Remote intervention combining physical and mental practice to improve Freezing of Gait in People with Parkinson's Disease: Randomized Controlled Trial

To investigate the effects of a remote intervention combining mental and physical practice on FOG episodes in people with PD.

A single-blinded, controlled, randomized clinical trial was conducted in accordance with CONSORT guidelines. People with idiopathic PD were randomly assigned to either an experimental group (EG) or a control group (CG). The inclusion criteria were: (1) confirmed diagnosis of idiopathic PD, (2) use of dopaminergic medication, (3) experiencing at least one daily episode of FOG, and (4) internet access for video calls. Exclusion criteria included (1)  the presence of neurological disorders, severe cardiovascular and respiratory conditions, uncorrected visual and auditory impairments, or dementia, and (2) impaired ability for motor imagery assessed by Kinesthetic and Visual Imagery Questionnaire-20 (cut-off 20). Both groups completed 10 online remote sessions (2 per week) of gait training,  conducted by a physiotherapist, identical in volume, intensity, and components, differing only in the inclusion of MP for the EG. The MP consisted of first-person imagery of gait in different environments that usually increase the FOG episodes. Assessments were conducted at baseline (EV1), post-intervention (EV2), and 30 days after the intervention (EV3). The primary outcomes were self-reported FOG severity, measured by the New FOG Questionnaire (NFOG-Q), and the percentage of time spent in FOG during the Rapid Turn Test. Secondary outcomes included global cognitive capacity, measured by the Telephone-Montreal Cognitive Assessment (T-MoCA); motor disability, assessed by the Unified Parkinson's Disease Rating Scale Part II (UPDRS-II); and mobility-related quality of life, assessed by the Mobility domain of the Parkinson's Disease Questionnaire (M-PDQ-39).

No significant differences were found between the two groups regarding clinical and demographic characteristics at baseline. Repeated-measures ANOVA revealed significant improvements in NFOG (F1,17 = 20.58, p 0.0002, ES = 0.98), %FOG (F1,17 = 22.44, p 0.03, ES = 0.76), UPDRS-II (F1,17 = 7.82, p 0.01, ES = 0.75), and M-PDQ-39 (F1,17 = 4.8, p 0.04, ES = 0.54). Post-hoc analysis (Tukey) confirmed significant improvements between EV1 and EV2, and between EV1 and EV3 (p 0.01) in all measures. There were no reported adverse effects such as falls.

Remote interventions are effective in improving FOG, motor disability, and mobility-related quality of life in people with PD, regardless of the inclusion of mental practice.

The findings highlight the feasibility of delivering gait training remotely. This could potentially expand access to rehabilitation for a broader population and offer an innovative, accessible, and effective approach to managing FOG and enhancing overall mobility.