Figure 1. Flow chart of the review process. Flow diagram depicting the subsequent stages of searching for relevant reports, abstract screening the reports for potential candidates, and assessing the full-texts of those reports to select the studies that comply with the pre-defined inclusion criteria. The reasons for exclusion are stated.
Table I. Characteristics of the studies included in the systematic review. |
|||||
Participants |
Intervention and control groups |
Responsive outcomes |
FOG scores |
FOG differences |
|
Zhu et al [25] |
IG (1): n = 23 (67 ± 5 years) IG (2): n = 23 (65 ± 6 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stages II-III; stable medication for over 2 weeks; ability to walk independently; ability to stand at least 20 min unassisted; no physical therapy conducted over the past 6 months MMSE: minimum score >24 |
Length: 6 weeks IG (1): 30 min of aquatic therapy five times per week IG (2): 30 min of obstacle aquatic therapy five times per week |
Recruitment: 90.2% (46 out of 51) Attrition rate: IG (1): 0.0% (23 to 23) IG (2): 0.0% (23 to 23) Adherence rate: IG (1): NR IG (2): NR Adverse events: none |
Pre-test: IG (1): 11.7 ± 3.6 IG (2): 12.3 ± 3.9 Post-test: IG (1): 8.7 ± 3.3 IG (2): 6.2 ± 2.1 |
Intergroup difference: Post IG (1) vs. Post IG (2) e Intragroup differences: Pre IG (1) vs. Post IG (1) (NR) Pre IG (2) vs. Post IG (2) (NR) |
Cheng et al [19] |
IG (1): n = 12 (65.8 ± 11.5 years) IG (2): n = 12 (67.3 ± 6.4 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stages I-III; stable medication; history of other serious medical conditions MMSE: NR (IG = 27.7 ± 1.3; CG = 28.1 ± 1.1) |
Length: 4-6 weeks IG (1): 30 min of curved walking training for 12 sessions IG (2): 30 min of general exercises for 12 sessions |
Recruitment: 75% (24 out of 32) Attrition rate: IG (1): 0% (12 to 12) IG (2): 0% (12 to 12) Adherence rate: IG (1): 100% IG (2): 100% Adverse events: muscle soreness (n = 2) |
Pre-test: IG (1): 11.8 ± 4.7 IG (2): 10.6 ± 5.6 Post-test: IG (1): 7.8 ± 4 IG (2): 10.3 ± 5.9 |
Intergroup difference: Post IG (1) c vs. Post IG (2) Intragroup differences: Pre IG (1) vs. Post IG (1) d Pre IG (2) vs. Post IG (2) (NS) |
Rocha et al [22] |
IG (1): n = 10 (70.2 ± 5.5 years) IG (2): n = 11 (72.9 ± 5.5 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stages I-IV; ability to stand for at least 2 min; ability to walk independently for more than 3 m MMSE: minimum score >24 (IG = 29.3 ± 1.0; CG = 29.2 ± 0.8) |
Length: 8 weeks IG (1): 60 min of in-person Argentine tango once per week, as well as 40 min of self-managed home dance program once per week IG (2): 60 min of in-person mixed-genre therapeutic dance once per week, as well as 40 min of self-managed home dance program once per week |
Recruitment: 50% (21 out of 42) Attrition rate: IG (1): 20% (10 to 8) IG (2): 9.1% (11 to 10) Adherence rate: IG (1): 70% IG (2): 78.4% Adverse events: none |
Pre-test: IG (1): 9.5 ± 6.7 IG (2): 7.8 ± 6.4 Post-test: IG (1): 6.9 ± 6.7 IG (2): 5.3 ± 4.9 |
Intergroup difference: Post IG (1) vs. Post IG (2) (NS) Intragroup differences: Pre IG (1) vs. Post IG (1) (NS) Pre IG (2) vs. Post IG (2) c |
Volpe et al [24] |
IG (1): n = 12 (61.6 ± 4.5 years) IG (2): n = 12 (65.0 ± 5.3 years) Inclusion criteria: mild to moderate Idiopathic PD; Hoehn and Yahr stage less than III MMSE: score range = 24-29 (IG = 26.5 ± 1.4; CG = 26.3 ± 1.8) |
