The effect of physical activity on Parkinson's disease outcomes in patients with bilateral subthalamic nucleus deep brain stimulation: a systematic review.

BACKGROUND: Subthalamic nucleus deep brain stimulation (DBS-STN) is a recognized treatment for advanced Parkinson's disease. While it improves some clinical symptoms, especially bradykinesia and rigidity, it has limited application for late motor symptoms. Moreover stimulation-related motor adverse effects can increase the motor burden. There is a clear need to develop additional therapies that complement deep brain stimulation in controlling late motor symptoms. Physical activity is a commonly used and recommended form of therapy for patients with Parkinson's disease, supplementary to pharmacological therapy. However, there are no clear recommendations including patients after implantation of DBS-STN stimulators in the group undergoing physiotherapy.

OBJECTIVE: The objective of this study is to systematically review the literature on physiotherapy interventions for patients who have undergone DBS-STN implantation and their influence on motor outcomes.

METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and a total of 10 studies were included.

RESULTS: Despite heterogeneous physiotherapy protocols, the main outcomes (balance, postural stability, gait speed, functional mobility) improved consistently, while motor severity scores and cognitive or neurophysiological effects remain underexplored.

CONCLUSION: Current evidence supports the use of physiotheruapy as a potentially effective and safe addition to the management of motor symptoms in patients after DBS-STN. Future trials with standardized physiotherapy protocols and uniform outcome measures are needed to create overall recommendations.