper design that delivers data that is valid, meaningful and trust worthy. Therefore it is necessary to be developed. The outstanding issue is whether specific components or the entire package of care should be evaluated.
At this juncture there is division amongst the scholars, since some are for the whole package and some against. The ones that supports the entire package retaliates that it shall be reflective of the clinical practice which is vital in giving complete and correct results. In addition to that, they add that if the standard package is not effective then even the parts of the package will be ineffective (Heinemann, Watson, 2006). While the anti entire package evaluation states that the core issue is with the methodological difficulties which hampers meaningful results and hence not all parts shall be incorrect (Peterson, 2006, p.98).
Therefore through evaluating parts there is a likelihood of obtaining some trustworthy data. These two sides both bear some validity and complementarities in contributing towards the knowledge data bank for the intervention. There are a number of various random uncontrolled and uncontrolled clinical trials done to determine general package in the multi-disciplinary rehabilitation which is inclusive of the physiotherapy. These clinical trials that have been conducted include the inpatients hospital setting, those inpatients in the progressive phase and multi- disciplinary out patient rehabilitation done weekly.
In addition to that there are community based self management programs, home based multidisciplinary management, remitting phase and planned multidisciplinary assessment. Hence all these work depicts the short term advancement and improvement in many outcomes. However the trials are geared towards attaining a overall package of the health care, hence the physiotherapeutic place have not attained its place in entire evaluation. In the research history there are limited numbers of trials that have been conducted in an attempt to establish the short term effectiveness of various packages of physiotherapy in different settings.
These researches that are limited include evaluation of physiotherapy within the inpatient hospital inpatient and outpatient rehabilitation settings. Indeed no much study have done in relation to community based therapy, but there is only comparative studies carried out that compares effectiveness of one package of physiotherapy to another. In this connection the comparative studies involves the effectiveness of the home based physiotherapy with a focus on specific functional activities, which are compared to hospital outpatient physiotherapy with a focus on specific facilitation techniques.