Effect of rehabilitation interventions on freezing of gait in people with Parkinson's disease: a systematic review and meta-analyses

Purpose To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. Methods A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. Results Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= -0.26, 95% CI= -0.38 to -0.14, 95% prediction interval (PI)= -0.38 to -0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= -0.58, 95% CI= -0.86 to -0.29, 95% PI= -1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= -0.56, 95% CI= -1.16 to 0.05); and dance to multimodal exercises (Hedges' g= -0.64, 95% CI= -1.53 to 0.25). Conclusions We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.