Rutz D1
1Centre Hospitalier Universitaire Vaudois (CHUV), Neurology, Lausanne, Switzerland
Background: Freezing of gait (FOG) is a major cause of falls and disability in Parkinson's disease (PD) and often refractory to medication. Physical therapy (PT) which includes learning of strategies and treadmill seems to reduce FOG.
Purpose: The aim of this systematic review was to assess the evidence for the various physical interventions for FOG and to establish recommendations for clinical practice.
Methods: Systematic search in PubMed, Embase, Physiotherapy Evidence Database (PEDro) and CINAHL for randomized controlled trials (RCT) of PT interventions for FOG in PD patients with the following keywords: Parkinson's disease, freezing of gait, physical therapy, cues, treadmill, coordination and balance adapted to perform search equations from January 1996 to April 2018. Both investigators independently assessed methodological quality using the PEDro Scale and based their writing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). All of the selected studies were analyzed separately to highlight individual outcomes of interventions. Thereafter interventions that have an effect are counted to determine a clinical recommendation. We classified the studies (I to IV) according to the quality criteria of the European Federation of Neurological Societies (EFNS). We use the same criteria to give clinical recommendations (A-C).
Results: Twenty randomized controlled trials were included (median PEDro Scale score of 6.5, range = 4-8): in 12 RCTs, physical therapy (PT) for FOG was assessed which was the primary outcome measure in 9 RCTs. In 8 RCTs, PT for gait disturbances (without specifying presence of FOG) in PD was assessed. The majority of the including RCT with the following PT interventions reduce FOG: treadmill walking (9 studies with all class II); cueing strategy: visual (6 studies with class I-II), auditory (8 studies, Class I-II), tactile cues (3 studies, class I-II); balance and coordination training (3 studies, class II), aquatic therapy (2 studies, class II-III). The results in the majority of the selected trials point to an important and immediate effect on FOG and on gait disturbances in kinematic gait analysis (cadence, stride and step length) with auditory and visual cues, and treadmill (class II). In 7 RCTs, the results demonstrate the efficacy of combining various interventions, the efficacy is in the majority of interventions short-lasting.
Conclusion(s): There is evidence level A (effective) for visual and auditory cueing and treadmill training. Tactile cues and other specifics therapies targeting FOG need further studies. We can recommend the cueing and treadmill intervention for the management of FOG and gait disturbances in PD patients.
Implications: This systematic review give a recent summary of all the physical interventions for freezing of gait and clinical recommendations for practice. It can help clinicians to manage freezing of gait and gait disturbances. This review show the importance of the training gait with specific interventions for the management of the walking diseases in PD patient especially with FOG. This work also highlights the need of further investigations to validate other clinical interventions.
Keywords: Parkinson's disease, freezing of gait, physical therapy
Funding acknowledgements: There was no sponsor for this review
Purpose: The aim of this systematic review was to assess the evidence for the various physical interventions for FOG and to establish recommendations for clinical practice.
Methods: Systematic search in PubMed, Embase, Physiotherapy Evidence Database (PEDro) and CINAHL for randomized controlled trials (RCT) of PT interventions for FOG in PD patients with the following keywords: Parkinson's disease, freezing of gait, physical therapy, cues, treadmill, coordination and balance adapted to perform search equations from January 1996 to April 2018. Both investigators independently assessed methodological quality using the PEDro Scale and based their writing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). All of the selected studies were analyzed separately to highlight individual outcomes of interventions. Thereafter interventions that have an effect are counted to determine a clinical recommendation. We classified the studies (I to IV) according to the quality criteria of the European Federation of Neurological Societies (EFNS). We use the same criteria to give clinical recommendations (A-C).
Results: Twenty randomized controlled trials were included (median PEDro Scale score of 6.5, range = 4-8): in 12 RCTs, physical therapy (PT) for FOG was assessed which was the primary outcome measure in 9 RCTs. In 8 RCTs, PT for gait disturbances (without specifying presence of FOG) in PD was assessed. The majority of the including RCT with the following PT interventions reduce FOG: treadmill walking (9 studies with all class II); cueing strategy: visual (6 studies with class I-II), auditory (8 studies, Class I-II), tactile cues (3 studies, class I-II); balance and coordination training (3 studies, class II), aquatic therapy (2 studies, class II-III). The results in the majority of the selected trials point to an important and immediate effect on FOG and on gait disturbances in kinematic gait analysis (cadence, stride and step length) with auditory and visual cues, and treadmill (class II). In 7 RCTs, the results demonstrate the efficacy of combining various interventions, the efficacy is in the majority of interventions short-lasting.
Conclusion(s): There is evidence level A (effective) for visual and auditory cueing and treadmill training. Tactile cues and other specifics therapies targeting FOG need further studies. We can recommend the cueing and treadmill intervention for the management of FOG and gait disturbances in PD patients.
Implications: This systematic review give a recent summary of all the physical interventions for freezing of gait and clinical recommendations for practice. It can help clinicians to manage freezing of gait and gait disturbances. This review show the importance of the training gait with specific interventions for the management of the walking diseases in PD patient especially with FOG. This work also highlights the need of further investigations to validate other clinical interventions.
Keywords: Parkinson's disease, freezing of gait, physical therapy
Funding acknowledgements: There was no sponsor for this review
Topic: Neurology: Parkinson's disease; Disability & rehabilitation; Education: clinical
Ethics approval required: No
Institution: Centre Hospitalier Universitaire Vaudois - CHUV
Ethics committee: Swiss Ethics
Reason not required: Systematic review of the literature with no intervention
All authors, affiliations and abstracts have been published as submitted.
