Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review.
Study Goal
The researchers aimed to determine if combining walking training with tDCS improves walking metrics (speed, cadence, step length), reduces falls and freezing, and enhances social participation in people with Parkinson's disease, compared to walking training alone or no/sham intervention.
Results Summary
The study found that adding tDCS to walking training provided negligible additional benefits over walking training alone for walking speed, step length, or cadence. No evidence was available to assess effects on freezing of gait, falls, or social participation.
Population
Ambulatory adults with a clinical diagnosis of Parkinson's disease.
Effective Dosage
Training sessions lasted 30 to 60 minutes, conducted two to three times per week.
Duration
Average intervention period was 4 weeks.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
tDCS combined with walking training | no change | walking speed | ambulatory adults with a clinical diagnosis of Parkinson's disease | MD -0.01 m/s, 95% CI -0.05 to 0.04 | produced negligible additional benefit over the effect of walking training alone | #1 |
tDCS combined with walking training | no change | step length | ambulatory adults with a clinical diagnosis of Parkinson's disease | MD 1.2 cm, 95% CI -1.2 to 3.5 | produced negligible additional benefit over the effect of walking training alone | #2 |
tDCS combined with walking training | no change | cadence | ambulatory adults with a clinical diagnosis of Parkinson's disease | MD -3 steps/minute, 95% CI -6 to 1 | produced negligible additional benefit over the effect of walking training alone | #3 |
tDCS combined with walking training | no change | freezing of gait | ambulatory adults with a clinical diagnosis of Parkinson's disease | - | No evidence was identified with which to estimate the effect | #4 |
tDCS combined with walking training | no change | falls | ambulatory adults with a clinical diagnosis of Parkinson's disease | - | No evidence was identified with which to estimate the effect | #5 |
tDCS combined with walking training | no change | social participation | ambulatory adults with a clinical diagnosis of Parkinson's disease | - | No evidence was identified with which to estimate the effect | #6 |
QUESTIONS: Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN: A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS: Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION: tDCS combined with walking training. OUTCOME MEASURES: Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS: Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION: The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION: PROSPERO CRD42020162908.