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

Edoardo Bianchini; Camilla Onelli; Carmen Morabito; Marika Alborghetti; Domiziana Rinaldi; Paolo Anibaldi; Adriano Marcolongo; Marco Salvetti; Francesco E Pontieri

doi:10.3389/fneur.2022.909197

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

Front Neurol. 2022 Jun 16:13:909197. doi: 10.3389/fneur.2022.909197. eCollection 2022.

Authors

Edoardo Bianchini^{1

2}, Camilla Onelli¹, Carmen Morabito², Marika Alborghetti^{1

2}, Domiziana Rinaldi^{1

2

3}, Paolo Anibaldi², Adriano Marcolongo², Marco Salvetti^{1

2

4}, Francesco E Pontieri^{1

2

3}

Affiliations

¹ Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.
² Sant'Andrea University Hospital, Rome, Italy.
³ Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy.
⁴ Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.

Abstract

Introduction: Parkinson'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 methods: Twenty-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.

Results: The 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.

Conclusion: Our findings demonstrate that telerehabilitation is safe, feasible, and effective on motor symptoms in mild-to-moderate PD patients.

Keywords: Parkinson's disease; neurorehabilitation; physiotherapy; remote treatment; telehealth; telemedicine; telerehabilitation.