Systematic review of kinematic and kinetic parameters in Parkinson's disease, with and without freezing of gait

BACKGROUND: Parkinson's Disease (PD) is a chronic, progressive disorder, impairing gait, balance and overall functionality. Freezing of gait (FOG) is a debilitating and pervasive symptom of PD, presenting as an inability to make forward progression despite the intention to walk. Commonly seen within FOG are rigid movements and postural instability, inducing a fear of falling which can inhibit quality of life. The aim of this review was to identify the key biomechanical parameters that differentiate individuals with and without FOG during gait-related mobility tasks. METHODS: A search was conducted in EBSCOhost and SCOPUS up to May 2025 to retrieve studies measuring kinematic and kinetic parameters during gait mobility tasks in individuals with and without FOG. Methodological quality was assessed using a modified Downs and Black checklist. Overall quality of evidence was assessed using the GRADE system. Hedges' g effect sizes were reported as standardised mean differences and 95% confidence intervals. FINDINGS: Sixteen studies involving 513 participants (259 with FOG, 254 without FOG) were included. Results showed individuals with FOG produced delayed head rotation timing during turning, decreased hip range of motion and increased hip-knee and hip-ankle decomposition indices during backward walking. Moreover, results found postural instability and mechanical inefficiencies during walking in individuals with FOG. DISCUSSION: FOG involves more than spatiotemporal irregularities, and key biomechanical parameters such as joint range of motion, knee and hip flexion patterns, centre of mass displacement and ground reaction force patterns can provide clinical markers for assessing freezing severity and monitoring rehabilitation outcomes. PROSPERO registration: CRD42024514366.