Table 1. Summary of the 46 Included Trials.
| Source (country) | Sample size (mean age, y) [H&Y stage] | Intervention | Control | Primary outcome | Main findings |
|---|---|---|---|---|---|
| Acarer et al,43 2015 (Turkey) | 60 (67) [2-3] | Vestibular rehabilitation | No intervention | Not specified | Vestibular rehabilitation was effective for improving balance (BBS, ABC, DGI) after 8 wk |
| Agosti et al,23 2016 (Italy) | 20 (62.9) [NA]a | GPR | No intervention | Kinematic parameters of gait, UPDRS III | GPR group had significant improvement in kinematic parameters of gait and UPDRS III persisting after 12 wk |
| Akhila et al,33 2022 (India) | 32 (70.8) [1.5-3.0]a | Task-related trunk training | Standard PT | Mini-BESTest | Task-related trunk training appeared more beneficial than standard physiotherapy in balance capacity after 6 wk |
| Alagumoorthi et al,36 2022 (India) | 192 (69.7) [1.5-3.0]a | Wii training | Balance training | Number of participants who fell | Wii group significantly improved over control group at 12th and 36th week in number of fallers, fall rate, and bodily discomfort component of PDQ-39 |
| Au et al,39 2022 (US) | 22 (69.7) [2.1]a | Spaced PT | Burst PT | TUG | Spaced PT group had stability of the TUG at 6 mo; burst group had significant worsening once PT was discontinued after 6 wk |
| Bonnì et al,20 2019 (Italy) | 16 (71.8) [NA]a | Blindfolded balance training | Standard PT | Gait, neurophysiological | Decrease of stance and double stance phase and increase of swing phase with respect to gait cycle in BBT group vs PT group after 2 wk |
| Capato et al,18 2020 (Brazil) | 35 (77) [4]a | PT, RAS | Standard PT | Mini-BESTest | RAS and regular balance training improved balance in patients with PD after 5 wk, but long-term effects, up to 6 mo, were sustained only in the RAS group |
| Capecci et al,44 2014 (Brazil) | 20 (73.4) [3] | Postural rehabilitation or postural rehabilitation plus kinesiology taping | No intervention | BBS, TUG, trunk bending | All treated patients showed significant improvement in trunk posture, gait, and balance at 1 mo; benefits persisted at 2 mo for all measures except lateral trunk bend |
| Carpinella et al,29 2017 (Italy) | 42 (73) [2.7]a | Balance and gait training with gamepad | Structured PT | BBS, 10MWT | Gamepad-based training was superior to PT in improving BBS performance and retaining it for 1 mo; 10MWT data were comparable between groups after training |
| Carvalho et al,45 2015 (Brazil) | 22 (64.1) [2.1] | Strength training or aerobic training | Regular PT | UPDRS III | Strength and aerobic training groups had UPDRS III improved by 27.5% and 35%, respectively; regular PT improved by 2.9% after 12 wk |
| Cholewa et al,28 2017 (Poland) | 42 (61.3) [3.2]a | Rehabilitation exercises | No intervention | Gait speed, mean step length, step frequency | Rehabilitation group showed significant improvement in gait speed (12.35%), mean step length (18.00%), and frequency step (2.40%) vs control group after 9 mo |
| Clarke et al,16 2016 (UK) | 762 (70) [NA]a | PT | No intervention | NEADL scale score | PT and OT were not associated with clinically meaningful improvements in ADLs or QOL at 3 mo |
| Clerici et al,30 2019 (Italy) | 60 (67) [2.7] | AT plus motor cognitive rehabilitation | Motor cognitive rehabilitation | FOG | MIRT improved FOG at 4 wk; AT added no further benefits |
| de Natale et al,40 2017 (Italy) | 16 (67) [2.5]a | DT | Traditional PT | 9-HPT | DT had motor and cognitive outcomes significantly improved at 2 wk of treatment and retained after follow-up of 8 wk vs TR |
| Dipasquale et al,24 2017 (Italy) | 40 (69.9) [2]a | Standard PT | General exercises | FIM, HRS, TUG, UPDRS | PT seemed more effective than a generic exercise program at 4 mo in patients with H&Y stage II PD |
| Feng et al,25 2019 (China) | 28 (67.5) [3.1]a | Virtual reality training | Conventional PT | BBS, TUG, UPDRS III, FGA | 12 wk of VR training improved gait and balance vs conventional PT (significant for BBS, TUG, and FGA but not UPDRS III) |
| Ferrazzoli et al,26 2018 (Italy) | 36 (64.5) [NA] | Multidisciplinary intensive rehabilitation plus rotiogotine | Rotigotine only | UPDRS III | During 18 mo, no differences in UPDRS III between the 2 groups, but MIRT plus rotigotine group improved in 6MWT and TUG |
| Ferreira et al,22 2018 (Brazil) | 35 (64.1) [1]a | Resistance training | No intervention | Anxiety symptoms and QOL | Significant reduction in anxiety symptoms and increase in QOL after 24 wk |
| Frazzitta et al,46 2012 (Italy) | 50 (72) [3]a | IRT | Walking instructions at home | UPDRS, UPDRS II, UPDRS III | IRT group preserved UPDRS, UPDRS II, and UPDRS III values over 1 y; control group had a significant increase in those variables in same period |
