Effects of cueing techniques on gait, gait-related mobility, and functional activities in patients with Parkinson’s disease: a systematic review and meta-analysis

Abstract

Background

Parkinson’s disease (PD) is a neurodegeneration of dopaminergic neurotransmitters results in disturbance in gait, balance, and impairs the functional activities. Cueing techniques which are spatial stimuli facilitating repetitive movements are used in combination with other interventions to manage these disturbances.

Objectives

To determine the effects of cueing techniques for PD patients on the outcomes of gait, balance, functional activity, and freezing of gait.

Methods

The search was conducted in Medline, CINAHL, Cochrane, OVID and PEDro databases. In addition, a manual search in Google Scholar and reference lists of the included studies was conducted. Randomized Controlled Trials (RCTs) that compare the effects of cueing techniques with other interventions on any of the previously mentioned outcomes for PD patients were included according to the eligibility criteria.

Results

A total of 8 RCTs were included (n = 239 participants); 5 used auditory cueing, 3 used visual, and 1 used proprioceptive. The results revealed a significant medium effect of non-cueing techniques on gait (MD of 0.41(95% CI, 0.14, 0.68; p = 0.003), a non-significant small effect of cueing on balance (MD of −0.13 (95% CI, −0.52, 0.27; p = 0.54)), and a significant effect of cueing on functional activities (MD of −0.54 (95% CI, −0.86, −0.21; p = 0.001). While no quantitative outcome measures were assessing freezing of gait, a meta-analysis for it was not applicable.

Conclusions

Cueing techniques are beneficial in improving functional activities and balance. It may not provide a significant change on gait parameters when compared to non-cueing techniques unless combined with other treatment programs.

KEYWORDS:

• Parkinson’s disease
• cueing techniques
• gait
• balance
• functional activities

Acknowledgements

We would like to extend a special thanks to Nada Elbassiouny for her willingness to give her time so generously and helping us in providing feedback.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Assmaa Magdi

Assmaa Magdi is a year-4 undergraduate physiotherapy student in Fatima College of Health Sciences in Abu Dhabi, United Arab Emirates. She is currently undergoing clinical training as part of fulfilling her Bachelor's degree requirements. Her interests in research are neurological physiotherapy and evidence based practice.

Asma Mohammed Sayed Ahmed

Asma Mohammed Sayed Ahmed is a year-4 undergraduate physiotherapy student in Fatima College of Health Sciences in Abu Dhabi, United Arab Emirates. She is currently undergoing clinical training as part of fulfilling her Bachelor's degree requirements. Her interests in research are neurological physiotherapy and evidence based practice.

Esraa Elsayed

Esraa Elsayed is a year-4 undergraduate physiotherapy student in Fatima College of Health Sciences in Abu Dhabi, United Arab Emirates. She is currently undergoing clinical training as part of fulfilling her Bachelor's degree requirements. Her interests in research are neurological physiotherapy and evidence based practice.

Razan Ahmad

Razan Ahmad is a year-4 undergraduate physiotherapy student in Fatima College of Health Sciences in Abu Dhabi, United Arab Emirates. She is currently undergoing clinical training as part of fulfilling her Bachelor's degree requirements. Her interests in research are neurological physiotherapy and evidence based practice.

Senthilnathan Ramakrishnan

Senthilnathan Ramakrishnan currently works as Assistant Professor in Physiotherapy at Coventry University in the UK since January 2021. Previously he worked as Lecturer in Physiotherapy at Fatima College of Health Sciences in Al Ain, United Arab Emirates. He has completed PhD in 2019 with the focus on physiotherapy clinical education. He is interested in educational research and neurological physiotherapy and rehabilitation research. He is particularly interested in mixed-methods research and systematic reviews. He has published articles in peer-reviewed journals and contributed to book chapters and presented in the world physiotherapy congress 2021.

Marian Grace Gabor

Marian Grace Gabor qualified as a physiotherapist in 2007 and completed her master's degree in 2011 with a major on musculoskeletal physiotherapy. She is currently a Senior Lecturer at Fatima College of Health Sciences in Abu Dhabi, United Arab Emirates where she coordinates and instructs courses on musculoskeletal assessment and treatment to physiotherapy undergraduates. Her research interests lie mainly on physiotherapy education and evidence-based physiotherapy practice, which were the main focus of her PhD work that concluded in 2020.