The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis
Open accessAbstract
Parkinson's disease (PD) is a neurodegenerative disorder affecting the physical, psychological, social, and functional status of individuals. Exercise programs may be an effective strategy to delay or reverse functional decline for people with PD and a large body of empirical evidence has emerged in recent years. The objective is to systematically review randomized controlled trials (RCTs) reporting on the effectiveness of exercise interventions on outcomes (physical, psychological or social functioning, or quality of life) for people with PD. RCTs meeting the inclusion criteria were identified by systematic searching of electronic databases. Key data were extracted by two independent researchers. A mixed methods approach was undertaken using narrative, vote counting, and random effects meta-analysis methods. Fourteen RCTs were included and the methodological quality of most studies was moderate. Evidence supported exercise as being beneficial with regards to physical functioning, health-related quality of life, strength, balance and gait speed for people with PD. There was insufficient evidence support or refute the value of exercise in reducing falls or depression. This review found evidence of the potential benefits of exercise for people with PD, although further good quality research is needed. Questions remain around the optimal content of exercise interventions (dosing, component exercises) at different stages of the disease.
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Prior research has shown significant improvements in aerobic capacity and muscle strength in persons with PD following exercise training.
“Prior research has shown significant improvements in aerobic capacity (Schenkman et al., 2012) and muscle strength (Goodwin et al., 2008; Mehrholz et al., 2010), in persons with PD following exercise training.”
From Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease (2022) · cites this paper as Goodwin et al., 2008
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“No research to date has shown a benefit of exercise on depressive symptoms in PD (28).”
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MethodInfluentialExercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial
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Physiotherapy for Parkinson's disease: a comparison of techniques.
Tomlinson, C., Herd, C. P., Clarke, C., Meek, C., Patel, S., Stowe, R., Deane, K. H. O., Shah, L., Sackley, C., Wheatley, K., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002815.pub2 · Cited by 243 · see citing works
Dance as an intervention for people with Parkinson's disease: A systematic review and meta-analysis
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Physical activity and the brain: A review of this dynamic, bi-directional relationship
Loprinzi, P. D., Herod, S. M., Cardinal, B. J., & Noakes, T. D. (2013) · Brain Research · doi:10.1016/j.brainres.2013.10.004 · Cited by 222 · see citing works
The benefits and mechanisms of exercise training for Parkinson's disease
Feng, Y.-S., Yang, S., Tan, Z., Wang, M., Xing, Y., Dong, F., & Zhang, F. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.117345 · Cited by 222 · see citing works
Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis
Ernst, M., Folkerts, A., Gollan, R., Lieker, E., Caro-Valenzuela, J., Adams, A., Cryns, N., Monsef, I., Dresen, A., Roheger, M., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013856.pub2 · Cited by 231 · see citing works
Foster, E. R., Golden, L., Duncan, R. P., & Earhart, G. M. (2012) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.07.028 · Cited by 216 · see citing works
Physical therapy in Parkinson's disease: Evolution and future challenges
Keus, S. H. J., Munneke, M., Nijkrake, M. J., Kwakkel, G., & Bloem, B. R. (2008) · Movement Disorders · doi:10.1002/mds.22141 · Cited by 217 · see citing works
Psychosis, apathy, depression and anxiety in Parkinson's disease
Gallagher, D. A., & Schrag, A. (2012) · Neurobiology of Disease · doi:10.1016/j.nbd.2011.12.041 · Cited by 211 · see citing works
“Exercise has been proposed to have a beneficial effect on depression but a meta-analysis of exercise in PD showed benefits in physical functioning and HR-QoL, but there was insufficient evidence for a mood benefit (Goodwin et al., 2008).”
Dance as therapy for individuals with Parkinson disease.
Earhart, G. M. (2009) · PubMed · Cited by 207 · see citing works
The Effects of Physical Activity in Parkinson’s Disease: A Review
Lauzé, M., Daneault, J., & Duval, C. (2016) · Journal of Parkinson s Disease · doi:10.3233/jpd-160790 · Cited by 204 · see citing works
“Keywords: Parkinson, exercise, physical activity, rehabilitation, bradykinesia, tremor”
Canning, C. G., Paul, S. S., & Nieuwboer, A. (2014) · Neurodegenerative Disease Management · doi:10.2217/nmt.14.22 · Cited by 201 · see citing works
Tarantino, U., Iolascon, G., Cianferotti, L., Masi, L., Marcucci, G., Giusti, F., Marini, F., Parri, S., Feola, M., Rao, C., et al. (2017) · Journal of Orthopaedics and Traumatology · doi:10.1007/s10195-017-0474-7 · Cited by 201 · see citing works
“However, the efficacy of balance exercise at preventing fractures in PD patients is not supported by sufficient evidence [128].”
