JMIR Publications

ABSTRACT

Background:

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by gait disturbance, balance impairment, and reduced quality of life. Wearable devices have been proposed as assistive technologies to deliver cueing or feedback and to support rehabilitation, but their clinical efficacy remains uncertain.

Objective:

To evaluate, within the International Classification of Functioning, Disability and Health (ICF) framework, the effects of wearable-device interventions on gait performance, balance, and health-related quality of life in people with PD.

Methods:

We systematically searched multiple electronic databases up to November 18, 2025 and included randomized controlled trials. Random-effects meta-analyses with Hartung–Knapp adjustment were used to pool mean differences (MDs) or standardized mean differences (SMDs). Between-study heterogeneity (τ²) was estimated for each meta-analysis, and 95% prediction intervals were reported only when at least three studies were available for an outcome. Risk of bias was assessed using the Cochrane risk-of-bias tool, and the certainty of evidence was rated with GRADE. The review protocol was registered in PROSPERO (CRD42024585686).

Results:

Nine RCTs were included. Wearable devices produced a small improvement in stride length (MD 0.10 m, 95% CI 0.03 to 0.17; 95% prediction interval 0.00 to 0.21 m), but there was no clear benefit for 10-meter walk test time (MD 0.04 s, 95% CI −0.06 to 0.15). Double support time showed no reduction (MD −1.59% gait cycle, 95% CI −3.79 to 0.61; prediction interval −4.22 to 1.03). Freezing of gait (FOG-Q / NFOG-Q) did not significantly improve (SMD −0.24, 95% CI −0.72 to 0.24; prediction interval −0.89 to 0.41). Motor severity (UPDRS III) showed a small, non-significant trend favoring wearable devices (MD −2.16 points, 95% CI −4.39 to 0.07; prediction interval −4.85 to 0.53). For balance, pooled results from BBS, Mini-BESTest, and POMA balance suggested a borderline effect (SMD 0.48, 95% CI −0.02 to 0.98; prediction interval −0.33 to 1.30). Wearable devices did not meaningfully improve Parkinson’s Disease Questionnaire scores (SMD −0.28, 95% CI −0.74 to 0.17; prediction interval −0.91 to 0.34), EQ-5D utility (MD 0.10, 95% CI −0.24 to 0.44), or Falls Efficacy Scale–International scores (MD −0.04, 95% CI −1.10 to 1.02; prediction interval −35.66 to 35.58). Across outcomes, GRADE ratings were generally low to very low.

Conclusions:

Wearable-device interventions for PD produced small improvements in stride length but no consistent benefits for gait speed, double support time, freezing of gait, balance, health-related quality of life, or fear of falling. Wide prediction intervals and low-to-very-low certainty of evidence suggest that any benefits are modest and may not be robust across settings. Wearable technologies are therefore best considered adjuncts to, rather than replacements for, multidisciplinary rehabilitation. Larger, methodologically rigorous trials with standardized outcomes and longer follow-up are needed to determine which patients benefit and how wearable devices can be optimally integrated into PD care. Clinical Trial: Not applicable