| Frisaldi et al,17 2021 (Italy) | 38 (60.7) [2]a | Conventional PT and dance therapy | Conventional PT | MDS-UPDRS III | DT method was more effective than intensive program of conventional PT in improving motor impairment in patients with mild PD after 5 wk |
| de Oliveira Gondim et al,27 2017 (Brazil) | 28 (65) [2]a | Individualized orientation and phone monitoring | Usual exercise instructions | ADLs, UPDRS-motor, PDQ-39 | Significant improvement in ADL and UPDRS-motor, PDQ-39 total and dimensions mobility, emotional well-being, and bodily discomfort in the experimental vs control group at 12 wk |
| Hirsch et al,47 2003 (US) | 15 (70.8) [1.8]a | Balance and resistance training | Balance training | SOT, muscle strength | Both types of training improved SOT performance for at least 4 wk; effect was larger in combined group |
| King et al,48 2015 (US) | 58 (63.9) [2.4] | Home exercise program, individual PT, or group class | No intervention | 7-PPT | Only the individual group significantly improved in the 7-PPT after 4 wk, mostly in functional and balance measures |
| Marchese et al,49 2000 (Italy) | 20 (65) [1.5-3]a | Cued PT | Noncued PT | Not specified | Both groups had significant reduction of ADLs and motor sections of UPDRS after 6 wk of rehabilitation; this improvement largely faded in the noncued group but was still significant in the cued group after 12 wk |
| McGinley et al,50 2012 (Australia) | 210 (67.9) [2.5] | Progressive strength training or movement strategy training (both with fall prevention) | Life skills | Feasibility of rehabilitation and PT programs | All 3 programs proved feasible, suggesting they may be safely implemented for people with PD in community-based clinical practice |
| Modugno et al,51 2010 (Italy) | 24 (62) [3]a | Active theater program | Standard PT | Clinical disability and QOL | Theater group showed progressive significant improvements at the end of the third year in all clinical scales |
| Monticone et al,52 2015 (Italy) | 70 (74.1) [2.5-4]a | Multidisciplinary rehabilitation care | General PT | MDS-UPDRS III | Multidisciplinary rehabilitation care positively changed the course of motor impairment, balance, and activities of daily living; effects lasted for at least 1 y after the intervention |
| Morris et al,38 2017 (Australia) | 133 (71) [2] | Progressive resistance strength training | Nonspecific life skills training | Rate of falls | Home program of strength and movement strategy training and falls education did not prevent falls in 12 mo when applied at the study dose |
| Nieuwboer et al,53 2007 (UK, Belgium, the Netherlands) | 153 (67.5) [2.5]a | Home cueing program followed by 3 wk with no training | 3 wk of no training followed by home cueing program | Posture and gait score | Significant improvements after intervention on the posture and gait scores; severity of freezing was reduced in freezers only; gait speed, step length, and timed balance tests improved in the full cohort; effects of intervention were reduced at 6-wk follow-up |
| Pazzaglia et al,34 2020 (Italy) | 51 (72) [NA]a | VR rehabilitation program | Conventional rehabilitation program | BBS | VR rehabilitation program led to increase in BBS and DGI scores vs conventional rehabilitation program at 6 wk |
| Pelosin et al,31 2018 (Italy) | 70 (70.4) [2.4]a | Action observation therapy | Standard PT | FOG | AOT was feasible, safe, and efficacious in improving FOG at 5 wk |
| Pérez-de la Cruz,37 2018 (Spain) | 29 (65.9) [NA]a | Aquatic Ai Chi program | Dry land conventional PT | TUG, PDQ-39-SS, LS, VAS, FTSTS, Yesavage test | Ai Chi program reduced limb bradykinesia and joint rigidity, decreased pain, and improved self-reported QOL at 11 wk in patients with H&Y stage 1-3 PD |
| Qutubuddin et al,54 2007 (US) | 22 (71.2) [NA]a | CDP therapy | Balance PT | BBS, CDP variables | No differences found between treatment groups, but both groups demonstrated improvement on selected outcome measures |
| Raciti et al,21 2022 (Italy) | 30 (65.7) [2] | Experimental robotic therapy | Conventional PT | 9-HPT | Exoskeleton-assisted therapy may be a safe and effective strategy for delivering highly intensive and repetitive training |
| San Martín Valenzuela et al,32 2020 (Spain) | 40 (66.4) [1-3]a | Dual task training | Single task training | Velocity and spatiotemporal parameters of gait | Dual-task group demonstrated improved velocity and stride length time in all assessment conditions after 5 wk of training and improved perceived QOL |
