The effect of functional-task training on activities of daily living for people with Parkinson's disease, a systematic review with meta-analysis

Objective: To evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson's Disease. Methods: We searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in a meta-analyses and heterogeneity was explored by meta-regression analysis. Results: Out of 2546 identified studies, 69 full texts articles were checked for eligibility, of which ten were included in the systematic review. Moderate quality of evidence indicated that exercise interventions containing functional-task training had a positive effect on ADL performance scores on the Unified Parkinson's Disease Rating Scale (UPDRS) in people with Parkinson (pwp) directly after intervention (UPDRS=-2.62(-5.34;0.10)). This effect improved, in favor of functional-task interventions, at the first follow-up (UPDRS=-4.0(-7.56;0.4)). A post-hoc meta-regression analysis yielded a significant relationship between intensity rate (minutes/ week) and the size of the (average) effect on ADL score. Conclusion: Exercise interventions containing functional-task training have a clinically important positive effect on ADL performance in pwp directly after intervention and at first follow-up, compared to no intervention or placebo. The intensity rate of the functional-task training should be as intense as possible, within the capabilities of the person with PD. Future research is necessary to determine the exact amount of effect that can be contributed to functional-task training.