Effects of Rhythmic Auditory Stimulation Using Sensory Feedback-Based Wearable Devices on Gait and Balance in Patients with Parkinson’s Disease: A Systematic Review and Meta-Analysis = 감각 피드백 기반 착용형 장치를 활용한 리듬청각자극이 파킨슨 환자의 보행과 균형에 미치는 영향: 체계적 고찰과 메타분석

다국어 초록 (Multilingual Abstract)

This paper presents a systematic review and meta-analysis to identify the effects of Rhythmic Auditory Stimulation （RAS） delivered via wearable devices on the gait and balance in patients with Parkinson’s disease. The PICO criteria were established according to the PRISMA 2020 guidelines, and literature searches were performed across five databases covering studies published between 2015 and 2025: PubMed, Embase, Cochrane, Scopus, and Web of Science. After applying the inclusion criteria, eleven randomized controlled trials （RCTs） were selected. The quality of the studies was evaluated using the PEDro Scale and ROB-2. Statistical analyses were performed using Review Manager 5.4 based on the number of samples, means, and standard deviations to calculate the effect sizes. The analysis results showed that wearable RAS significantly improved the gait speed （SMD = 0.49, p〈 0.05） and balance ability （SMD = 0.40, p〈 0.05）, while no significant differences in the gait pattern, FOG-Q, or UPDRS-III were observed. The heterogeneity among studies was low, and the funnel plots were distributed symmetrically, indicating minimal publication bias. The average PEDro score was 7.33, suggesting moderate-to-high methodological quality. wearable RAS was identified as an evidence-based intervention effective in improving the gait speed and balance in patients with Parkinson’s disease.

국문 초록 (Abstract)

본 연구는 웨어러블 기기를 통해 제공되는 리듬청각자극（Rhythmic Auditory Stimulation, RAS）이 파킨슨병 환자의 보행 및 균형에 미치는 효과를 확인하기 위하여 체계적 문헌고찰 및 메타분석을 시행하였다. PRISMA 2020 지침에 따라 PICO 기준을 설정하였으며, 2015년부터 2025년까지 출판된 연구를 대상으로 PubMed, Embase, Cochrane, Scopus 및 Web of Science의 5개 데이터베이스에서 문헌검색을 시행하였다. 선정기준을 적용한 결과, 11편의 무작위 대조군 연구（randomized controlled trials, RCTs）가 선정되었다. 연구의 질은 PEDro Scale과 ROB-2를 사용하여 평가하였다. 분석 결과, 웨어러블 기기를 활용한 리듬청각자극은 보행속도（SMD = 0.49, p 〈 0.05）와 균형능력（SMD = 0.40, p 〈 0.05）을 유의하게 향상시켰다. 반면, 보행패턴, FOG-Q 및 UPDRS-III에서는 유의한 차이가 관찰되지 않았다. 연구 간 이질성은 낮았으며, 깔때기 그림은 대칭적으로 분포하여 출판편향이 낮은 것으로 나타났다. PEDro 평균 점수는 7.33점으로, 중등도에서 높은 수준의 방법론적 질을 나타냈다. 따라서 웨어러블 기기를 활용한 리듬청각자극은 파킨슨병 환자의 보행속도와 균형을 향상시키는데 효과적인 근거 기반 중재로 확인되었다.

목차 (Table of Contents)

• Ⅰ. Introduction 1
• 1. Necessity of study 1
• 2. Purpose and Hypothesis of the Study 6
• Ⅱ. Theoretical background 7
• 1. Parkinson’s disease （PD） 7
• 2. Rhythmic Auditory Stimulation （RAS） 10
• 3. Wearable Device 12
• 4. Systematic review 14
• 5. Meta-analysis 16
• Ⅲ. Method 17
• 1. Research Design and Procedure 17
• 1） PICO formulation 17
• 2. Information and Search Strategy 18
• 3. Critetia for Inclusion and Exclusion of Data 21
• 1） Inclusion Criteria 21
• 2） Exclusion Criteria 22
• 4. Data Extraction and Organization 23
• 5. Data Analysis 24
• 6. Assessment of Study Quality 26
• 1） PEDro scale 26
• 2） ROB-2 （Risk of Bias 2.0） 28
• 3） GRADE 30
• IV. Result 31
• 1.General Overview of Selected Studies 31
• 1） General Characteristics of Studies 31
• 2） Protocol of Rhythmic Auditory Stimulation 32
• 2. Quality and Risk of Bias Assessment of Selected Studies 37
• 1） Methodological Quality Assessment（PEDro Scale） 37
• 2） Summary and Distribution of Risk of Bias（ROB-2） 38
• 3. Meta-Analysis 40
• 1） Meta-Analysis and Publication Bias of Gait Speed 40
• 2） Meta-Analysis and Publication Bias of Cadence 42
• 3） Meta-Analysis and Publication Bias of Gait Spatial 44
• 4） Meta-Analysis and Publication Bias of Gait Variability 46
• 5） Meta-Analysis and Publication Bias of Balance Ability 48
• 6） Meta-analysis and publication bias for FOG-Q 50
• 7） Meta-analysis and publication bias for UPDRS-III 52
• 4. GRADE 54
• V. Discussion 56
• VI. Conclusion 65
• Reference 66
• Abstract 75
• Appendix 76