Length: 6 months IG (1): 90 min of Irish set dancing once a week IG (2): 90 min of standard physiotherapy exercises once a week |
Recruitment: NR Attrition rate: IG (1): 0% (12 to 12) IG (2): 0% (12 to 12) Adherence rate: IG (1): 90.9% IG (2): 87.8% Adverse events: non-injurious falls (n = 1) |
Pre-test: IG (1): 11.4 ± 2.8 IG (2): 10.8 ± 3.4 Post-test: IG (1): 4.9 ± 2.1 IG (2): 10.2 ± 4.5 |
Intergroup difference: Post IG (1) e vs. Post IG (2) Intragroup differences: Pre IG (1) vs. Post IG (1) d Pre IG (2) vs. Post IG (2) (NS) |
Schlenstedt et al [23] |
IG (1): n = 12 (78.3 ± 5.8 years) IG (2): n = 8 (81.4 ± 7.3 years) Inclusion criteria: idiopathic PD; stable medication; no participation in previous exercise treatment MMSE: NR (IG = 27.4 ± 3.7; CG = 26.2 ± 4.0) |
Length: 7 weeks IG (1): 60 min of lower limb muscle strength exercises twice per week IG (2): 60 min of static and dynamic postural control tasks twice per week |
Recruitment: NR Attrition rate: IG (1): 0% (12 to 12) IG (2): 0% (8 to 8) Adherence rate: IG (1): NR IG (2): NR Adverse events: NR |
Pre-test: IG (1): 6.6 ± 7.2 IG (2): 5.9 ± 4.4 Post-test: IG (1): 6.9 ± 9.1 IG (2): 8.7 ± 5.1 |
Intergroup difference: Post IG (1) vs. Post IG (2) (NS) Intragroup differences: Pre IG (1) vs. Post IG (1) (NS) Pre IG (2) vs. Post IG (2) (NS) |
Hackney et al [21] |
IG (1): n = 9 (72.6 ± 2.2 years) IG (2): n = 10 (69.6 ± 2.1 years) Inclusion criteria: idiopathic PD; stable medication MMSE: NR |
Length: 13 weeks IG (1): 1 h of progressive tango dance lessons for 20 sessions IG (2): 1 h of structured strength/flexibilityexercise classes for 20 sessions |
Recruitment: NR Attrition rate: IG(1): 0.0% (9 to 9) IG(2): 0.0% (10 to 10) Adherence rate: IG(1): 100% IG(2): 100% Adverse events: NR |
Pre-test: IG (1): 8.4 ± 0.6 IG (2): 7.9 ± 0.5 Post-test: IG (1): 7.4 ± 0.6 IG (2): 6.5 ± 0.5 |
Intergroup difference: Post IG (1) vs. Post IG (2) (NR) Intragroup differences: Pre IG (1) vs. Post IG (1) (NS) Pre IG (2) vs. Post IG (2) (NS) |
Frazzitta et al [20] |
IG (1): n = 20 (71 ± 8 years) IG (2): n = 20 (71 ± 7 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stage III; stable medication; ability to walk without any physical assistance; FOG at the time of peak medication effect MMSE: minimum score > 26 |
Length: 4 weeks IG (1): 20 min of treadmill training associated with auditory and visual cues every day IG (2): 20 min of rehabilitation including auditory and visual cues every day |
Recruitment: NR Attrition rate: IG (1): 0% (20 to 20) IG (2): 0% (20 to 20) Adherence rate: IG (1): NR IG (2): NR Adverse events: NR |
Pre-test: IG (1): 11.6 ± 3 IG (2): 11.4 ± 2.4 Post-test: IG (1): 6.5 ± 1.9 IG (2): 7.7 ± 1.8 |
Intergroup difference: Post IG (1) d vs. Post IG (2) Intragroup differences: Pre IG (1) vs. Post IG (1) e Pre IG (2) vs. Post IG (2) e |
Allen et al [15] a |
IG: n = 24 (66 ± 10 years) CG: n = 24 (68 ± 7 years) Inclusion criteria: idiopathic PD; stable medication for over 2 weeks; ability to walk independently; aged 30-80; fallen or at risk of falling MMSE: minimum score > 24 (IG = 29 ± 1; CG = 29 ± 1) |
Length: 6 months IG: 40-60 min of progressive lower limb strengthening and balance exercises three times per week CG: usual care |
Recruitment: 54.4% (48 out of 92) Attrition rate: IG: 12.5% (24 to 21) CG: 0% (24 to 24) IG adherence rate: 70% Adverse events: none |
