# Comparative efficacy of non-pharmacological interventions for Parkinson’s disease with constipation: a systematic review and network meta-analysis

## TL;DR

This study compares non-drug treatments for Parkinson's disease with constipation, finding physical agents to be most effective.

## Contribution

The novel contribution is a network meta-analysis comparing non-pharmacological interventions for Parkinson’s disease with constipation.

## Key findings

- Physical agents (PAs) showed the highest efficacy in treating constipation in Parkinson’s disease.
- Evidence-based nursing (EBN) was more effective than complementary and alternative medicine (CAM) and traditional Chinese medicine (TCM).
- Only 12 RCTs were included, highlighting the need for more high-quality studies.

## Abstract

This network meta-analysis aims to evaluate the comparative efficacy of non-pharmacological interventions on Parkinson’s disease (PD) with constipation.

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.

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 (PAs), and traditional Chinese medicine (TCM). Direct comparisons revealed significantly superior efficacy for both EBN and PAs compared to control conditions (p < 0.05). The NMA demonstrated consistent superiority of PAs and EBN over passive control, placebo, and sham interventions (all p < 0.05), with the following efficacy hierarchy: PAs (most effective) > EBN > CAM > TCM (least effective).

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.

https://www.crd.york.ac.uk/PROSPERO/, CRD42024565248.