{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:14:49Z","timestamp":1793146489175,"version":"4.5.0"},"reference-count":51,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JRM"],"abstract":"<jats:p>Objective: To evaluate the effectiveness of sequential and simultaneous motor and cognitive treatment on motor functions, activities of daily living, and quality of life in people with Parkinson\u2019s disease.\nDesign: Systematic review and meta-analysis.\nSubjects\/Patients: Patients with Parkinson\u2019s disease.\nMethods: A search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Functional mobility was assessed as the main outcome, and balance, gait, activities of daily living, and quality of life as secondary outcomes. Meta-analyses were conducted using mean difference or standardized mean difference with 95% confidence intervals and fixed or random effect models. Heterogeneity was explored, setting a cut-off value of I2\u2009=\u200950%.\nResults: Sixteen studies were included, with 8 -eligible for meta-analysis. Results showed that sequential combined treatment offered no clear advantage over motor rehabilitation alone for functional mobility, although a significant benefit was found for activities of daily living. Results on simultaneous combined treatment suggested improvements in quality of life, but no significant differences between treatments for functional mobility.\nConclusion: Motor-cognitive approaches may enhance prefrontal cortex efficiency, supporting complex motor tasks and reducing the risk of falls. Future research should elucidate neural mechanisms and compare simultaneous and sequential strategies to develop personalized, multidisciplinary rehabilitation protocols.<\/jats:p>","DOI":"10.2340\/jrm.v58.45360","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T11:37:13Z","timestamp":1779709033000},"page":"jrm45360","source":"Crossref","is-referenced-by-count":1,"title":["The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson\u2019s disease: a systematic review and meta-analysis"],"prefix":"10.2340","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-9253","authenticated-orcid":false,"given":"Luisa","family":"Cacciante","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8460-6752","authenticated-orcid":false,"given":"Alex","family":"Lando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emine Gulden","family":"Ozcan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3588-6924","authenticated-orcid":false,"given":"Daniela","family":"D\u2019Imperio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Meroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-4383","authenticated-orcid":false,"given":"Agnieszka","family":"Guzik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4511-8419","authenticated-orcid":false,"given":"Mariusz","family":"Dru\u017cbicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-7860","authenticated-orcid":false,"given":"B\u0142a\u017cej","family":"Cie\u015blik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5990-5734","authenticated-orcid":false,"given":"Pawe\u0142","family":"Kiper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"156437","doi-asserted-by":"crossref","unstructured":"Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol 2020; 27: 27\u201342.","DOI":"10.1111\/ene.14108"},{"key":"156438","unstructured":"DeMaagd G, Philip A. Parkinson\u2019s disease and its management: Part 1: Disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P T 2015; 40: 504\u2013532."