The effect of rehabilitation interventions on freezing of gait in people with Parkinson’s disease is unclear: a systematic review and meta-analyses

Abstract

Purpose

To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson’s disease.

Methods

A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework.

Results

Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges’ g= −0.26, 95% CI= −0.38 to −0.14, 95% prediction interval (PI)= −0.38 to −0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges’ g= −0.58, 95% CI= −0.86 to −0.29, 95% PI= −1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges’ g= −0.56, 95% CI= −1.16 to 0.05); and dance to multimodal exercises (Hedges’ g= −0.64, 95% CI= −1.53 to 0.25).

Conclusions

We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.

Implications for rehabilitation

• FOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain.

• Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling.

• Interventions for FOG should be personalized based on the individual’s triggers and form part of a broader exercise program addressing gait, balance, and falls prevention.

• Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change.

Keywords:

• Freezing of gait
• Parkinson’s disease
• rehabilitation
• systematic review
• meta-analyses

Acknowledgements

The authors thank the following people: Dr Tamine Capato for providing data for our statistical analyses; Dr Yu Gu for assisting with translation; Dr Michael Borenstein for his support with statistical analyses; and all authors who kindly responded to requests for data or information.

Author contributions

L. Goh: research conception and execution, data analysis, writing of the first draft, manuscript review; C.G. Canning: research conception and execution, data analysis, manuscript review; J. Song: research conception and execution, data analysis and manuscript review; L. Clemson: research conception and manuscript review; N.E. Allen: research conception and execution, data analysis, manuscript review.

Disclosure statement

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

Additional information

Funding

LG is supported by an Australian Government Research Training Program Scholarship.