Qualitative Assessment of Network Meta-Analyses of Exercise Therapy for Parkinson's Disease: A Scoping Review

TL;DR

This review finds that network meta-analyses on exercise therapy for Parkinson's disease lack methodological rigor despite good reporting standards.

Contribution

Systematic evaluation of methodological quality and reporting standards in recent network meta-analyses of exercise therapy for Parkinson's disease.

Findings

Most NMAs had critically low methodological confidence with no 'High' AMSTAR 2 ratings.

Only 13.6% of NMAs were rated as 'Moderate' in methodological quality.

PRISMA-NMA reporting standards were generally followed, but study conduct lacked rigor.

Abstract

The number of network meta-analyses (NMAs) regarding exercise therapy for Parkinson’s disease (PD) has increased rapidly. However, using their findings to inform clinical practice requires confidence in their methodological rigor. This scoping review systematically evaluated the methodological quality and reporting standards of recent NMAs in this field. Comprehensive research was conducted across PubMed, CENTRAL, CINAHL, Web of Science, and other databases through August 31, 2025. Eligible NMAs comparing exercise interventions for PD were assessed using AMSTAR 2 for methodological rigor and PRISMA-NMA for reporting completeness. Twenty-two NMAs were included. While the majority originated from China (68.2%), a sensitivity analysis revealed no systematic methodological differences between Chinese and non-Chinese reviews. Overall methodological confidence was critically low; no NMA achieved a “High” AMSTAR 2 rating, and only three (13.6%) were rated as “Moderate.” Fundamental deficits were prevalent in comprehensive literature searching (Item 4) and the justification for excluded studies (Item 7), with adherence rates of only 9.1% and 4.5%, respectively. Financial transparency was also negligible (<10%). Conversely, adherence to PRISMA-NMA reporting standards was generally satisfactory (>95% for network-specific items), highlighting a discrepancy between reporting compliance and actual study conduct. Current NMAs on exercise for PD exhibit a significant gap between their clinical recommendations and the robustness of the supporting evidence. The widespread lack of comprehensive searching and financial transparency undermines the reliability of these reviews. Future research must prioritize strict adherence to methodological standards over simply completing reporting checklists to provide trustworthy evidence for clinical decision-making.

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