Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson’s Disease: A Systematic Review

Table 1

Compend of studies examining different nonpharmacological strategies aiming to improve the balance in PD and their psychological benefits.

Author (citation)	Training method	Class of evidence	Training time	Sample size	Outcome measure	Balance improvement	Psychological benefits
General exercise and physiotherapy
Schenkman et al. [10]	Exercise	1c	10 weeks	23 + 23	FAR, FR	Yes
Toole et al. [11]	Balance and strength training program	1c	10 weeks		Equilibrium, knee flexion/extension strength	Yes
Hirsch et al. [12]	Balance training and high-intensity resistance training	1c	10 weeks	15	SOT	Yes
Ashburn et al. [13]	Exercise	1c; 1c	8 weeks; 8 weeks	70 + 72; 70 + 72	FR, [lower fall rates]; BBS, SPDDS	Yes; No	QoL
Gobbi et al. [14]	Intensive exercise program; Adaptive program	1c; 1c	6 months; 6 months	21; 13	BBS, TUG; BBS, TUG	Yes; Yes
Wong-Yu Is and Mak [15]	Balance exercise	1c	8 months	26 + 26	MiniBESTest, ABC, MDS-PIGD	Yes
Nocera et al. [16]	Home-based exercise on postural control	1c	10 weeks	10 + 10	CDP, SOT	Yes
Kara et al. [17]	Supervised exercise	2b	12 weeks	17	Balance Master protocol	Yes
Frazzitta et al. [18]	Intensive rehabilitation treatment	2b	4 weeks	130	UPDRS II and III, SPDDS, BBS, 6 MWT	Yes
Frazzitta et al. [18]	Balance training	2b	12 weeks	5	MiniBESTest	Yes
Capecci et al. [19]	Postural rehabilitation; Kinesio taping	1c; 1c	4 weeks; 4 weeks	(7 + 6) + 7; (7 + 6) + 7	BBS, TUG, trunk bending; BBS, TUG, trunk bending	Yes; Yes
Conradsson et al. [20]	Progressive group balance training	2b	12 weeks	5	MiniBESTest	Yes	Motivated to continue
Dibble et al. [21]	High intensity eccentric resistance training	1c	12 weeks	10 + 10	UPDRS III, 10 MWT, TUG	Yes	QoL
Corcos et al. [22]	Progressive resistance exercise	1c	2 years	20 + 18	UPDRS III	Yes	QoL
Treadmill
Herman et al. [23]	Treadmill	2b	6 weeks	9	PDQ-39, UPDRS III, WV,; Swing time variability, SPPB	Yes; Yes	QoL
Ganesan et al. [24]	Weight-supported treadmill	1c	4 weeks	20 + 20	UPDRS III, MLI, BBS, LOS, POMA	Yes
Bello et al. [25]	Treadmill	1c	5 weeks	11 + 11	Preferred speed walking, SL at the preferred; Maximal WV, TUG, Static posturography	Yes; Yes
Cakit et al. [26]	Speed-dependent treadmill	1c	8 weeks	21 + 10	Walking distance, Tolerated maximum speed,; BBS, DGI, FES	Yes; Yes
Toole et al. [27]	Treadmill	1c	6 weeks	23	Dynamic posturography, falls, BBS, UPDRS III	Yes
Filippin et al. [28]	Treadmill with additional body load	2b	18 weeks	9	UPDRS III	Yes	QoL
Robotic gait training
Picelli et al. [29]	Robotic gait training	1c	3 weeks	21 + 20	10 MWST, 6 MWT	Yes
Picelli et al. [30]		1c	4 weeks	17 + 17	BBS, NUTT	Yes
Paker et al. [31]	Robotic treadmill training	2b	5 weeks	70	TUG test, 10 MWT, UPDRS	Yes	QoL
Tai Chi, Qi Gong, and  Yoga
Hackney and Earhart [32]	Tai Chi	1c	10–13 weeks	17 + 16	BBS, UPDRS, TUG, tandem stance test,; 6 MWT, backward walking; Forward walking, UST	Yes; Yes; No
Tsang [33]		1c	24 weeks	65 + 65 + 65	Maximum excursion, Direction control, SL, FR,; knee flexion/extension, TUG, UPDRS III, falls	Yes; Yes
Li and Fitzgerald [34]		1c	24 weeks	65 + 65 + 65	LOS (maximum excursion, directional control),; SL, WV, FR, TUG, UPDRS III, RoF	Yes; Yes
Kim et al. [35]		2b	12 weeks	12	Dynamic postural stability	Yes
Gao et al. [36]		1c	12 weeks	37 + 39	BBS, falls; UPDRS III, TUG	Yes; No
Amano et al. [37]		1c	16 weeks	23 + 22	UPDRS III	No
Loftus [38]	Qi Gong	2b	3 months	41	BBS, falls	Yes
Sharma et al. [39]	Yoga	1c	12 weeks	8 + 5			QoL
Boulgarides et al. [40]		2b	8 weeks	10	SLB	Yes	HADS
Virtual reality
Esculier et al. [41]	Nintendo Wii	2b	6 weeks	10 + 8	TUG, STST, UST, 10 MWT,; CBM, POMA, force platform	Yes; Yes
Mhatre et al. [42]		2b	8 weeks	10	BBS, DGI, postural sway, Romberg with eyes closed; Activities-specific Balance Confidence	Yes; No
Herz et al. [43]		2b	4 weeks	20	UPDRS III, TUG	Yes	QoL
Pompeu et al. [44]		1c	7 weeks	16 + 16	BBS, UST	Yes
Pompeu et al. [45]	Kinect adventures	2b	5 weeks	7	6 MWT, BEST, DGI, PDQ-39	Yes
Summa et al. [46]	Kinect	2b	5 weeks	5	TUG, 10 MWT, reduction of movement duration and curvature, movement acceleration	Yes; Yes
Shih et al. [47]	Xbox Kinect	1c	4 weeks	10	AT, [LOS, AT, TUG]	Yes
Shih et al. [47]	Virtual reality-augmented balance training	1c	6 weeks	14 + 14 + 14	SOT; Attentional demand for postural control	Yes; No
van den Heuvel et al. [48]	Augmented visual feedback	1c	5 weeks	17 + 16	[BBS, the single leg stance test, 10 MWT]	No
Lee et al. [49]	Virtual reality dance exercise	1c	6 weeks	10 + 10	BBS	Yes	BDI
Neurofeedback
Azarpaikan et al. [50]	Neurofeedback	1c	2, 5 weeks	8 + 8	Biodex, BBS	Yes
Mirelman et al. [51]	Audiobiofeedback	2b	6 weeks	7	BBS, [TUG]	Yes	GDS, PDQ-39
Asseman et al. [52]	Vibrotactile neurofeedback	2b	2 weeks	10	Body sway, RoF, SOT, DHI, ABC	Yes
Dance
Marchant et al. [53]	Contact improvisation dance	2b	2 weeks	11	UPDRS III, BBS, increased swing and decreased	Yes	Reported enjoyment, motivated to continue
					Stance % during walking, backward step length	Yes
Batson [54]	Modern dance	2b	3 weeks; 3 weeks	11; 11	FAB; TUG	Yes; No
Hackney and Earhart [55]		2b	10 weeks	39	BBS, WV, cadence	Yes	Reported enjoyment, motivated to continue
Heiberger et al. [56]	Dance	2b	8 months; 8 months	11; 11	UPDRS III; TUG, SeTa	Yes; No	QoL
Rosario et al. [57]		2b	9 weeks	8	TUG	Yes
Hashimoto et al. [58]		1c	12 weeks	46	TUG, BBS, FAB, UPDRS	Yes	AS, SDS
Westheimer et al. [59]		2b	8 weeks	12	UPDRS III	Yes	Reported emotional and social benefits
			8 weeks	12	BBS	No
Houston and McGill [60]	Ballet	2b	12 weeks		FAB	Yes
Hackney and Earhart [61]	Tango	2b	2 weeks	14	BBS, UPDRS III, time in stance during forward walking	Yes
			2 weeks	14	TUG, 6 MWT	No
Hackney and Earhart [62]		1c	13 weeks	19 + 19 + 19 + 18	QoL	Yes	QoL
Hackney et al. [63]		1c	12 weeks	19 + 19	ABC, Modified FES, FR, UST, WV	Yes	Reported enjoyment
Romenets et al. [64]		1c	12 weeks	18 + 15	Mini-BESTest, TUG time, [FSS]	Yes	Reported enjoyment, felt “overall” treatment satisfaction
Deep brain stimulation
Nilsson et al. [65]	STN stimulation	2b		10	BBS, FES, posturography	Yes
Other methods
Vivas et al. [66]	Aquatic therapy	1c	2 weeks	6 + 5	FRT, BBS, UPDRS	Yes
Ebersbach et al. [67]	Whole Body Vibration	1c	6 weeks	13 + 14	Tinetti Balance Scale, stand-walk-sit test,	Yes
Lauhoff et al. [68]	Cycle ergometry	2b	6 weeks	23	BBS, TUG, ADL, UPDRS III.	Yes
Kaski et al. [69]	Exercise + tDCS	1c	1 weeks	8 + 8	PT, WV	Yes
Shen and Mak [70]	Repetitive step training	1c	4 weeks	6 + 6	Reaction time, movement velocity, LOS, UPDRS-PG	Yes
Morris et al. [71]	Movement strategies	1c	2 weeks	14 + 14	UPDRS, 10 MWT, balance	Yes

