A systematic review on the effectiveness of perturbation-based balance training in postural control and gait in Parkinson's disease.

BACKGROUND

Pharmacological and surgical interventions do not improve postural control and gait effectively in people with Parkinson's disease (PD). An innovative and promising therapeutic intervention is perturbation-based balance training (PBT).

OBJECTIVE

To perform a systematic review to summarise the current evidence for PBT on postural control and gait in people with PD. Intervention studies including PBT, in isolation or associated with other physical interventions, were included.

LITERATURE SURVEY

PubMed, SciELO, PEDro and Cochrane databases were searched between June 2000 and March 2020.

METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and is registered in the PROSPERO database (CRD42020203961). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. Studies were assessed for methodological quality using the PEDro scale. Two of the authors reviewed the search results and selected studies using predefined selection criteria. No restrictions based on severity of PD, time since diagnosis or age were used.

SYNTHESIS

Eleven studies were selected for final evaluation. Most outcomes were downgraded in quality of evidence, mainly because of publication bias and limitations. The most consistent results indicate that PBT can improve postural control and gait in people with PD, including a reduction in the number of falls and a decrease in the severity of PD.

CONCLUSION

PBT may be a promising option for the treatment of people with PD, and an adjunct to conventional physiotherapeutic treatment. However, deficiencies in the methodological quality and quality of evidence of studies included in this review have limited the reliability of the conclusions.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020203961.