Motor and non-motor outcomes post rehabilitation for persons with freezing of gait and Parkinson's disease: A systematic review and Meta-analysis
Abstract
Introduction Freezing of gait (FOG), a symptom of Parkinson's disease (PD), involves dysfunction across motor, cognitive, and limbic domains. Rehabilitation for PD traditionally emphasizes motor impairments, leaving non-motor FOG contributors underexplored, which may contribute to limited understanding of mechanisms underlying FOG or optimal FOG rehabilitation. To investigate this, we quantified within-group clinical outcomes related to postural control, executive function, and limbic domains to evaluate the impacts of rehabilitation studies on multidomain FOG pathophysiology in people with PD and FOG (PD + FOG). Methods Search of PubMed and CINAHL used terms PD, FOG, rehabilitation, postural control, cognitive, and limbic outcomes. Full-text articles were assessed by two reviewers to confirm their eligibility. Eligible studies utilized >1 rehabilitation intervention session, reported pre- and post-training data for ≥1 FOG-related symptom domain outcome specifically for PD + FOG. Fixed or random effect meta-analyses were conducted for each domain, resulting in summary effect sizes Cohen's d (95% confidence interval) reflecting standardized within-group changes. Results The search returned eighteen studies eligible for data extraction. Postural control results: 17 unique participant groups (n = 458), d = 0.49 (0.36, 0.62). Cognitive processing results: 8 unique participant groups (n = 193), d = −0.22 (−0.42, −0.02). Limbic (anxiety, depression) results: 4 unique participant groups (n = 55), d = −0.08 (−0.45, 0.30). Discussion Postural control and cognitive domain outcomes demonstrated significant post-intervention improvements following rehabilitation for PD + FOG. Limbic domain results showed small, nonsignificant pre-post changes. Few studies reported clinical outcome measures covering motor and non-motor domains. Further studies should assess motor and non-motor FOG-related domains and more comprehensive rehabilitation approaches for PD + FOG populations.