To evaluate (1) effectiveness of DT for improving dynamic balance, extrapyramidal motor function, functional mobility, and reducing falls; and (2) influence of intervention dosage, including exercise intensity, challenge, duration, and adherence on DT treatment outcomes.
Literature was searched to January 2024. Cochrane Risk of Bias (RoB) tools, Physiotherapy Evidence Database (PEDro), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evaluated risk of bias, methodological and evidence quality, respectively. Berg Balance Scale (BBS), Unified Parkinson's Disease Rating Scale-III (UPDRS-III), and Timed Up and Go (TUG) were used to assess dynamic balance, extrapyramidal motor function, and functional mobility, respectively. Falls were recorded. Meta-analysis evaluated intervention effects, and meta-regression investigated how dose changes impacted intervention effects.
Meta-analysis included 24 studies involving 1,146 PD people. The mean PEDro score was 6.4, low risk of bias was 45% studies, and GRADE evidence quality ranged from low to high. Meta-analysis revealed significant DT effect improving dynamic balance (mean difference [MD]=4.57; 95%CI=3.64, 5.50; p0.001; n=11 studies), extrapyramidal motor function (MD=−2.29, 95%CI=−3.57, −1.02; p0.001; n=11), functional mobility (MD=−0.73; 95%CI=−1.03, −0.43; p0.001; n=11), and reducing falls (risk ratio=0.33; 95%CI=0.03, 0.62; P=0.03; n=1). Meta-regression revealed dynamic balance improved with DT of moderate challenge and intensity practised 2 hours per week, with ≥90% adherence to prescribed sessions.
DT benefits dynamic balance, but positive changes in extrapyramidal motor function and functional mobility are not clinically relevant. More studies are required to explore DT effects on falls. Practising DT 2 hours per week for >4 weeks at moderate intensity and challenge is crucial for improving dynamic balance.
DT training has substantial opportunities to improve participants' outcomes and treatment quality. The use of DT training enhances functional outcomes by addressing both motor and cognitive impairments. Secondly, delivering personalised DT intervention is possible by adjusting the challenge and intensity, which enables the intervention to be used among a wide range of PD participants with varying functional capabilities. Lastly and more importantly, DT training mimics real-life circumstances such as multi-tasking. Addressing the deficiency during motor-cognitive interaction enables easy translation of the learned skills into day-to-day tasks such as safe walking in a crowded walkway. This may positively influence the reduction of accidental outdoor falls, which are common among people with PD.
Meta-analysis and meta-regression
Falls