BackgroundCurrent treatment options for Alzheimer’s disease and Parkinson’s disease dementia
Y.Y. Szeto, J., & J.G. Lewis, S. (2016) · Current Neuropharmacology · doi:10.2174/1570159x14666151208112754 · Cited by 198 · see citing works
“Exercise and physical activities have merit for improving motor manifestations of PD [104, 105], and accumulating evidence has suggested that such approach may also have benefits for cognitive functioning in PD patients [106-110].”
BackgroundExercise increases caudate dopamine release and ventral striatal activation in Parkinson's disease
Sacheli, M., Neva, J. L., Lakhani, B., Murray, D., Vafai, N. M., Shahinfard, E., English, C., McCormick, S., Dinelle, K., Neilson, N., et al. (2019) · Movement Disorders · doi:10.1002/mds.27865 · Cited by 197 · see citing works
Physiotherapy versus placebo or no intervention in Parkinson's disease
Tomlinson, C. L., Patel, S., Meek, C., Clarke, C. E., Stowe, R. L., Shah, L., Sackley, C. M., Deane, K. H., Wheatley, K., & Ives, N. J. (2001) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002817 · Cited by 193 · see citing works
Uhrbrand, A., Stenager, E., Pedersen, M. S., & Dalgas, U. (2015) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2015.04.004 · Cited by 190 · see citing works
“Despite a number of previous reviews [13,32–37] being published on exercise therapy, a high number of relevant studies have been published in recent years [10,18–22,25,27,38,39], calling for an update of the literature.”
ResultProgression of motor symptoms in Parkinson’s disease
Xia, R., & Mao, Z. (2012) · Neuroscience Bulletin · doi:10.1007/s12264-012-1050-z · Cited by 186 · see citing works
“[73] Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL.”
BackgroundReuter, I., Mehnert, S., Leone, P., Kaps, M., Oechsner, M., & Engelhardt, M. (2011) · Journal of Aging Research · doi:10.4061/2011/232473 · Cited by 182 · see citing works
“A review on the effectiveness of exercise in PD has shown that exercise is effective at improving physical functioning, health-related quality of life (HRQL), leg strength, walking and balance [19, 20].”
BackgroundStructural brain plasticity in Parkinson's disease induced by balance training
Sehm, B., Taubert, M., Conde, V., Weise, D., Claßen, J., Dukart, J., Draganski, B., Villringer, A., & Ragert, P. (2013) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2013.06.021 · Cited by 182 · see citing works
“Clinical studies provide evidence that exercise and rehabilitation programs might improve motor symptoms in PD patients and beneficially modify disease progress (Goodwin et al., 2008).”
BackgroundLee, N.-Y., Lee, D.-K., & Song, H.-S. (2015) · Journal of Physical Therapy Science · doi:10.1589/jpts.27.145 · Cited by 180 · see citing works
Physical therapy and occupational therapy in Parkinson's disease
Radder, D. L. M., Sturkenboom, I. H. W. M., van Nimwegen, M., Keus, S. H. J., Bloem, B. R., & de Vries, N. M. (2016) · International Journal of Neuroscience · doi:10.1080/00207454.2016.1275617 · Cited by 174 · see citing works
“Exercise consists of planned, structured and repetitive physical activity [61].”
BackgroundFactors Associated With Exercise Behavior in People With Parkinson Disease
Ellis, T. D., Cavanaugh, J. T., Earhart, G. M., Ford, M. P., Foreman, K. B., Fredman, L., Boudreau, J. K., & Dibble, L. E. (2011) · Physical Therapy · doi:10.2522/ptj.20100390 · Cited by 171 · see citing works
Mirelman, A., Rochester, L., Reelick, M. F., Nieuwhof, F., Pelosin, E., Abbruzzese, G., Dockx, K., Nieuwboer, A., & Hausdorff, J. M. (2013) · BMC Neurology · doi:10.1186/1471-2377-13-15 · Cited by 174 · see citing works
“however, the effects on fall risk tend to be small and the reported changes are largely focused on motor aspects with limited long-term retention [45-47].”
