The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson's disease: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with Parkinson's disease |
| I — Intervention | Combined motor and cognitive rehabilitation (sequential or simultaneous) |
| C — Comparator | Motor rehabilitation alone or other control interventions |
| O — Outcomes | Primary: functional mobility; Secondary: balance, gait, activities of daily living, quality of life |
Bottom Line
This systematic review and meta-analysis examined combined motor-cognitive rehabilitation in Parkinson's disease patients. While the search strategy was comprehensive, only 8 of 16 studies were suitable for meta-analysis. Results were mixed: sequential combined treatment showed no advantage over motor rehabilitation alone for the primary outcome of functional mobility, though activities of daily living improved. Simultaneous combined treatment appeared to benefit quality of life but not functional mobility. The evidence suggests potential neuroplasticity benefits through prefrontal cortex efficiency, but the clinical significance remains unclear. Given the limited and mixed evidence, routine implementation of combined motor-cognitive rehabilitation cannot be strongly recommended over standard motor rehabilitation alone. Clinicians should consider individual patient factors and resource availability. Further high-quality randomized controlled trials are needed to establish optimal intervention protocols and identify patients most likely to benefit from combined approaches.
Key Findings
P Value: Significant benefit found for activities of daily living with sequential treatment
Effect Size: Not specified in abstract
Primary Outcome: Functional mobility showed no clear advantage for combined treatment over motor rehabilitation alone
Nnt Or Sensitivity: Not calculable from available data
Confidence Interval: 95% confidence intervals used but specific values not provided
Clinical Application
Combined motor-cognitive approaches require specialized training and may increase resource requirements compared to standard motor rehabilitation Relevant to Australian neurological rehabilitation services; may require consideration under NDIS funding for Parkinson's disease patients; aligns with multidisciplinary care approaches recommended by Parkinson's Australia Patients with Parkinson's disease suitable for rehabilitation interventions
Abstract
OBJECTIVE: To evaluate the effectiveness of sequential and simultaneous motor and cognitive treatment on motor functions, activities of daily living, and quality of life in people with Parkinson's disease. DESIGN: Systematic review and meta-analysis. SUBJECTS/PATIENTS: Patients with Parkinson's disease. METHODS: A search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Functional mobility was assessed as the main outcome, and balance, gait, activities of daily living, and quality of life as secondary outcomes. Meta-analyses were conducted using mean difference or standardized mean difference with 95% confidence intervals and fixed or random effect models. Heterogeneity was explored, setting a cut-off value of I2 = 50%. RESULTS: Sixteen studies were included, with 8 -eligible for meta-analysis. Results showed that sequential combined treatment offered no clear advantage over motor rehabilitation alone for functional mobility, although a significant benefit was found for activities of daily living. Results on simultaneous combined treatment suggested improvements in quality of life, but no significant differences between treatments for functional mobility. CONCLUSION: Motor-cognitive approaches may enhance prefrontal cortex efficiency, supporting complex motor tasks and reducing the risk of falls. Future research should elucidate neural mechanisms and compare simultaneous and sequential strategies to develop personalized, multidisciplinary rehabilitation protocols.
References
- 1.Cacciante, L., Lando, A., Ozcan, E. G., D'Imperio, D., Meroni, R., Guzik, A., Drużbicki, M., Cieślik, B., & Kiper, P. (2026). The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson's disease: a systematic review and meta-analysis. Journal of Rehabilitation Medicine, 58, Article 45360. https://doi.org/10.2340/jrm.v58.45360
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