SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Dementia and Neurodegenerative Diseases
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1579556
Comparative efficacy of non-pharmacological interventions for Parkinson's disease with constipation: A systematic review and network meta-analysis
Provisionally accepted
- 1Chengdu University of Traditional Chinese Medicine, Chengdu, China
- 2Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei Province, China
- 3University of Chinese Academy of Sciences, Beijing, Beijing, China
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Background: This network meta-analysis aims to evaluate the comparative efficacy of nonpharmacological interventions on Parkinson's disease (PD) with constipation.Methods: A comprehensive search was conducted in seven major databases (CINAHL, the Cochrane Central Register of Controlled Trials [CENTRAL], Embase, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI] and Wanfang) up to August 2024. Eligible randomized controlled trials (RCTs) that evaluated non-pharmacological interventions for PD with constipation were included. Methodological quality was assessed using the Cochrane Risk of Bias tool, and a frequentist network meta-analysis (NMA) was performed using STATA 18 to estimate relative treatment effects.Results: From 2084 initially identified records, 12 RCTs (n = 881 patients) met inclusion criteria. The four interventions evaluated included complementary and alternative medicine (CAM), evidence-based nursing (EBN), physical agents (PA), and traditional Chinese medicine (TCM). Direct comparisons revealed significantly superior efficacy for both EBN and PA compared to control conditions (p < 0.05). The NMA demonstrated consistent superiority of PA and EBN over passive control, placebo, and sham interventions (all p < 0.05), with the following efficacy hierarchy: PA (most effective) > EBN > CAM > TCM (least effective).Conclusions: Our findings suggest that non-pharmacological approaches, particularly PA-based interventions, may offer clinically meaningful benefits for constipation management in PD. Nevertheless, the relatively small number of available studies and methodological limitations in several trials necessitate cautious interpretation. Further rigorously designed RCTs are warranted to confirm these preliminary observations and establish optimal treatment protocols.
Keywords: Parkinson's disease, Constipation, non-pharmacological interventions, Network meta-analysis, Therapeutic effect
Received: 19 Feb 2025; Accepted: 07 May 2025.
Copyright: © 2025 Zhang, Su, Han, Zhao, Wang, Yang and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hejiang Ye, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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