BackgroundEvidence on the effects of exercise therapy in the treatment of chronic disease
Kujala, U. M. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.059808 · Cited by 172 · see citing works
Physiotherapy versus placebo or no intervention in Parkinson's disease
Tomlinson, C. L., Patel, S., Meek, C., Clarke, C. E., Stowe, R. L., Shah, L., Sackley, C. M., Deane, K. H., Herd, C. P., Wheatley, K., et al. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002817.pub3 · Cited by 165 · see citing works
Treadmill training for patients with Parkinson's disease
Mehrholz, J., Kügler, J., Storch, A., Pohl, M., Elsner, B., & Hirsch, K. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007830.pub3 · Cited by 168 · see citing works
van Nimwegen, M., Speelman, A. D., Overeem, S., van de Warrenburg, B. P. C., Smulders, K., Dontje, M. L., Borm, G. F., BACKX, F. J. G., Bloem, B. R., Munneke, M. A. M., et al. (2013) · BMJ · doi:10.1136/bmj.f576 · Cited by 161 · see citing works
Manenti, R., Brambilla, M., Benussi, A., Rosini, S., Cobelli, C., Ferrari, C., Petesi, M., Orizio, I., Padovani, A., Borroni, B., et al. (2016) · Movement Disorders · doi:10.1002/mds.26561 · Cited by 161 · see citing works
“The evidence highlights the potential importance of including physical therapy as an adjuvant to pharmacological and neurosurgical treatments for PD.(9-22) Currently there is growing interest in the application of transcranial direct current stimulation (tDCS) as an additional therapeutic approach in neurological diso…”
BackgroundResultWhy is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model
Brancatisano, O., Baird, A., & Thompson, W. F. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.02.008 · Cited by 167 · see citing works
Goodwin, V. A., Richards, S. H., Henley, W., Ewings, P., Taylor, A. H., & Campbell, J. (2011) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-300919 · Cited by 158 · see citing works
Self-citationGalna, B., Jackson, D., Schofield, G., McNaney, R., Webster, M., Barry, G., Mhiripiri, D., Balaam, M., Olivier, P. L., & Rochester, L. (2014) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-11-60 · Cited by 155 · see citing works
“Exercise is emerging as an effective therapy to improve gait, balance and mobility in PD [3,4].”
BackgroundOlson, M. C., Lockhart, T. E., & LIEBERMAN, A. N. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00062 · Cited by 155 · see citing works
Munneke, M., Nijkrake, M. J., Keus, S. H. J., Kwakkel, G., Berendse, H. W., Roos, R. A. C., Borm, G. F., Adang, E., Overeem, S., & Bloem, B. R. (2009) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70327-8 · Cited by 159 · see citing works
Argentine tango in Parkinson disease – a systematic review and meta-analysis
Lötzke, D., Ostermann, T., & Büssing, A. (2015) · BMC Neurology · doi:10.1186/s12883-015-0484-0 · Cited by 154 · see citing works
“and walking [2, 7, 8].”
Intensive Rehabilitation Increases BDNF Serum Levels in Parkinsonian Patients
Frazzitta, G., Maestri, R., Ghilardi, M. F., Riboldazzi, G., Perini, M., Bertotti, G., Boveri, N., Buttini, S., Lombino, F. L., Uccellini, D., et al. (2013) · Neurorehabilitation and neural repair · doi:10.1177/1545968313508474 · Cited by 153 · see citing works
Heiberger, L. (2011) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2011.00014 · Cited by 152 · see citing works
“Numerous studies have demonstrated that physical activity for individuals with PD has positive effects on gait velocity, muscular strength, balance, and quality of life (Goodwin et al., 2008).”
BackgroundInfluentialThe association between lifestyle factors and Parkinson's disease progression and mortality
Paul, K. C., Chuang, Y., Shih, I., Keener, A. M., Bordelon, Y. M., Bronstein, J. M., & Ritz, B. R. (2019) · Movement Disorders · doi:10.1002/mds.27577 · Cited by 150 · see citing works
“functioning, balance, and gait and may protect PD patients against dementia.(8,9) The aim of the present study was to examine whether coffee or alcohol consumption, physical activity, or cigarette smoking habits in adults before PD diagnosis influences motor progression, cognitive decline, and survival in a population…”
BackgroundWallén, M. B., Franzén, E., Nero, H., & Hagströmer, M. (2015) · Physical Therapy · doi:10.2522/ptj.20140374 · Cited by 149 · see citing works
Duchesne, C., Lungu, O., Nadeau, A., Robillard, M.-È., Boré, A., Bobeuf, F., Lafontaine, A., Gheysen, F., Bherer, L., & Doyon, J. (2015) · Brain and Cognition · doi:10.1016/j.bandc.2015.07.005 · Cited by 146 · see citing works
Dhami, P., Moreno, S., & DeSouza, J. F. X. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01478 · Cited by 166 · see citing works
Shu, H., Yang, T., Yu, S., Huang, H., Jiang, L.-L., Gu, J., & Kuang, Y.-Q. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100503 · Cited by 144 · see citing works
“Some related systematic reviews drew a different conclusion that the evidence supported exercise as being beneficial with regards to health-related quality of life for patients with PD [48,49], but the evidence was gained through the utilization of various exercise therapies.”