Pre-test: IG: 6.8 ± 5.1 CG: 8.3 ± 5.8 Post-test: IG: 5.5 ± 5.9 CG: 9.4 ± 6.2 |
Intergroup difference: Post IG c vs. Post CG Intragroup differences: Pre IG vs. Post IG (NR) Pre CG vs. Post CG (NR) |
Duncan et al [16] a |
IG: n = 32 (63.3 ± 1.9 years) CG: n = 30 (69.0 ± 1.5 years) Inclusion criteria: PD; Hoehn and Yahr stages I-IV; history of other serious medical conditions MMSE: NR |
Length: 12 months IG: 1 h of community-based Argentine tango classes twice per week CG: usual care |
Recruitment: 50.4% (62 out of 123) Attrition rate: IG: 50% (32 to 16) CG: 36.7% (30 to 19) IG adherence rate: 78.5% Adverse events: NR |
Pre-test: IG: 6.1 ± 5.1 CG: 4.6 ± 4.6 Post-test: IG: 5.7 ± 5 CG: 6.5 ± 6 |
Intergroup difference: Post IG d vs. Post CG Intragroup differences: Pre IG vs. Post IG (NR) Pre CG vs. Post CG (NR) |
Fietzek et al [17] a |
IG: n = 14 (69.8 ± 6.5 years) CG: n = 9 (64.2 ± 5.9 years) Inclusion criteria: PD; Hoehn and Yahr stages I-IV; a gait disorder with freezing; ability to walk independently outside the house MMSE: NR |
Length: 2 weeks IG: 30 min of repetitive physiotherapy exercises with cueing and movement strategies three times per week CG: delayed treatment |
Recruitment: 43.4% (23 out of 53) Attrition rate: IG: 0% (14 to 14) CG: 22.2% (9 to 7) IG adherence rate: NR Adverse events: NR |
Pre-test: IG: 13.5 ± 3.7 CG: 15.6 ± 2.4 Post-test: IG: 11.7 ± 3.6 CG: 15 ± 2.3 |
Intergroup difference: Post IG d vs. Post CG Intragroup differences: Pre IG vs. Post IG (NR) Pre CG vs. Post CG (NR) |
Carroll et al [14] |
IG: n = 11 (69.5 years) CG: n = 10 (74 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stages I-III; stable medication over 3 months; ability to walk 10 m three times without assistance MMSE: minimum score > 24 |
Length: 6 weeks IG: 45 min of aquatic exercise therapy twice per week CG: usual care |
Recruitment: 42% (21 out of 50) Attrition rate: IG: 9.1% (11 to 10) CG: 20% (10 to 8) IG adherence rate: NR Adverse events: none |
Pre-test: IG: 5.5 (3.75-8.25) b CG: 5.0 (2.25-13) b Post-test: IG: 3.5 (1-9) b CG: 6.5 (3.5-12.75) b |
Intergroup difference: Post IG vs. Post CG (NS) Intragroup differences: Pre IG vs. Post IG (NR) Pre CG vs. Post CG (NR) |
Santos et al [18] a |
IG: n = 11 (73.1 ± 9.8 years) CG: n = 11 (78.1 ± 5.2 years) Inclusion criteria: idiopathic PD; Hoehn and Yahr stages I-III; stable medication; ability to stand on two feet for at least 2 min; ability to walk at least 10 m without assistance; no neurological disease MMSE: mean score > 24 |
Length: 6 weeks IG: 23 min of balance training using a slackline twice per week CG: control group |
Recruitment: NR Attrition rate: IG: 9.1% (11 to 10) CG: 9.1% (11 to 10) IG adherence rate: NR Adverse events: NR |
Pre-test: IG: 3.9 ± 3.6 CG: 4.4 ± 6.2 Post-test: IG: 2.9 ± 3.7 CG: 4.8 ± 6.5 |
Intergroup difference: Post IG vs. Post CG (NR) Intragroup differences: Pre IG vs. Post IG c Pre CG vs. Post CG (NS) |
Statistics are reported as means ± standard deviations unless otherwise specified. CG: control group; FOG: freezing of gait; IG: intervention group; MMSE: Mini-Mental State Examination; NR: not reported; NS: non-significant; PD: Parkinson’s disease. a Studies included in the meta-analysis; b Values are reported as median (interquartile range); c p < 0.05; d p < 0.01; e p < 0.001. |
Table II. Quality assessment (PEDro scale). |
||||||||||||
