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.

Abstract

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. A comprehensive search was conducted across six databases. The search included randomized controlled trials published in English or Chinese, focusing on PD patients with gait disturbances. A total of 137 RCTs involving 2,006 PD patients were included. Studies were selected based on predefined PICOS criteria: (P) PD patients with gait disorders, (I) 17 rehabilitation therapies combined with medication, (C) Clinical Nursing Therapy (CNT) as the control, (O) outcomes including gait function (Time Up and Go [TUG], gait speed), gait symptoms (fall risk, freezing of gait [FOG]), and ADL, (S) RCTs only. 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. Network meta-analysis was performed using STATA 17.0. Key findings included: Network meta-analysis showed that, for gait function, TCRT significantly improved gait speed (Hedges' g = 1.87, 95% CI [0.70, 3.04]) and XRRT significantly reduced fall risk (Hedges' g = 0.88, 95% CI [0.21, 1.54]). For quality of life (QOL), both HRT (Hedges' g = 1.79, 95% CI [0.69, 2.88]) and CKT (Hedges' g = 1.03, 95% CI [0.29, 1.77]) demonstrated significant improvements. Although some interventions showed high SUCRA 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 confidence intervals, indicating limited strength of evidence. The overall risk of bias was low in 84.87% of the included studies. This network meta-analysis highlights the differential efficacy of rehabilitation therapies for PD. TCRT, XRRT, RTRT, and ULRT showed strong evidence for improving specific gait and ADL outcomes, while NIBST and HRT exhibited potential despite limited statistical significance. Clinicians should prioritize therapies with robust evidence, such as TCRT and XRRT, while further large-scale, standardized trials are needed to validate other interventions.