Effects of digital technology-based interventions on balance function and non-motor outcomes in Parkinson’s disease: a systematic review and meta-analysis

Abstract

Background Various digital technologies have been adopted for rehabilitation training and extended care in patients with Parkinson’s disease (PD), yet their effectiveness remains unclear. This review aims to evaluate the effectiveness of digital technology-based interventions on balance and non-motor outcomes (cognitive function, depression, and quality of life) in individuals with PD. Methods We systematically searched six electronic databases (PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO) in March 2026. Two reviewers independently screened randomized controlled trials (RCTs) meeting the inclusion criteria and assessed methodological quality using the Cochrane RoB Tool. We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs) to pool effect sizes for studies with consistent outcome measures, and performed subgroup analyses by intervention type, duration, and frequency. Results We included 29 RCTs with 1,298 PD patients. Meta-analysis revealed that versus the control group, digital technology-based interventions were associated with favorable improvements in balance function (SMD = 0.62, 95%CI 0.16 to 1.09) and cognitive function (SMD = 0.50, 95% CI 0.18 to 0.83) in patients with PD. No significant improvements were found in depression (SMD = −0.17, 95% CI −0.42 to 0.09) or quality of life (SMD = 0.01, 95% CI −0.15 to 0.16). Exploratory subgroup analyses suggested that virtual reality (SMD = 0.88, p = 0.02), robotics (SMD = 0.49, p = 0.03), interventions lasting ≥ 8 weeks (SMD = 2.91, p < 0.0001), 3 weekly sessions (SMD = 0.36, p = 0.03), > 3 weekly sessions (SMD = 2.77, p = 0.002), and active exercise training (SMD = 0.75, p = 0.006) might be associated with improvements in balance function in PD patients. Conclusion Digital technology-based interventions have the potential to enhance balance and cognitive function in PD patients, while their effects on depression and quality of life remain inconclusive. Exploratory subgroup analyses showed that virtual reality, robotic training, intervention duration ≥8 weeks, frequency ≥3 sessions per week, and active exercise training were associated with improvements in balance function, though these findings should be considered hypothesis-generating. Given the high heterogeneity, unstable sensitivity analysis for the primary outcome, high risk of performance bias across all trials, and unclear allocation concealment in most studies, the current evidence remains preliminary, and its clinical value requires confirmation through further high-quality research. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628620, identifier (CRD42024628620).