},{"key":"156439","doi-asserted-by":"crossref","unstructured":"Dorsey ER, Sherer T, Okun MS, Bloem BR. The emerging evidence of the Parkinson pandemic. J Parkinsons Dis 2018; 8: S3\u2013S8.","DOI":"10.3233\/JPD-181474"},{"key":"156440","doi-asserted-by":"crossref","unstructured":"Ehlen F, Schindlbeck K, Nobis L, Maier A, Klostermann F. Relationships between activity and well-being in people with Parkinson\u2019s disease. Brain Behav 2018; 8: e00976.","DOI":"10.1002\/brb3.976"},{"key":"156441","doi-asserted-by":"crossref","unstructured":"Schrag A, Jahanshahi M, Quinn N. How does Parkinson\u2019s disease affect quality of life? A comparison with quality of life in the general population. Mov Disord 2000; 15: 1112\u20131118.","DOI":"10.1002\/1531-8257(200011)15:6<1112::AID-MDS1008>3.0.CO;2-A"},{"key":"156442","unstructured":"Borovac JA. Side effects of a dopamine agonist therapy for Parkinson\u2019s disease: a mini-review of clinical pharmacology. Yale J Biol Med 2016; 89: 37\u201347"},{"key":"156443","doi-asserted-by":"crossref","unstructured":"Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, et al. Physiotherapy for Parkinson\u2019s disease: a comparison of techniques. Cochrane Database Syst Rev 2014; 2014: CD002815.","DOI":"10.1002\/14651858.CD002815.pub2"},{"key":"156444","unstructured":"Keus S, Munneke M, Gaziano M, Paltamaa J, Pelosin E, Ramaswamy B, et al. European physiotherapy guideline for Parkinson\u2019s disease; 2014. Available from: https:\/\/www.parkinsonnet.nl\/app\/uploads\/sites\/3\/2019\/11\/eu_guideline_parkinson_guideline_for_pt_s1.pdf"},{"key":"156445","doi-asserted-by":"crossref","unstructured":"Chua LK, Chung YC, Bellard D, Swan L, Gobreial N, Romano A, et al. Gamified dual-task training for individuals with Parkinson disease: an exploratory study on feasibility, safety, and efficacy. Int J Environ Res Public Health 2021; 18: 12384.","DOI":"10.3390\/ijerph182312384"},{"key":"156446","doi-asserted-by":"crossref","unstructured":"El Semary MM, Abdelmageed SM, El-Serougy HR, Elzanaty MY, Ragab WM, Salama AM, et al. Efficacy of cognitive rehabilitation on functional outcomes & quality of life in Parkinson\u2019s patients. Int J Pharmaceut Res 2020; 12: 1305\u20131309.","DOI":"10.31838\/ijpr\/2020.SP2.123"},{"key":"156447","doi-asserted-by":"crossref","unstructured":"Bykov YN, Bender TB, Vasiliev YN, Kalyagin AN, Maksikova TM, Orlova GM, et al. Impact of stimulating cognitive-motor training on neuropsychological status and quality of life in patients with Parkinson \u2018s disease. Nevrologiya, Neiropsikhiatriya, Psikhosomatika 2018; 10: 65\u201371.","DOI":"10.14412\/2074-2711-2018-4-65-71"},{"key":"156448","doi-asserted-by":"crossref","unstructured":"Barone P, Aarsland D, Burn D, Emre M, Kulisevsky J, Weintraub D. Cognitive impairment in nondemented Parkinson\u2019s disease. Mov Disord 2011; 26: 2483\u20132495.","DOI":"10.1002\/mds.23919"},{"key":"156449","doi-asserted-by":"crossref","unstructured":"Lauenroth A, Ioannidis AE, Teichmann B. Influence of combined physical and cognitive training on cognition: a systematic review. BMC Geriatr 2016; 16: 141.","DOI":"10.1186\/s12877-016-0315-1"},{"key":"156450","doi-asserted-by":"crossref","unstructured":"Rieker JA, Reales JM, Muinos M, Ballesteros S. The effects of combined cognitive-physical interventions on cognitive functioning in healthy older adults: a systematic review and multilevel meta-analysis. Front Hum Neurosci 2022; 16: 838968.","DOI":"10.3389\/fnhum.2022.838968"},{"key":"156451","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol 2021; 134: 178\u2013189.","DOI":"10.1016\/j.jclinepi.2021.03.001"},{"key":"156452","doi-asserted-by":"crossref","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan: a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210.","DOI":"10.1186\/s13643-016-0384-4"},{"key":"156453","doi-asserted-by":"crossref","unstructured":"Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.","DOI":"10.1136\/bmj.l4898"},{"key":"156454","doi-asserted-by":"crossref","unstructured":"Barker