Combining immersive exergaming with physiotherapy in a specialized intensive Parkinson's disease rehabilitation program: a randomized controlled trial.

Only mild-to-moderate PD was included (Hoehn and Yahr I to III, no recent falls, MoCA at least 21), so the findings may not apply to your more disabled patients or those with cognitive impairment. The sample was heterogeneous in age, disease duration, and severity, and the analysis did not adjust for these factors. Overall compliance was modest, and it was lower in the sequential group, which may bias results toward the combined group. All participants were on stable dopaminergic medication throughout, so the effects of the exercise programme cannot be separated from the medication background. There was no no-treatment control group, so it is impossible to tell how much of the improvement came from the exergaming versus the physiotherapy that both groups received. The study was powered for 30 participants to detect a large effect (Cohen's d of 1.16) on the primary outcome; smaller real-world effects would not have been detected.

Do not read the 16-week TUG cognitive difference as proof that the exergame works. Both groups received the same PD physiotherapy, the primary 6-week outcome was null, and there was no no-treatment control group. The between-group difference at 16 weeks is a single secondary comparison in a small trial, and the authors themselves note they cannot isolate the effect of the exergaming from the physiotherapy.