Interventions to improve gait in Parkinson's disease: a systematic review of randomized controlled trials and network meta-analysis.

Autor: Hvingelby VS; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark. au340287@clin.au.dk.; Department of Nuclear Medicine, PET Centre Aarhus University Hospital, Aarhus, Denmark. au340287@clin.au.dk., Glud AN; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark., Sørensen JCH; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark., Tai Y; Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK., Andersen ASM; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark., Johnsen E; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Moro E; Division of Neurology, Centre Hospitalier Universitaire of Grenoble, Grenoble Alpes University, Grenoble, France.; Grenoble Institute of Neuroscience, Grenoble, France., Pavese N; Clinical Ageing Research Unit, Newcastle University, Newcastle Upon Tyne, UK.; Department of Nuclear Medicine, PET Centre Aarhus University Hospital, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2022 Aug; Vol. 269 (8), pp. 4068-4079. Date of Electronic Publication: 2022 Apr 05.
DOI: 10.1007/s00415-022-11091-1
Abstrakt: Introduction: Disabling gait symptoms, especially freezing of gait (FoG), represents a milestone in the progression of Parkinson's disease (PD). This systematic review and network meta-analysis assessed and ranked interventions according to their effectiveness in treating gait symptoms in people with PD across four different groups of gait measures.
Methods: A systematic search was carried out across PubMed, EMBASE, PubMed Central (PMC), and Cochrane Central Library from January 2000 to April 2021. All interventions, or combinations, were included. The primary outcome was changes in objective gait measures, before and after intervention. Outcome measures in the included studies were stratified into four different types of gait outcome measures; dynamic gait, fitness, balance, and freezing of gait. For the statistical analysis, five direct head-to-head comparisons of interventions, as well as indirect comparisons were performed. Corresponding forest plots ranking the interventions were generated.
Results: The search returned 6288 articles. From these, 148 articles could be included. Of the four different groups of measurement, three were consistent, meaning that there was agreement between direct and indirect evidence. The groups with consistent evidence were dynamic gait, fitness, and freezing of gait. 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: Some interventions can ameliorate gait impairment in people with PD. No recommendations on a superior intervention can be made. None of the studied interventions proved to be efficacious in the treatment of FoG. PROSPERO (registration ID CRD42021264076).
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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