Effects of cueing techniques on gait, gait-related mobility, and functional activities in patients with Parkinson’s disease: a systematic review and meta-analysis

Abstract

Background Parkinson’s disease (PD) is a neurodegeneration of dopaminergic neurotransmitters results in disturbance in gait, balance, and impairs the functional activities. Cueing techniques which are spatial stimuli facilitating repetitive movements are used in combination with other interventions to manage these disturbances. Objectives To determine the effects of cueing techniques for PD patients on the outcomes of gait, balance, functional activity, and freezing of gait. Methods The search was conducted in Medline, CINAHL, Cochrane, OVID and PEDro databases. In addition, a manual search in Google Scholar and reference lists of the included studies was conducted. Randomized Controlled Trials (RCTs) that compare the effects of cueing techniques with other interventions on any of the previously mentioned outcomes for PD patients were included according to the eligibility criteria. Results A total of 8 RCTs were included (n = 239 participants); 5 used auditory cueing, 3 used visual, and 1 used proprioceptive. The results revealed a significant medium effect of non-cueing techniques on gait (MD of 0.41(95% CI, 0.14, 0.68; p = 0.003), a non-significant small effect of cueing on balance (MD of −0.13 (95% CI, −0.52, 0.27; p = 0.54)), and a significant effect of cueing on functional activities (MD of −0.54 (95% CI, −0.86, −0.21; p = 0.001). While no quantitative outcome measures were assessing freezing of gait, a meta-analysis for it was not applicable. Conclusions Cueing techniques are beneficial in improving functional activities and balance. It may not provide a significant change on gait parameters when compared to non-cueing techniques unless combined with other treatment programs.