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

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. (C) 2021 Australian Physiotherapy Association. Published by Elsevier B.V.

Automated summary

A systematic review with meta-analyses of randomized clinical trials found that the addition of tDCS to walking training in patients with Parkinson's disease did not provide clinically significant benefits in walking outcomes such as speed, step length, and cadence. There was no evidence to suggest an effect of tDCS on freezing of gait, falls, or social participation in these patients.