TH, Habibi N, Aromataris E, Stone JC, Leonardi-Bee J, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth 2024; 22: 378\u2013388.","DOI":"10.11124\/JBIES-23-00268"},{"key":"156455","doi-asserted-by":"crossref","unstructured":"Christofoletti G, Beinotti F, Borges G, Damasceno BP. Physical therapy improves the balance of patients with Parkinson\u2019s disease: a randomized controlled trial. Parkinsonism Relat D 2010; 16: S58.","DOI":"10.1016\/S1353-8020(10)70204-2"},{"key":"156456","doi-asserted-by":"crossref","unstructured":"Killane I, Fearon C, Newman L, McDonnell C, Waechter SM, Sons K, et al. Dual motor-cognitive virtual reality training impacts dual-task performance in freezing of gait. IEEE J Biomed Health Inform 2015; 19: 1855\u20131861.","DOI":"10.1109\/JBHI.2015.2479625"},{"key":"156457","doi-asserted-by":"crossref","unstructured":"Pelosin E, Ponte C, Putzolu M, Lagravinese G, Hausdorff JM, Nieuwboer A, et al. Motor\u2013cognitive treadmill training with virtual reality in Parkinson\u2019s disease: the effect of training duration. Front Aging Neurosci 2022; 13.","DOI":"10.3389\/fnagi.2021.753381"},{"key":"156458","doi-asserted-by":"crossref","unstructured":"Clerici I, Maestri R, Bonetti F, Ortelli P, Volpe D, Ferrazzoli D, et al. Land plus aquatic therapy versus land-based rehabilitation alone for the treatment of freezing of gait in Parkinson disease: a randomized controlled trial. Phys Ther 2019; 99: 591\u2013600.","DOI":"10.1093\/ptj\/pzz003"},{"key":"156459","doi-asserted-by":"crossref","unstructured":"Gobbi LTB, Pelicioni PHS, Lahr J, Lirani-Silva E, Teixeira--Arroyo C, Santos P. Effect of different types of exercises on psychological and cognitive features in people with Parkinson\u2019s disease: a randomized controlled trial. Ann Phys Rehabil Med 2021; 64: 101407.","DOI":"10.1016\/j.rehab.2020.05.011"},{"key":"156460","doi-asserted-by":"crossref","unstructured":"Hajebrahimi F, Velioglu HA, Bayraktaroglu Z, Helvaci Yilmaz N, Hanoglu L. Clinical evaluation and resting state fMRI analysis of virtual reality based training in Parkinson\u2019s disease through a randomized controlled trial. Sci Rep 2022; 12: 8024.","DOI":"10.1038\/s41598-022-12061-3"},{"key":"156461","doi-asserted-by":"crossref","unstructured":"Alves MLM, Mesquita BS, Morais WS, Leal JC, Satler CE, dos Santos Mendes FA. Nintendo Wii\u2122 versus Xbox Kinect\u2122 for assisting people with Parkinson\u2019s disease. Percept Mot Skills 2018; 125: 546\u2013565.","DOI":"10.1177\/0031512518769204"},{"key":"156462","doi-asserted-by":"crossref","unstructured":"Fernandes A, Rocha N, Santos R, Tavares JMRS. Effects of dual-task training on balance and executive functions in Parkinson\u2019s disease: a pilot study. Somatosens Mot Res 2015; 32: 122\u2013127.","DOI":"10.3109\/08990220.2014.1002605"},{"key":"156463","doi-asserted-by":"crossref","unstructured":"Lau J, Regis C, Burke C, Kaleda M, McKenna R, Muratori LM. Immersive technology for cognitive-motor training in Parkinson\u2019s disease. Front Hum Neurosci 2022; 16: 863930.","DOI":"10.3389\/fnhum.2022.863930"},{"key":"156464","doi-asserted-by":"crossref","unstructured":"Maidan I, Nieuwhof F, Bernad-Elazari H, Bloem BR, Giladi N, Hausdorff JM, et al. Evidence for differential effects of 2 forms of exercise on prefrontal plasticity during walking in Parkinson\u2019s disease. Neurorehabil Neural Repair 2018; 32: 200\u2013208.","DOI":"10.1177\/1545968318763750"},{"key":"156465","doi-asserted-by":"crossref","unstructured":"Pompeu JE, Mendes FA, Silva KG, Lobo AM, Oliveira Tde P, Zomignani AP, et al. Effect of Nintendo Wii\u2122-based motor and cognitive training on activities of daily living in patients with Parkinson\u2019s disease: a randomised clinical trial. Physiotherapy 2012; 98: 196\u2013204.","DOI":"10.1016\/j.physio.2012.06.004"},{"key":"156466","doi-asserted-by":"crossref","unstructured":"Yang YR, Cheng SJ, Lee YJ, Liu YC, Wang RY. Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson\u2019s disease: a randomized controlled pilot study. PLoS One 2019; 14: e0218180.","DOI":"10.1371\/journal.pone.0218180"},{"key":"156467","doi-asserted-by":"crossref","unstructured":"Wong PL, Hung CW, Yang YR, Yeh NC, Cheng SJ, Liao YY, et al. Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson\u2019s disease: a randomized controlled trial. Eur J Phys -Rehabil Med 2024; 60: 611\u2013620.","DOI":"10.23736\/S1973-9087.24.08261-3"},{"key":"156468","doi-asserted-by":"crossref","unstructured":"Lin YP, Lin, II, Chiou WD, Chang HC, Chen RS, Lu CS, et al. Optimizing rehabilitation strategies in Parkinson\u2019s disease: a comparison of dual cognitive-walking treadmill training and single treadmill training. Sci Rep 2024; 14: 25210.","DOI":"10.1038\/s41598-024-75422-0"},{"key":"156469","doi-asserted-by":"crossref","unstructured":"Das J, Barry G, Walker R, Vitorio R, Celik Y, McDonald C, et al. The feasibility of a visuo-cognitive training -intervention using a mobile application and exercise with stroboscopic glasses in Parkinson\u2019s: findings from a pilot randomised controlled trial. PLoS Digital Health 2024; 3: e0000696.","DOI":"10.1371\/journal.pdig.0000696"},{"key":"156470","doi-asserted-by":"crossref","unstructured":"Barboza NM, Terra MB, Bueno MEB, Christofoletti G, Smaili SM. Physiotherapy versus physiotherapy plus cognitive training on cognition and quality of life in Parkinson disease: randomized clinical trial. Am J Phys Med Rehabil 2019; 98: 460\u2013468.","DOI":"10.1097\/PHM.0000000000001128"},{"key":"156471","doi-asserted-by":"crossref","unstructured":"Monticone M, Ambrosini E, Laurini A, Rocca B, Foti C. In-patient multidisciplinary rehabilitation for Parkinson\u2019s disease: a randomized controlled trial. Mov Disord 2015; 30: 1050\u20131058.","DOI":"10.1002\/mds.26256"},{"key":"156472","doi-asserted-by":"crossref","unstructured":"Terra MB, Barboza NM, Almeida IAD, Bueno MEB, Smaili SM. Does physiotherapy plus cognitive training improve balance in Parkinson\u2019s disease? Randomized clinical trial. Motriz Revista de Educacao Fisica 2020; 26: 687.","DOI":"10.1590\/s1980-6574202000020160"},{"key":"156473","doi-asserted-by":"crossref","unstructured":"Varalta V, Poiese P, Recchia S, Montagnana B, Fonte C, Filippetti M, et al. Physiotherapy versus consecutive physiotherapy and cognitive treatment in people with Parkinson\u2019s disease: a pilot randomized cross-over study. J Pers Med 2021; 11.","DOI":"10.3390\/jpm11080687"},{"key":"156474","doi-asserted-by":"crossref","unstructured":"Del Pino R, de Echevarr\u00eda AO, D\u00edez-Cirarda M, Ustarroz-Aguirre I, Caprino M, Liu J, et al. Virtual coach and telerehabilitation for Parkinson\u2019s disease patients: vCare system. J Public Health 2025; 33: 1583\u20131596.","DOI":"10.1007\/s10389-023-02082-1"},{"key":"156475","doi-asserted-by":"crossref","unstructured":"Hill EJ, Mangleburg CG, Alfradique-Dunham I, Ripperger B, Stillwell A, Saade H, et al. Quantitative mobility measures complement the MDS-UPDRS for characterization of Parkinson\u2019s disease heterogeneity. Parkinsonism Relat Disord 2021; 84: 105\u2013111.","DOI":"10.1016\/j.parkreldis.2021.02.006"},{"key":"156476","doi-asserted-by":"crossref","unstructured":"D\u2019Imperio D, Romeo Z, Maistrello L, Durgoni E, Della Pieta C, De Filippo De Grazia M, et al. Sensorimotor, attentional, and neuroanatomical predictors of upper limb motor deficits and rehabilitation outcome after stroke. Neural Plast 2021; 2021: 8845685.","DOI":"10.1155\/2021\/8845685"},{"key":"156477","doi-asserted-by":"crossref","unstructured":"VanGilder JL, Hooyman A, Peterson DS, Schaefer SY. Post-stroke cognitive impairments and responsiveness to motor rehabilitation: a review. Curr Phys Med Rehabil Rep 2020; 8: 461\u2013468.","DOI":"10.1007\/s40141-020-00283-3"},{"key":"156478","unstructured":"Hirsch MA, Farley BG. Exercise and neuroplasticity in persons living with Parkinson\u2019s disease. Eur J Phys Rehabil Med 2009; 45: 215\u2013229."