Freezing of gait (FOG) is a major cause of falls and disability in Parkinson disease (PD). As FOG only partially improves in response to dopaminergic medication, physical therapy is an important element of its management. The aim of this systematic review is to assess the evidence for the physical interventions for FOG and gait impairments and to establish recommendations for clinical practice.
This review follows the guidelines for systematic reviews: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic search in PubMed, Embase, Physiotherapy Evidence Databases and Cinahl for randomized controlled trials of PT interventions for FOG in PD patients until April 2018.
Twenty randomized controlled trials were reviewed. In 12 RCTs, PT for FOG was assessed, which was the primary outcome measure in nine of these RCTs. In eight RCTs, PT for gait impairment (not targeting specifically FOG) in PD was assessed. The following PT interventions reduce FOG with a good category A recommendation: cueing strategies (p<0.05) (visual and auditory); treadmill walking (p<0.05); aquatic obstacle training (pVisual and auditory cueing and the treadmill training are effective interventions for FOG and gait impairments in PD patients (evidence level A- according to the EFNS). Tactile cues and other specific therapies targeting FOG are probably effective but need further studies. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.