BackgroundSage, M. D., & Almeida, Q. J. (2009) · Movement Disorders · doi:10.1002/mds.22469 · Cited by 144 · see citing works
Awareness and current knowledge of Parkinson’s disease: a neurodegenerative disorder
Khan, A. U., Akram, M., Daniyal, M., & Zainab, R. (2018) · International Journal of Neuroscience · doi:10.1080/00207454.2018.1486837 · Cited by 145 · see citing works
“amount and mitochondria contained less amount of alpha-synuclein [147].”
BackgroundCapturing Ambulatory Activity Decline in Parkinson's Disease
Cavanaugh, J. T., Ellis, T. D., Earhart, G. M., Ford, M. P., Foreman, K. B., & Dibble, L. E. (2012) · Journal of Neurologic Physical Therapy · doi:10.1097/npt.0b013e318254ba7a · Cited by 141 · see citing works
Effects of Group, Individual, and Home Exercise in Persons With Parkinson Disease
King, L. A., Wilhelm, J. L., Chen, Y., Blehm, R., Nutt, J. G., Chen, Z., Serdar, A., & Horak, F. B. (2015) · Neurology Report · doi:10.1097/npt.0000000000000101 · Cited by 139 · see citing works
“People were excluded if they (1) needed assistance with activities of daily living (ADLs), (2) did not speak or read English, (3) participated in a different exercise study within the year, (4) engaged in more than 10 hours of exercise per week, (5) participated in a conflicting research study, (6) had a moderate-seve…”
BackgroundNonpharmacological enhancement of cognitive function in Parkinson's disease: A systematic review
Hindle, J. V., Petrelli, A., Clare, L., & Kalbe, E. (2013) · Movement Disorders · doi:10.1002/mds.25377 · Cited by 141 · see citing works
“Vigorous exercise has been suggested to have a neuroprotective effect in PD,(29) although a systematic review of exercise in PD did not include the effects on cognition.(30) Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive approaches that induce pro…”
BackgroundWii Fit Balance Board Playing Improves Balance and Gait in Parkinson Disease
Mhatre, P. V., Vilares, I., Stibb, S. M., Albert, M. V., Pickering, L., Marciniak, C. M., Kording, K. P., & Toledo, S. D. (2013) · PM&R · doi:10.1016/j.pmrj.2013.05.019 · Cited by 139 · see citing works
“Although no effect was seen on QoL measures, this is also consistent with prior studies that evaluated the effect of exercise on mood in patients with PD [22].”
MethodResultFerrazzoli, D., Ortelli, P., Zivi, I., Cian, V., Urso, E., Ghilardi, M. F., Maestri, R., & Frazzitta, G. (2018) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-316437 · Cited by 139 · see citing works
Oguh, O., Eisenstein, A., Kwasny, M., & Simuni, T. (2014) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2014.09.008 · Cited by 138 · see citing works
“[28] While the association is not surprising and several studies have shown the effects of exercise on balance, gait and reduction of falls in PD at least short term [29] the significance of the impact will have to be validated in the prospective studies.”
