Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review

• Main Authors: Lucas Rodrigues Nascimento, Willian Assis do Carmo, Gabriela Pinto de Oliveira, Fernando Zanela da Silva Arêas, Fernanda Moura Vargas Dias
• Format: Article
• Language: English
• Published: Elsevier 2021-07-01
• Series: Journal of Physiotherapy
• Subjects: Parkinson's disease; Rehabilitation; Gait; tDCS; Exercise therapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S1836955321000461

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.