Adherence rate, barriers to attend, safety and overall experience of a physical exercise program via telemonitoring during COVID‐19 pandemic for individuals with Parkinson's disease: A feasibility study

Abstract

Background Telemonitoring can maintain daily exercise routine during the COVID‐19 pandemic of individuals with Parkinson's disease (PD). However, there are barriers to adherence and attendance with remote physical rehabilitation. The main objective of this study was to evaluate adherence rate, barriers to attendance, and safety of a telemonitoring program for individuals with PD; and secondarily to evaluate the individual and their family members perceived overall experience when performing the telemonitoring physical exercise program. Methods This was a phase 1 of a clinical trial, engaging 19 individuals with idiopathic PD of an in‐person community rehabilitation program. For 24 weeks an asynchronous telemonitoring physical exercise program delivered two sessions per week by video including warm‐up, balance, aerobic and resistance exercises, and cool‐down. During the remote program were verified: adherence rate at entrance, attendance rate, barriers to attend, safety, and overall experience of the program. Results and conclusion Only one participant did not perform any session and 18 participants completed between 2 and 34 sessions. Participants with a caregiver showed higher attendance rates. The most frequently cited barriers to attend the program were: pain; lack of motor skills; and reduced physical fitness. In relation to safety of the program, the most frequently reported was fear of falling. Although participants reported the telemonitoring program induced health benefits and they had positive experiences for themselves and for their families, most of participants prefer an in‐person program. In this sense, the asynchronous telemonitoring physical exercise program was safe, showed moderate adherence, with attendance rate depending on the presence of a companion.

Successful implementation of technology in the management of Parkinson's disease: Barriers and facilitators

“…Table 1 provides an overview of the participant characteristics, interventions, methods and findings of these 34 articles included in this review [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] . Of these studies, three focused on a cueing intervention [17] , [18] , [19] , three focused on exergaming [20] , [21] , [22] , ten focused on remote monitoring using wearable sensors [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , eight focused on telerehabilitation [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] and ten focused on remote consultation [41] , [42] , [43] , [44] , [45] , [46] , ...…”

“… Category: telerehabilitation Barrier Study Facilitator Study Technical issues [35] , [36] , [37] , [39] , [40] Convenience [34] , [35] Feeling of being watched [38] Monitoring capability of the telehealth system [35] Sending alerts to caregivers (resulting in caregivers hurrying back when they are out, although that is rarely what the faller needed or wanted) [38] Support increases motivation to exercise [35] , [37] Instability of persons with PD hinders necessary tasks for calibration of the wearables [38] Personalized leading to confidence to exercise and/or using technology [35] Challenges in exercising at home due to PD symptoms [33] , [37] Potential benefits of telehealth (e.g. exercising when and where you like, or possibility to employ strategies into daily routines, no additional equipment needed) [33] , [34] , [35] , [37] Challenges in exercising at home due to not having the equipment and space at home [33] , [37] , [39] , [40] Accountability [35] More need for support and feedback [33] Beneficial effects (e.g. improved self-confidence and more able to venture into public spaces, improvements in motor- and non-motor symptoms, sense of achievement and satisfaction) [33] , [34] , [36] , [40] Diffi...…”

“…improved self-confidence and more able to venture into public spaces, improvements in motor- and non-motor symptoms, sense of achievement and satisfaction) [33] , [34] , [36] , [40] Difficult to maintain motivation [33] Physically and mentally challenging, but still appropriately tailored to capability of persons with PD [36] Isolating / lack of social contact [33] , [40] Variety in dance genres but progression in complexity [36] Concerns about the correct execution of exercises / postures [33] , [34] Variety of music, but a clear beat was key [36] , [40] Boredom [37] Input in music choice because of individual preferences for music [36] Time consuming [37] Instructor qualities (e.g. perception of dance proficiency, teaching skills and the ability to communicate positively, with respect, empathy, patience and understanding, and making sessions fun and challenging) [33] , [36] Feeling limited because the exercises and strategies were not accessible on a portable device [37] Instructor with knowledge about movement disorders and PD [33] , [36] Feeling embarrassed or self-conscious about exercise [37] Safety checks before and during each session [36] The decline in visits by the physiotherapists as the program progressed [37] Not cumbersome [38] Need to have a companion for safety reasons [39] No hinder or distraction for participants [38] Fear of injury ...…”

“…perception of dance proficiency, teaching skills and the ability to communicate positively, with respect, empathy, patience and understanding, and making sessions fun and challenging) [33] , [36] Feeling limited because the exercises and strategies were not accessible on a portable device [37] Instructor with knowledge about movement disorders and PD [33] , [36] Feeling embarrassed or self-conscious about exercise [37] Safety checks before and during each session [36] The decline in visits by the physiotherapists as the program progressed [37] Not cumbersome [38] Need to have a companion for safety reasons [39] No hinder or distraction for participants [38] Fear of injury [39] Comfortable way of applying the sensors [38] PD-related issues (e.g. freezing of gait, tremor, lack of motor skills and dual-task performance difficulty) [39] Related to traveling (no requirements, no issues, no adverse weather to face) [33] , [34] Cognitively challenging leading to mental tiredness [40] Clear description of the exercises [33] , [37] First exercises in the center gave confidence and knowledge to exercise at home [33] No health measures against COVID-19 [34] No safety concerns related to social movement activities in the local community [34] Interactive and interesting program [34] Greater effort and commitment in knowing that the physiotherapist would be returning …”

“…Eight studies on telerehabilitation were included, using a digital connection for home-based exercising [33] , [35] , [37] , [39] , an online dance therapy [36] , [40] , a home-based mindfulness yoga program [34] , or a RGB-D camera to record in-home falls and movements [38] . Some negative experiences were reported as a barrier for using a video connection for telerehabilitation, including technical issues (e.g.…”