1 b |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
Total |
|
Allen et al [15] a |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
8/10 |
Duncan et al [16] a |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
8/10 |
Zhu et al [25] |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
8/10 |
Fietzek et al [17] a |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
No |
Yes |
Yes |
7/10 |
Carroll et al [14] |
Yes |
Yes |
Yes |
Yes |
No |
No |
No |
Yes |
Yes |
Yes |
Yes |
7/10 |
Cheng et al [19] |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
No |
Yes |
Yes |
7/10 |
Rocha et al [22] |
Yes |
Yes |
No |
Yes |
No |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
7/10 |
Volpe et al [24] |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
No |
No |
Yes |
Yes |
6/10 |
Schlenstedt et al [23] |
Yes |
Yes |
No |
Yes |
No |
No |
Yes |
Yes |
No |
Yes |
Yes |
6/10 |
Hackney et al [21] |
Yes |
Yes |
No |
Yes |
No |
No |
Yes |
No |
No |
Yes |
Yes |
5/10 |
Frazzitta et al [20] |
Yes |
Yes |
No |
Yes |
No |
No |
No |
Yes |
No |
Yes |
Yes |
5/10 |
Santos et al [18] a |
Yes |
Yes |
No |
No |
No |
No |
No |
Yes |
No |
Yes |
Yes |
4/10 |
a Studies included in the meta-analysis; b Not included in total score. |
Figure 2. Forest plot of individual and pooled effect size estimates. 95% CI: 95% confidence interval; SMD: standardized mean differences.
Fisioterapia para la congelación de la marcha en la enfermedad de Parkinson: revisión sistemática y metaanálisis Introducción. La congelación de la marcha (CDM) es uno de los síntomas más graves asociados con la enfermedad de Parkinson (EP). El tratamiento fisioterapéutico podría ser una estrategia efectiva para su tratamiento, pero no se ha realizado ninguna revisión sistemática al respecto. Objetivo. Identificar las características, la calidad metodológica y los principales resultados de los estudios que han analizado los efectos de las intervenciones fisioterapéuticas en CDM hasta la fecha, mediante la realización de una revisión sistemática y un metaanálisis. Pacientes y métodos. Se realizaron búsquedas en cuatro bases de datos electrónicas para encontrar ensayos controlados aleatorizados que proporcionaran información con respecto a los efectos de cualquier tipo de tratamiento fisioterapéutico sobre la CDM. La calidad metodológica de las investigaciones se evaluó mediante la escala PEDro. Resultados. Se identificaron 12 estudios para su inclusión en el análisis cualitativo y cuatro ensayos controlados aleatorizados se incluyeron en el metaanálisis final. La calidad de los ensayos fue generalmente buena. Las modalidades de fisioterapia que incluían señales fueron más efectivas para tratar la CDM que los enfoques de fisioterapia tradicionales. El metaanálisis indicó que las intervenciones fisioterapéuticas tuvieron un impacto significativamente mayor sobre la CDM que las comparaciones de control. Conclusiones. El tratamiento fisioterapéutico, especialmente las modalidades que incluyen señales visuales y auditivas, debe prescribirse a los pacientes con EP con CDM. Se necesitan estudios futuros que incluyan pacientes con EP con deterioro cognitivo y herramientas de medición objetiva de la CDM para completar la evidencia científica existente. Palabras clave. Congelación de la marcha. Ejercicio. Enfermedad de Parkinson. Fisioterapia. Revisión sistemática. Señalización. |