Freezing of gait is considered one of the most disabling gait disorders in patients with PD. An effective treatment for freezing of gait is missing, thus current management requires a multidisciplinary approach. Among treatment options, physiotherapy is acknowledged to be crucial; however, a systematic review that demonstrates its efficacy is missing. This review aims at examining the short‐ and long‐term effects of physiotherapy in improving freezing of gait in PD patients. Five electronic databases were searched for English‐language full‐text articles, and only randomized controlled trials were considered. The freezing of gait questionnaire was selected as the primary outcome measure because it is the only validated measure used to evaluate the severity and impact of freezing of gait on patients’ daily life. From 1,130 trials, 19 relevant studies, including 913 patients, were selected. The included studies varied for sample size, methodology, and type of intervention. None of the studies had a low risk of bias, but the majority of randomized control trials presented a low risk for at least 6 of 13 biases. Our findings provide evidence for short‐term effectiveness of physiotherapy in improving freezing of gait (physiotherapy vs. no treatment: effect size = –0.28 [–0.45, –0.11], P = 0.001; physiotherapy vs. control: effect size = 0.43 [–0.65, –0.21], P < 0.0001), particularly when tailored interventions are applied. These results seem to be maintained at the follow‐up examinations (effect size = –0.52 [–0.78, –0.26]; P = 0.001). Promising findings on the potential benefits of physiotherapy in improving freezing of gait were found, although further randomized control trial studies are still needed. Questions remain on the type and duration of intervention that best fits for treating freezing of gait symptom in PD. © 2019 International Parkinson and Movement Disorder Society

中文翻译：

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物理疗法对帕金森病步态冻结的有效性：系统评价和荟萃分析

步态冻结被认为是 PD 患者最致残的步态障碍之一。缺乏一种有效的步态冻结治疗方法，因此目前的管理需要多学科的方法。在治疗选择中，理疗被认为是至关重要的。然而，缺乏证明其有效性的系统评价。本综述旨在检查物理疗法在改善 PD 患者步态僵硬方面的短期和长期影响。搜索了五个电子数据库中的英文全文文章，只考虑了随机对照试验。冻结步态问卷被选为主要结局指标，因为它是唯一经过验证的用于评估步态冻结对患者日常生活的严重程度和影响的量度。从 1,130 次试验中，共纳入19项相关研究，包括913例患者。纳入的研究因样本量、方法和干预类型而异。没有一项研究具有低偏倚风险，但大多数随机对照试验的 13 项偏倚中至少有 6 项存在低风险。我们的研究结果为物理疗法在改善步态冻结方面的短期有效性提供了证据（物理疗法与未治疗：效果大小 = –0.28 [–0.45, –0.11]，P = 0.001；物理疗法与对照：效果大小 = 0.43 [ –0.65, –0.21], P < 0.0001)，尤其是在应用量身定制的干预措施时。这些结果似乎在后续检查中保持不变（效果大小 = –0.52 [–0.78, –0.26]；P = 0.001）。发现了关于物理疗法在改善步态冻结方面的潜在益处的有希望的发现，尽管仍需要进一步的随机对照试验研究。问题仍然存在于最适合治疗 PD 步态冻结症状的干预类型和持续时间。© 2019 国际帕金森和运动障碍协会