Traditional Chinese exercises for the treatment of neuropsychiatric symptoms in Parkinson's disease: A systematic review and meta-analysis

Abstract

Objective: To systematically evaluate the efficacy of traditional Chinese exercises (TCEs) for neuropsychiatric symptoms (NPSs) in patients with Parkinson's disease.

Methods: A comprehensive literature search was performed across eight databases, including PubMed, Cochrane Library, Embase, Web of Science (WoS), SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database, covering studies published from their inception up to April 23, 2024. The search focused on identifying randomized controlled trials (RCTs) assessing the effectiveness of TCEs for NPSs in PD patients. The authors independently performed literature screening and data extraction. Meta-analysis was executed employing Review Manager V.5.3 software, and Stata 17.0 was used to detect publication bias and perform sensitivity analysis. GRADEpro GDT was used to grade the certainty of each outcome evidence.

Results: Eighteen studies involving 937 participants were included. The meta-analysis showed significant improvements in depression-related scales (standardized mean difference (SMD) = -1.30, 95 % confidence interval (CI): -2.10 to -0.49, p = 0.002), anxiety-related scales (SMD = -1.11, 95 %CI: -2.14 to -0.08, p = 0.03), sleep disorder-related scales (SMD = -0.71, 95 %CI: -0.99 to -0.43, p < 0.00001), and cognition-related scales (SMD = 0.91, 95 %CI: 0.44-1.38, p = 0.0001). Quality of life also improved (SMD = -1.35, 95 % CI: -2.38 to -0.31, p = 0.01; SMD = 0.99, 95 % CI: 0.54-1.43, p < 0.0001). Subgroup analyses grounded in the duration of the intervention suggested that interventions lasting up to 12 weeks showed more significant anti-depression and anti-anxiety effects while those lasting beyond 12 weeks demonstrated greater improvements in sleep quality and cognitive function. Additionally, subgroup analyses based on the type of intervention revealed that both using TCEs alone and the combination of TCEs with conventional medications showed greater effects on anti-depression and cognitive function, while the latter yield more significant anti-anxiety effects. However, no statistical significance was found for fatigue-related scales. The clinical trials included in this review also lacked a thorough description of the randomization process, and only a small proportion reported adequate allocation concealment procedures, raising concerns about potential selection bias. Moreover, owing to the inherent characteristics of TCEs, blinding both participants and practitioners is challenging, which may result in performance bias. Additionally, the absence of blinding could allow assessors' subjective influences to affect the outcomes, leading to detection bias. The overall quality of the evidence, as assessed according to the GRADE criteria, was rated as very low or low for most of outcomes.

Conclusions: The findings indicated that the use of TCEs may have potential to alleviate the severity of NPSs including depression, anxiety, sleep disorders, and enhance cognition function and overall quality of life in PD patients. Nevertheless, given the limited number of studies and their methodologic issues such as the absence of blinding, along with the small sample sizes, significant heterogeneity across these primary studies, careful interpretation of the results is warranted. More high-quality research with larger sample sizes, including double-blind studies or those employing an active control group involving exercises such as walking, ought to be carried out to validate the above findings and strengthen the evidence base.

Registration: PROSPERO: CRD42024540164.

Keywords: Meta-analysis; Neuropsychiatric symptoms; Parkinson’s disease; Traditional Chinese exercises.