Biofeedback in Parkinson's disease: A systematic review with meta-analysis.

ObjectivesThe objective was to examine whether the addition of biofeedback to practice is effective in improving lower limb activity compared with practice alone for people with Parkinson's disease.Data sourcesFour databases were searched for randomised trials of adults with idiopathic Parkinson's disease. Trials included biofeedback delivered concurrently during practice of sitting, standing up, standing and/or walking compared with the same amount of practice without biofeedback. Outcomes were measures of activity congruent with the activity trained, such as Berg Balance Scale, Timed Up and Go test, and walking speed.Review methodSystematic review with meta-analyses of randomised trials following PRISMA guidelines, using the PEDro scale for risk of bias and GRADE to determine quality of evidence.ResultsTwenty trials were included, involving 814 participants. Biofeedback during the practice of sitting and standing increased Berg Balance Scale score by 1.5 out of 56 (95% CI 0.7 to 2.3), biofeedback during the practice of standing and walking decreased Timed Up and Go time by 0.2 s (95% CI -1.4 to 1.8), and biofeedback during the practice of walking increased walking speed by 0.02 m/s (95% CI -0.06 to 0.1). The quality of the evidence was high for balance, moderate for mobility, and low for walking.ConclusionThis systematic review provides evidence that the addition of biofeedback to the practice of lower limb activities is no more effective than practice alone in people with Parkinson's disease.