ABC: Activities-Specific Balance Confidence Scale; API: Anteroposterior Index; AS: apathy scale; AT: Adaptation Test; BBS: Berg Balance Scale; BDI: Beck Depression Inventory; BEST: Balance Evaluation Systems Test; CBM: Community Balance and Mobility Assessment; CDP: computerised dynamic posturography; DGI: Dynamic Gait Index; DHI: Dizziness Handicap Inventory; FAB: Fullerton Advanced Balance Scale; FAR: functional axial rotation; FES: Falls Efficacy Scale; FR: functional reach; HADS: Hospital Anxiety and Depression Scale; MDS-PIGD: Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-postural instability, gait difficulty score; LOS: limits of stability; MLI: Mediolateral Index; MiniBESTest: Minibalance Evaluation Systems Test; NUTT: Nutt’s rating; OBI: Overall Balance Index; PDQ-39: Parkinson’s Disease Questionnaire; POMA: Performance-Oriented Mobility Assessment; PT: Pull Test; QoL: quality of life; RoF: Rates of falling; SDS: Self-Rating Depression Scale; SeTa: semitandem test; SL: stride length; SOT: Sensory Organization Test; SPPB: Short Physical Performance Battery; SPDDS: Self-Assessment Parkinson’s Disease Disability Scale; STST: Sit-to-Stand test; TUG: Timed Up and Go Test; UPDRS III.: Unified Parkinson’s disease rating scale-Part III. Motor examination; UPDRS-PG: Unified Parkinson’s disease rating scale-Posture and Gait; UST: Unipedal Stance Test; WV: Walking Velocity; 6 MWT: 6-Minute Walking Test; 10 MWST: 10-Minute Walking Speed Test; w: weeks; m: months;   : trends.