},{"key":"156479","doi-asserted-by":"crossref","unstructured":"Fisher BE, Li Q, Nacca A, Salem GJ, Song J, Yip J, et al. Treadmill exercise elevates striatal dopamine D2 receptor binding potential in patients with early Parkinson\u2019s disease. Neuroreport 2013; 24: 509\u2013514.","DOI":"10.1097\/WNR.0b013e328361dc13"},{"key":"156480","doi-asserted-by":"crossref","unstructured":"Sehm B, Taubert M, Conde V, Weise D, Classen J, Dukart J, et al. Structural brain plasticity in Parkinson\u2019s disease induced by balance training. Neurobiol Aging 2014; 35: 232\u2013239.","DOI":"10.1016\/j.neurobiolaging.2013.06.021"},{"key":"156481","doi-asserted-by":"crossref","unstructured":"Beall EB, Lowe MJ, Alberts JL, Frankemolle AM, Thota AK, Shah C, et al. The effect of forced-exercise therapy for Parkinson\u2019s disease on motor cortex functional connectivity. Brain Connect 2013; 3: 190\u2013198.","DOI":"10.1089\/brain.2012.0104"},{"key":"156482","doi-asserted-by":"crossref","unstructured":"Abbruzzese G, Marchese R, Avanzino L, Pelosin E. Rehabilitation for Parkinson\u2019s disease: current outlook and future challenges. Parkinsonism Relat Disord 2016; 22: S60\u2013S64.","DOI":"10.1016\/j.parkreldis.2015.09.005"},{"key":"156483","doi-asserted-by":"crossref","unstructured":"Daly JJ, McCabe JP, Holcomb J, Monkiewicz M, Gansen J, Pundik S. Long-dose intensive therapy is necessary for strong, clinically significant, upper limb functional gains and retained gains in severe\/moderate chronic stroke. Neurorehabil Neural Repair 2019; 33: 523\u2013537.","DOI":"10.1177\/1545968319846120"},{"key":"156484","doi-asserted-by":"crossref","unstructured":"Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019; 90: 498\u2013506.","DOI":"10.1136\/jnnp-2018-319954"},{"key":"156485","doi-asserted-by":"crossref","unstructured":"Jung SH, Hasegawa N, Mancini M, King LA, Carlson-Kuhta P, Smulders K, et al. Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson\u2019s disease. NPJ Parkinsons Dis 2020; 6: 31.","DOI":"10.1038\/s41531-020-00132-z"},{"key":"156486","doi-asserted-by":"crossref","unstructured":"Takeuchi H, Magistro D, Kotozaki Y, Motoki K, Nejad KK, Nouchi R, et al. Effects of simultaneously performed dual-task training with aerobic exercise and working memory training on cognitive functions and neural systems in the elderly. Neural Plasticity 2020; 2020: 3859824.","DOI":"10.1155\/2020\/3859824"},{"key":"156487","doi-asserted-by":"crossref","unstructured":"Peterson DS, King LA, Cohen RG, Horak FB. Cognitive contributions to freezing of gait in Parkinson disease: implications for physical rehabilitation. Phys Ther 2016; 96: 659\u2013670.","DOI":"10.2522\/ptj.20140603"}],"container-title":["Journal of Rehabilitation Medicine"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/download\/45360\/54052","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/download\/45360\/54052","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T11:37:24Z","timestamp":1779709044000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/view\/45360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":51,"URL":"https:\/\/doi.org\/10.2340\/jrm.v58.45360","relation":{},"ISSN":["1651-2081"],"issn-type":[{"value":"1651-2081","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}