Archives of physical medicine and rehabilitation · 2026
Comparative Efficacy of 17 Rehabilitation Therapies Combined With Medication for Improving Gait Disorders and Quality of Life in Parkinson's Disease: A Network Meta-Analysis of 137 RCTs.
СтатьяNetwork Meta-AnalysisСравнительное исследованиеОбзорНазвание и аннотация: Перевод пока не подготовлен
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Lin Xinyu, Li Haojie, Wu Xie
Аннотация
OBJECTIVE: This network meta-analysis aimed to systematically compare the efficacy of 17 rehabilitation therapies combined with medication in improving gait disorders and quality of life (QOL) in patients with Parkinson's disease (PD), providing evidence-based guidance for individualized rehabilitation protocols.
DATA SOURCES: A comprehensive search was conducted across 6 databases. The search included randomized controlled trials published in English or Chinese, focusing on patients with PD with gait disturbances.
STUDY SELECTION: A total of 137 RCTs involving 2006 patients with PD were included. Studies were selected based on predefined Population, Intervention, Comparison, Outcome, Study design criteria-Population: patients with PD with gait disorders; Intervention: 17 rehabilitation therapies combined with medication; Comparison: Clinical Nursing Therapy as the control; Outcome: outcomes including gait function (Time Up and Go, gait speed), gait symptoms (fall risk, freezing of gait), and activities of daily living; and Study design: RCTs only.
DATA EXTRACTION: Two independent researchers extracted data using a standardized matrix, including study characteristics, intervention details, and outcome measures. The Cochrane Risk of Bias Tool was employed for quality assessment, and the Confidence in Network Meta-Analysis framework evaluated evidence credibility.
DATA SYNTHESIS: Network meta-analysis was performed using STATA 17.0. Key findings included the following: network meta-analysis showed that, for gait function, Traditional Chinese Rehabilitation Therapy (TCRT) significantly improved gait speed (Hedges' g=1.87; 95% confidence interval [CI]: 0.70, 3.04) and Extended Reality Rehabilitation Therapy (XRRT) significantly reduced fall risk (Hedges' g=0.88; 95% CI: 0.21, 1.54). For QOL, both Hydrotherapy Rehabilitation Therapy (HRT) (Hedges' g=1.79; 95% CI: 0.69, 2.88) and Conventional Kinesitherapy (Hedges' g=1.03; 95% CI: 0.29, 1.77) demonstrated significant improvements. Although some interventions showed high Surface Under the Cumulative Ranking Curve Analysis scores, the absence of statistical significance in direct or network comparisons indicates that their potential benefits remain uncertain. Moreover, most estimates were associated with wide CIs, indicating limited strength of evidence. The overall risk of bias was low in 84.87% of the included studies.
CONCLUSION: This network meta-analysis highlights the differential efficacy of rehabilitation therapies for PD. TCRT, XRRT, Resistance Training Rehabilitation Therapy, and Upper Limb Rehabilitation Therapy showed strong evidence for improving specific gait and activities of daily living outcomes, whereas Noninvasive Brain Stimulation Therapy and HRT exhibited potential despite limited statistical significance. Clinicians should prioritize therapies with robust evidence, such as TCRT and XRRT, whereas further large-scale, standardized trials are needed to validate other interventions.
DATA SOURCES: A comprehensive search was conducted across 6 databases. The search included randomized controlled trials published in English or Chinese, focusing on patients with PD with gait disturbances.
STUDY SELECTION: A total of 137 RCTs involving 2006 patients with PD were included. Studies were selected based on predefined Population, Intervention, Comparison, Outcome, Study design criteria-Population: patients with PD with gait disorders; Intervention: 17 rehabilitation therapies combined with medication; Comparison: Clinical Nursing Therapy as the control; Outcome: outcomes including gait function (Time Up and Go, gait speed), gait symptoms (fall risk, freezing of gait), and activities of daily living; and Study design: RCTs only.
DATA EXTRACTION: Two independent researchers extracted data using a standardized matrix, including study characteristics, intervention details, and outcome measures. The Cochrane Risk of Bias Tool was employed for quality assessment, and the Confidence in Network Meta-Analysis framework evaluated evidence credibility.
DATA SYNTHESIS: Network meta-analysis was performed using STATA 17.0. Key findings included the following: network meta-analysis showed that, for gait function, Traditional Chinese Rehabilitation Therapy (TCRT) significantly improved gait speed (Hedges' g=1.87; 95% confidence interval [CI]: 0.70, 3.04) and Extended Reality Rehabilitation Therapy (XRRT) significantly reduced fall risk (Hedges' g=0.88; 95% CI: 0.21, 1.54). For QOL, both Hydrotherapy Rehabilitation Therapy (HRT) (Hedges' g=1.79; 95% CI: 0.69, 2.88) and Conventional Kinesitherapy (Hedges' g=1.03; 95% CI: 0.29, 1.77) demonstrated significant improvements. Although some interventions showed high Surface Under the Cumulative Ranking Curve Analysis scores, the absence of statistical significance in direct or network comparisons indicates that their potential benefits remain uncertain. Moreover, most estimates were associated with wide CIs, indicating limited strength of evidence. The overall risk of bias was low in 84.87% of the included studies.
CONCLUSION: This network meta-analysis highlights the differential efficacy of rehabilitation therapies for PD. TCRT, XRRT, Resistance Training Rehabilitation Therapy, and Upper Limb Rehabilitation Therapy showed strong evidence for improving specific gait and activities of daily living outcomes, whereas Noninvasive Brain Stimulation Therapy and HRT exhibited potential despite limited statistical significance. Clinicians should prioritize therapies with robust evidence, such as TCRT and XRRT, whereas further large-scale, standardized trials are needed to validate other interventions.