BackgroundSardinian Folk Dance for Individuals with Parkinson's Disease: A Randomized Controlled Pilot Trial
Solla, P., Cugusi, L., Bertoli, M., Cereatti, A., Croce, U. D., Pani, D., Fadda, L., Cannas, A., Marrosu, F., Defazio, G., et al. (2019) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0413 · Cited by 137 · see citing works
Short duration, intensive tango dancing for Parkinson disease: An uncontrolled pilot study
Hackney, M. E., & Earhart, G. M. (2009) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2008.10.005 · Cited by 134 · see citing works
Physical Activity Behavior Change in Persons With Neurologic Disorders
Ellis, T. D., & Motl, R. W. (2013) · Neurology Report · doi:10.1097/npt.0b013e31829157c0 · Cited by 133 · see citing works
Marques‐Aleixo, I., Oliveira, P. J., Moreira, P. I., Magalhães, J., & Ascensão, A. A. M. R. (2012) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2012.08.002 · Cited by 132 · see citing works
Progressive resistance training improves gait initiation in individuals with Parkinson's disease
Hass, C. J., Buckley, T. A., Pitsikoulis, C., & Barthélemy, E. J. (2012) · Gait & Posture · doi:10.1016/j.gaitpost.2011.12.022 · Cited by 133 · see citing works
Reynolds, G., Otto, M. W., Ellis, T. D., & Cronin‐Golomb, A. (2015) · Movement Disorders · doi:10.1002/mds.26484 · Cited by 132 · see citing works
“Exercise has been shown to be beneficial to individuals with PD across Hoehn & Yahr stages I-IV, with most trials focusing on stages II and III.(6,12,216-218) At the same time, the potential neuroprotective and neurorestorative effects of exercise(118) underscore its importance early in the course of the disease.”
BackgroundKelly, N. A., Ford, M. P., Standaert, D. G., Watts, R. L., Bickel, C. S., Moellering, D. R., Tuggle, S. C., Williams, J. Y., Lieb, L., Windham, S. T., et al. (2014) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01277.2013 · Cited by 125 · see citing works
Using Mobile Phones for Activity Recognition in Parkinson’s Patients
Albert, M. V., Toledo, S. D., Shapiro, M. B., & Kording, K. P. (2012) · Frontiers in Neurology · doi:10.3389/fneur.2012.00158 · Cited by 125 · see citing works
“This is particularly important in motor disabilities such as Parkinson’s disease (PD) that respond to an increasing variety of treatment options, including drugs and various exercise therapies (Palmer et al., 1986; Schenkman et al., 1998; Goodwin et al., 2008; Dibble et al., 2009).”
BackgroundSix-Minute Walk Distance in Persons With Parkinson Disease: A Hierarchical Regression Model
Falvo, M. J., & Earhart, G. M. (2009) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2008.12.018 · Cited by 127 · see citing works
Broeder, S., Nackaerts, E., Heremans, E., Vervoort, G., Meesen, R., Verheyden, G., & Nieuwboer, A. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.08.010 · Cited by 125 · see citing works
da Silva, S. G., Unsain, N., Mascó, D. H., Toscano‐Silva, M., de Amorim, H. A., Araújo, B. H. S., Simões, P. S. R., Naffah‐Mazzacoratti, M. D. G., Mortara, R. A., Scorza, F. A., et al. (2010) · Hippocampus · doi:10.1002/hipo.20903 · Cited by 121 · see citing works
“Exercise improves cognitive functions (Kramer et al., 2006; Kashihara et al., 2009), reduces anxiety and depression (Martinsen, 2008), and protects the brain against neurodegenerative disorders (Goodwin et al., 2008, Rolland et al., 2008; Honea et al., 2009).”
Background
- Authors
- Goodwin, V. A., Richards, S. H., Taylor, R. S., Taylor, A. H., & Campbell, J. L.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Goodwin, Victoria A.
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 2008-01-07
- Volume
- 23
- Issue
- 5
- Pages
- 631-640
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- OpenAlex
- W1986148405
- Cited by
- 922
- References
- 48
- Citations by year
- 2026: 31 · 2025: 29 · 2024: 47 · 2023: 31 · 2022: 53 · 2021: 61 · 2020: 51 · 2019: 62 · 2018: 48 · 2017: 45 · 2016: 62 · 2015: 59 · 2014: 58 · 2013: 79 · 2012: 58
- FWCI
- 6.92
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Movement Disorders (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Figshare (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Funders
- Clinical Academic Fellowship Scheme funded by Devon and Cornwall Workforce Development Confederation
- Plymouth Teaching Primary Care Trust
- Personal Award Scheme Researcher Development Award from the National Institute of Health Research
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- Parkinson's disease, exercise intervention, physical function, health-related quality of life, balance, walking speed, muscle strength, falls, depression, functional decline
- MeSH terms
- Postural Balance, Exercise Therapy, Humans, Motor Activity, Parkinson Disease, Quality of Life, Randomized Controlled Trials as Topic, Treatment Outcome
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