Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta‐Analyses

Abstract

A BS TRACT: Freezing of gait is considered one of the most disabling gait disorders in patients with PD. An effective treatment for freezing of gait is missing, thus current management requires a multidisciplinary approach. Among treatment options, physiotherapy is acknowledged to be crucial; however, a systematic review that demonstrates its efficacy is missing. This review aims at examining the short-and long-term effects of physiotherapy in improving freezing of gait in PD patients. Five electronic databases were searched for English-language full-text articles, and only randomized controlled trials were considered. The freezing of gait questionnaire was selected as the primary outcome measure because it is the only validated measure used to evaluate the severity and impact of freezing of gait on patients' daily life. From 1,130 trials, 19 relevant studies, including 913 patients, were selected. The included studies varied for sample size, methodology, and type of intervention. None of the studies had a low risk of bias, but the majority of randomized control trials presented a low risk for at least 6 of 13 biases. Our findings provide evidence for short-term effectiveness of physiotherapy in improving freezing of gait (physiotherapy vs. no treatment: effect size = -0.28 [-0.45, -0.11], P = 0.001; physiotherapy vs. control: effect size = 0.43 [-0.65, -0.21], P < 0.0001), particularly when tailored interventions are applied. These results seem to be maintained at the follow-up examinations (effect size = -0.52 [-0.78, -0.26]; P = 0.001). Promising findings on the potential benefits of physiotherapy in improving freezing of gait were found, although further randomized control trial studies are still needed. Questions remain on the type and duration of intervention that best fits for treating freezing of gait symptom in PD.

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

“…Apart from cues, treadmill training [164][165][166][167][168], obstacle aquatic training [169], supervised slackline training [170], walk-bicycle [171], and action observation [172,173] have also shown positive effects on FOG. Recently, Cosentino C et al [174] performed a systematic review and metaanalysis to evaluate the effectiveness of physiotherapy intervention on FOG symptoms. A total of 19 studies, including 913 patients, were enrolled and FOGQ was used as the primary outcome measure.…”

“…However, the efficacy of various cueing devices need to be further tested outside the home or laboratory and in a larger PD patients with FOG. Apart from cues, a systematic review and meta-analysis found that action observation, treadmill combined with cueing, and prolonged homebased exercise trainings were able to impact on FOG more than other approaches [174].…”

Efficacy and Characteristics of the Stimuli of Action Observation Therapy in Subjects With Parkinson's Disease: A Systematic Review

“…Consequently, studies aimed at investigating the effects of AOT on motor and functional abilities have been published over the past years, suggesting that AOT improves autonomy, walking ability, or typical motor signs such as freezing of gait and bradykinesia in patients with PD ( 17 – 20 ); however, a systematic review on this topic is missing. In particular, a single meta-analysis investigating the effectiveness of physiotherapy in these patients have reported positive results of AOT on freezing of gait ( 21 ), but the efficacy of this innovative tool on other functional outcome measures adopted in rehabilitation of patients with PD has never been systematically quantified. Moreover, AOT can be delivered alone or in association with usual physiotherapy through video-clips representing motor contents ( 20 , 22 ).…”

Die Geschichte des ‚Freezing-of-gait‘ beim Parkinson-Syndrom – vom Phänomen zum Symptom

“…Tatsächlich gibt es dabei einen sehr guten Nachweis, dass gezielte Physiotherapie gerade das FOG positiv beeinflussen kann. Zwei Meta-Analysen fassen die positiven Effekte der derzeit existierenden kontrollierten Studien zusammen [69,70]. Dabei wurden verschiedene physiotherapeutische Strategien einbezogen: visuelles und auditorisches Cueing-Training, Balance-Training, Heim-basiertes Bewegungstraining, Bewegungsbeobachtung/-nachahmung ("Action observation"), Aqua-Training und Laufband-Training bis hin zum überwachten Slackline-Training [69].…”

“…Zwei Meta-Analysen fassen die positiven Effekte der derzeit existierenden kontrollierten Studien zusammen [69,70]. Dabei wurden verschiedene physiotherapeutische Strategien einbezogen: visuelles und auditorisches Cueing-Training, Balance-Training, Heim-basiertes Bewegungstraining, Bewegungsbeobachtung/-nachahmung ("Action observation"), Aqua-Training und Laufband-Training bis hin zum überwachten Slackline-Training [69]. Speziell die auf das individuelle FOG der Patienten zugeschnittenen Therapieformen erzielten in den Meta-Analysen sehr gute Effekte im Vergleich zur Standard-Physiotherapie.…”