| Chivers Seymour,35 2019 (UK, Belgium) | 474 (71) [1-4]a | PDSAFE | DVD plus counseling | Risk of repeat falling | PDSAFE did not reduce falling at 6 mo |
| Tamir et al,55 2007 (Israel) | 23 (67.4) [NA]a | Combination of imagery and physical practice | Physical practice | Not specified | Significantly faster performance of movement sequences at 12 wk and higher gains in mental and motor subsets of the UPDRS and in cognitive tests vs the control group |
| Tickle-Degnen et al,56 2010 (US) | 117 (66.3) [2-3] | 18-h Rehabilitation or 27-h rehabilitation | No intervention | HRQOL | Both groups had significant beneficial effects in HRQOL at 6 wk, with benefits persisting at 2- and 6-mo follow-up |
| van Nimwegen et al,57 2013 (the Netherlands) | 586 (65.1) [1-3]a | ParkFit program | Standard PT | Activity diary and monitor | ParkFit did not change the overall volume of physical activities in older, sedentary patients with PD |
| Varalta et al,19 2021 (Italy) | 20 (70.8) [NA]a | Consecutive PT and cognitive training | Standard PT | MOCA, UPDRS III | Improvements in walking abilities were noted after both interventions, but only the patients treated with consecutive training showed better performance on functional mobility and memory tasks |
| Vivas et al,58 2011 (Spain) | 12 (65.7) [2.67]a | Water-based therapy | Land-based therapy | Not specified | Main effect of both therapies seen at 4 wk for the FRT; only the AT group improved in the BBS and the UPDRS |
| Volpe et al,59 2014 (Italy) | 34 (68) [2.82]a | Hydrotherapy | Land-based standard rehabilitation | Center of the pressure sway area | Better improvement in patients who underwent hydrotherapy than land-based therapy in the center of pressure sway area closed eyes, BBS, ABC, Falls Efficacy Scale, PDQ-39, and falls diary at 2 mo |
| Volpe et al,41 2017 (Italy) | 30 (70.6) [2-3]a | Water-based physiotherapy | Non–water-based physiotherapy | Cervical and dorsal flexion, lateral trunk inclination | After 8 wk of treatment, only the water-based group showed a significant improvement of trunk posture with a significant reduction of cervical flexion, dorsal flexion, and lateral inclination of the trunk |
| Volpe et al,60 2013 (Italy) | 24 (61.6) [2-3]a | Irish set dancing classes plus home program | Standard PT | UPDRS | Irish dancing and PT were safe and feasible, with good adherence over 6 mo; although improvements were made in both groups, the dance group showed results superior to standard physiotherapy for FOG, balance, and motor disability |
| Wade et al,61 2003 (UK) | 24 (71.3) [NA] | Active rehabilitation | No intervention | Not specified | Patients with PD declined significantly over 6 mo, but short-term multidisciplinary rehabilitation may improve mobility |
| Wróblewska et al,42 2019 (Poland) | 40 (72.1) [2-3]a | Nordic walking | No intervention | FOG | NW training had a beneficial effect on FOG in PD at 3 mo that persisted to 6 mo |
Abbreviations: 7-PPT, 7-item physical performance test; 9-HPT, hole peg test; 10MWT, 10-m walking test; ABC, activities-specific balance confidence scale; ADLs, activities of daily living; AOT, action observation therapy; AT, aquatic therapy; BBS, Berg Balance Scale; CDP, computerized dynamic posturography; DGI, dynamic gait index; DT, dance therapy; FGA, functional gait assessment; FIM, functional independence measure; FOG, freezing of gait; FRT, functional reach test; FTSTS, 5 times sit-to-stand test; GPR, global postural reeducation; H&Y, Hoehn and Yahr; HRQOL, health-related quality of life; HRS, Hamilton Rating Scale; IRT, intensive rehabilitation treatment; LS, leg standing; MDS-UPDRS III, Movement Disorder Society Sponsored Revision of the Unified Parkinson Disease Rating Scale; mini-BESTest, Mini Balance Evaluation System Test; MIRT, multidisciplinary intensive rehabilitation treatment; MOCA, Montreal Cognitive Assessment Test; NA, not applicable; NEADL, Nottingham Extended Activities of Daily Living; NW, Nordic walking; OT, occupational therapy; PD, Parkinson disease; PDQ-39, Parkinson Disease Questionnaire; PDQ-39-SS, Parkinson Disease Questionnaire–Social Support; PT, physical therapy; QOL, quality of life; RAS, rhythmical auditory stimulation; SOT, sensory orientation test; TR, traditional rehabilitation; TUG, timed up and go test; UPDRS, Unified Parkinson’s Disease Rating Scale; UPDRS II, Unified Parkinson Disease Rating Scale for activities of daily living; UPDRS III, Unified Parkinson Disease Rating Scale for motor skills; VAS, visual analog scale; VR, virtual reality.
a
Variables of the experimental group were included in the table if the mean age and/or baseline H&Y stage of the trial participants was not mentioned.