EFFECT OF HOME-BASED TELEREHABILITATION ON BALANCE, FUNCTIONAL MOBILITY AND QUALITY OF LIFE IN PERSONS WITH PARKINSON'S DISEASE: A SYSTEMATIC REVIEW

A.F. D'Souza¹, A. Jagadish¹, D.B. Jasti², M. Natarajan¹

¹Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India, ²Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India

Background: Persons with Parkinson’s disease (PwPD) require long-term care for the maintenance of optimal functional independence. Falls resulting from postural instability and gait disorder significantly degrade quality of life. Exercise therapy has been proven to be superior to pharmacological interventions in the management of postural instability in PwPD. Home exercise programs are the cornerstone of the long-term management of PD, but compliance is usually poor. Telerehabilitation might facilitate the efficient delivery and maintenance of the home exercise program. Home-based telerehabilitation enables convenient, on-demand, tailored physiotherapy management that is relatively inexpensive and has implications for use in low-resource settings.

Purpose: To ascertain the effect of home-based telerehabilitation on balance, functional mobility, and quality of life in persons with Parkinson's disease.

Methods: A systematic literature search was conducted in PubMed, CINAHL, Embase, OvidSP, ProQuest, Scopus, Web of Science, Cochrane CENTRAL, and PEDro from inception through August 2022. The Rayyan web application was used for deduplication and screening the articles. Inclusion criteria were randomized controlled trials on home-based telerehabilitation for PwPD which utilized exercise as the primary intervention with balance, functional mobility, or quality of life as the outcomes. The risk of bias was assessed using the PEDro scale. Studies not published in the English language and those with a PEDro score < 6 were excluded.

Results: The literature search yielded 6,303 articles. Based on eligibility, seven studies were included in this systematic review. These studies recruited 383 participants between Hoehn and Yahr stages 1 and 3. Exercises delivered via telerehabilitation were multimodal, ranging from resistance, aerobic, and flexibility training to specific interventions for balance and mobility. Three studies described the use of individually tailored exercises. Three studies included direct therapist supervision (via live videoconference). Five studies were conducted in a high-income country. While none of the studies were specifically designed for use in low-resource settings, the intervention from three studies may translate to such settings. Balance was predominantly evaluated using the Mini Balance Evaluation Systems Test (Mini-BESTest). Functional mobility was mostly assessed using the 6-Minute Walk Test (6MWT), and 10-Meter Walk Test (10MWT). Quality of life was commonly measured using the 39-item Parkinson's Disease Questionnaire (PDQ-39). Statistically significant improvement between groups was reported by one study each for balance (p=0.04) and quality of life (p=0.027) respectively. None of the studies reported a significant improvement in functional mobility outcomes between groups. Adverse events were reported in five studies, they included non-fatal falls (two studies) and musculoskeletal pain (three studies).

Conclusions: Home-based telerehabilitation has limited effectiveness in improving balance and quality of life among PwPD. Although there was no significant improvement in functional mobility, it was found to be relatively safe.

Implications: Home-based telerehabilitation with adequate remote supervision by a physiotherapist may prove to be beneficial for improving balance, functional mobility, and quality of life in PwPD. Future studies must focus on the same with special considerations for applications in low-resource settings where access to in-person rehabilitation might be limited.

Funding acknowledgements: This systematic review has not received a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Keywords:
Parkinson Disease
Telerehabilitation
Postural Balance

Topics:
Neurology
Neurology: Parkinson's disease
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? No

Reason: Ethics approval is not required because data from previously published studies were retrieved and analyzed.