BACKGROUND: Rhythmic-auditory stimulation (RAS) has a profound effect on the motor system of individuals with Parkinson's disease (PD), as physiological research has proven. The mechanism of action seems to work within different pathways in the brain and on spinal level. A large number of clinical trials have examined the effectiveness of rhythm and music on locomotion in PD. OBJECTIVES: The aim of this systematic review is to summarize the effectiveness of RAS on gait in patients with PD. The focus was on trials recently published, within the last 10 years, that compared RAS interventions with placebo or alternative methods. Furthermore, an analysis was performed on applied frequencies, which had been self-paced or predetermined, as well as on intervention intervals. To show long-term effects on walking performance, the duration of follow-up periods was demonstrated. SEARCH STRATEGY AND SELECTION CRITERIA: Two independent researchers searched in the following databases: Medline, Cochrane Movement Disorders Group Specialized Register, the Cochrane Controlled Trials Regis-ter, CINAHL, REHABDATA and PEDro. Only clinical trials and RCTs (or quasi-RCTs) were included. The studies must have been published between 01.01.2004 and 31.12.2013. Data collection and analysis: Methodological quality of the included studies was assessed with the PEDro scale by both researchers, and data extraction was performed by the main author. A meta-analysis was conducted if two or more relevant randomized controlled trials (RCT) with the same outcome parameter were present. Main results: A total of 24 studies were included in this review (16 clinical trials, six controlled studies with moderate evidence and two high-quality RCTs). Because of different study designs, no data pooling was possible. Half of the trials used a single-session design. The other studies investigated cueing during one or more weeks. Only a few trials (34%) performed follow-up measurements. Thus, evidence for long-term effectiveness remains unclear. Furthermore, no clear recommendation can be made on individual RAS frequencies to be most effective. CONCLUSION: Spatio-temporal parameters can be improved with RAS for a short-term duration. Some trails with follow-up measurements indicate that effects of RAS only last when training is performed constantly. In patients with cognitive decline, RAS can function as a dual-task and therefore increase the risk of falling. It remains inconclusive in how far a constant application of auditory cues can induce adaptions.

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