Objective: To summarize the effect of rehabilitation-based interventions on freezing of gait (FOG) in Parkinson’s disease (PD).

Background: Rehabilitation is emerging as an important adjunct therapy for FOG in PD. Patients are trained to reduce FOG itself or improve its related gait and balance functions to enhance mobility. This meta-analysis investigates the evidence for the overall beneficial effects of rehabilitation for reducing FOG in PD.

Method: PubMed, MEDLINE, EMBASE, Web of Science and Google Scholar electronic databases were systematically searched on Dec 13th 2018 for studies assessing the effect of any training-based intervention of at least 2 days on FOG severity in PD (either as the primary or secondary outcome), as compared to an active (e.g. sham exercise) or passive (e.g. wait-list) control. Pharmacological, surgical and non-invasive brain stimulation studies were excluded. The titles and abstracts were screened and meta-data extracted by two independent assessors. An inverse variance random-effects meta-analysis was then performed in RevMan (v5.3). For this preliminary analysis only studies that reported Freezing of Gait Questionnaire (FOGQ) data as an outcome were analyzed. A second meta-analysis was conducted across a sub-set of studies that compared the intervention effects to a passive control (i.e. wait-list or usual care).

Results: Out of 1661 non-duplicate hits, 35 studies were included for review and 23 studies reporting usable FOGQ data were included in the preliminary meta-analysis, of which 4 reported the new-FOGQ. Overall, a significant effect of 0.51 was found favoring the experimental rehabilitation (n=493) over the control condition (n=482) (Z=4.07, p<0.01), although large heterogeneity existed between studies (I^2=65%). Importantly, a positive effect of 0.40 was also found in the second meta-analysis on 13 studies comparing the experimental rehabilitation (n=310) to a passive control condition (n=299; Z=4.06, p<0.01), with little heterogeneity across study effects (I^2=24%).

Conclusion: Our preliminary results indicate a favorable effect for rehabilitation in reducing subjective FOG severity. A detailed risk- and publication bias assessment will be performed next, warranting careful interpretation of the present results. The effects of rehabilitation on objective FOG outcomes will also be analyzed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-rehabilitation-on-freezing-of-gait-in-parkinsons-disease-a-meta-analysis/