Effects of remote monitoring-supported home-based exercise on motor function in people with Parkinson’s disease: a systematic review and meta-analysis

People with Parkinson’s disease experience motor symptoms and impaired balance, functional mobility, and gait. Remote monitoring-supported home-based exercise combines home exercise with remote supervision, feedback, or digital monitoring, but its comparative effects remain uncertain. We searched PubMed, Embase, Web of Science, the Cochrane Library, and CINAHL from inception to 9 June 2026 without language restrictions. We included randomised controlled trials of adults with Parkinson’s disease comparing the target intervention with control conditions. The primary outcome was MDS-UPDRS III/UPDRS III; key secondary outcomes were balance function, functional mobility, and gait or walking function. We pooled Hedges’ g with 95% confidence intervals (CIs), with g > 0 favouring the target intervention. Comparator-specific meta-analyses used restricted maximum likelihood random-effects models with Hartung–Knapp adjustment. Risk of bias and certainty were assessed with RoB 2 and GRADE. Sixteen trials were included; 13 contributed 26 estimates to 11 comparator-specific primary evidence bodies. For MDS-UPDRS III/UPDRS III, estimates versus passive/minimal control, ordinary home exercise, and active therapist-led rehabilitation were g = 0.31 (95% CI − 4.31 to 4.93), 0.41 (− 0.27 to 1.09), and 0.30 (− 0.25 to 0.85), respectively. All point estimates favoured the target intervention but were imprecise. For balance versus active therapist-led rehabilitation, g was 0.26 (95% CI − 0.12 to 0.65; 95% prediction interval − 0.29 to 0.81). Functional mobility and gait/walking comparisons likewise did not rule out little or no difference. All 11 CIs included the null; nine evidence bodies had very low certainty and two had low certainty. Sensitivity analyses did not change this interpretation. Adherence, safety, falls, and technology-related outcomes were inconsistently reported and not pooled. Evidence is insufficient to determine whether remote monitoring-supported home-based exercise consistently improves motor-function outcomes relative to comparator categories. It neither establishes an independent effect of remote monitoring nor shows that this model is superior or equivalent to, or can replace, face-to-face rehabilitation. Incomplete reporting prevented conclusions about implementation or safety advantages. Adequately powered, prospectively registered trials with appropriate comparators and transparent reporting are needed. PROSPERO CRD420261428928.