Article

Postural instability and freezing of gait (FOG) are key features of Parkinson's
disease (PD) that are closely related to falls. Uncovering the postural control
differences between individuals with and without FOG contributes to our
understanding of the relationship between these phenomena.
The objective of this
meta-analysis was to investigate whether postural control deficits, as detected
by clinical balance scales, were more apparent in FOG+ compared to FOG-.
Furthermore, we aimed to identify whether different scales were equally sensitive
to detect postural control deficits and whether medication affected postural
control differentially in each subgroup. Relevant articles were identified via
five electronic databases. We performed a meta-analysis on nine studies which
reported clinical balance scale scores in 249 freezers and 321 non-freezers.
Methodological analysis showed that in 5/9 studies disease duration differed
between subgroups. Despite this drawback, postural control was found to be
significantly worse in FOG+ compared to FOG-. All included clinical balance
scales were found to be sufficiently sensitive to detect the postural control
differences. Levodopa did not differentially affect postural control (p=0.21), as
in both medication states FOG+ had worse postural stability than FOG-. However,
this finding warrants a cautious interpretation given the limitations of the
studies included. From subscore analysis, we found that reactive and dynamic
postural control were the most affected postural control systems in FOG+. We
conclude that our findings provide important evidence for pronounced postural
instability in individuals with FOG, which can be easily picked up with clinical
evaluation tools. Posturographic measures in well-matched subgroups are needed to
highlight the exact nature of these deficits.
CI - Copyright (c) 2017 Elsevier B.V. All rights reserved.

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