Feasibility, Safety, and Effectiveness of Telerehabilitation in Mild-to-Moderate Parkinson's Disease

Abstract

IntroductionParkinson's disease (PD) patients frequently engage in rehabilitation to ameliorate symptoms. During the Coronavirus disease 2019 (COVID-19) pandemic, access to rehabilitation programs has been markedly limited, consequently, telerehabilitation gained popularity. In this prospective, open-label, and pilot study, we aimed to investigate feasibility, safety, and efficacy of telerehabilitation in mild-to-moderate PD patients.Materials and MethodsTwenty-three PD patients, with Hoehn and Yahr stage <3, without gait disturbances or dementia and capable of using the televisit platform, were recruited for a 5-week telerehabilitation program, consisting of 1 remote visit with a therapist and a minimum of two sessions of >30-min of self-conducted exercises per week. Patients received video tutorials of exercises and were asked to keep a diary of sessions. At baseline (T0), at the end of the intervention (T1), and 1 month after the end of treatment (T2), patients were remotely assessed with MDS-UPDRS part I-III, PDQ-39, Functional Independence Measure (FIM), and Frontal Assessment Battery scales, respectively. Acceptable compliance to the program was defined as >60% matching of frequency and duration of sessions, whereas optimal compliance was set at >80% matching.ResultsThe dropout rate was 0%. Over 85% of patients reached acceptable adherence cut-off and around 70% reached optimal one. No adverse events were reported during sessions. The repeated measure analysis of variance (rANOVA) showed a significant effect of factor “time” for MDS-UPDRS-III (p < 0.0001) with a mean reduction of 4.217 points between T0 and T1 and return to baseline at T2. No significant effect was found for other outcome measures.ConclusionOur findings demonstrate that telerehabilitation is safe, feasible, and effective on motor symptoms in mild-to-moderate PD patients.

Participants’ perspectives of “NeuroSask: Active and Connect”—a virtual chronic disease management program for individuals with a neurological condition

“…Respondents also highlighted the impact that NeuroSask has had on motivation, sense of personal power, and accomplishment. This may suggest benefits extend beyond symptom management to improving daily life experience, and perhaps further informs our understanding of Virtual chronic disease management programs can provide participants with similar physical benefits compared to in-person programs, in a safe, and effective manner (28)(29)(30)(31)(32). Current literature also supports the growing use of videoconferencing for rehabilitation in neurological conditions to improve physical activity and functional mobility (33-38).…”

“…Virtual chronic disease management programs can provide participants with similar physical benefits compared to in-person programs, in a safe, and effective manner ( 28–32 ). Current literature also supports the growing use of videoconferencing for rehabilitation in neurological conditions to improve physical activity and functional mobility ( 33–38 ).…”

Development of a Physical Therapy Telehealth Examination Battery for People with Parkinson Disease

“…Although many physical therapy interventions for PwP are amenable to telehealth, development of an individualized multi-modal intervention plan requires a comprehensive examination battery to facilitate clinical decision making, design the plan of care, and evaluate patient progress ( Flynn et al, 2023 ; Osborne et al, 2022 ; Quinn et al, 2020 ; Shih et al, 2022 ; van der Kolk et al, 2019 ). One of the primary concerns in telehealth is safety of administering tests and measures when a therapist is not in person to provide guarding and environmental cueing ( Bennell et al, 2021 ; Bianchini et al, 2022 ; Colón-Semenza et al, 2023 ; Cubo et al, 2021 ; Thwaites et al, 2023 ). While there are a few outcomes that do not lend themselves well to telehealth administration (i.e., compensatory stepping, 6MWT), many movement-based assessments can readily be adapted to telehealth administration.…”

Telerehabilitation by Videoconferencing for Balance and Gait in People with Parkinson’s Disease: A Scoping Review

“…Although 14 studies [8,10,16,19,[25][26][27][28][57][58][59][60][61][62] used telerehabilitation by videoconferencing for PD, of these, only 7 studies [8,10,19,[25][26][27][28] used videoconferencing to both assess and treat balance and gait, as demonstrated in Table 1. Although no study has investigated the implementation of wearable technology into telerehabilitation programs to assess and treat balance and gait remotely, we also created a search term to evaluate this Although 14 studies [8,10,16,19,[25][26][27][28][57][58][59][60][61][62] used telerehabilitation by videoconferencing for PD, of these, only 7 studies [8,10,19,[25][26][27][28] used videoconferencing to both assess and treat balance and gait, as demonstrated in Table 1. Although no study has investigated the implementation of wearable technology into telerehabilitation programs to assess and treat balance ...…”