Category: Parkinson’s Disease: Clinical Trials
Objective: This systematic review and network meta-analysis sought to quantify and rank interventions targeting gait in PD.
Background: Among the disabling motor symptoms of Parkinson’s Disease (PD), gait symptoms such as Freezing of Gait (FoG) represent a milestone in disease progression. Further, these symptoms are generally less responsive to dopaminergic substation and may even be aggravated by advanced treatments like deep brain stimulation (DBS).
Method: A systematic search across the following databases was carried out: PubMed, Embase, PubMed Central (PMC) and the Cochrane Central Library. The search terms included studies published between January 1 2000 until April 2021. There were no constraints on the type of treatment or treatment combinations included in this review. The primary outcome was changes observed in objective measures of gait following treatment. Gait measures were divided into four dimensions of assessment: Dynamic gait, fitness, FoG and balance. The motor component of the Unified Parkinson’s Disease Rating Scale (UPDRS) served as secondary outcome measure. For the statistical analysis five networks were generated and effect sizes compared.
Results: We identified 6,288 studies. 148 of these were included for meta-analysis. The network for balance was inconsistent. The other three had agreement between direct and indirect evidence. For dynamic gait measures, treatments with the largest observed effect were Aquatic Therapy with dual task exercising (SMD 1.99[-1.00;4.98]) and strength and balance training (SMD 1.95[-0.20;4.11]). For measures of fitness, treatments with the largest observed effects were aquatic therapy (SMD 3.41[2.11;4.71] and high- frequency repetitive transcranial magnetic stimulation (SMD 2.51[1.48;3.55]). For FoG measures, none of the included interventions yielded significant results.
Conclusion: Symptoms of gait are difficult to treat and respond in a highly varying manner to treatment or exercise interventions. Several interventions were observed to alleviate symptoms of gait in PD although none achieved statistical significance in the treatment of freezing of gait.
To cite this abstract in AMA style:
V. Hvingelby, A. Glud, JC. Sørensen, Y. Tai, AS. Andersen, VE. Johnsen, E. Moro, N. Pavese. Interventions to Improve Gait in Parkinson’s Disease: A Systematic Review of Randomised Controlled Trials and Network Meta-Analysis [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/interventions-to-improve-gait-in-parkinsons-disease-a-systematic-review-of-randomised-controlled-trials-and-network-meta-analysis/. Accessed July 3, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/interventions-to-improve-gait-in-parkinsons-disease-a-systematic-review-of-randomised-controlled-trials-and-network-meta-analysis/