Lavoie V1, Bouchard M1, Turcotte S1, Tousignant M2,3
1Centre de Recherche du CISSS de Chaudière-Appalaches, Lévis, Canada, 2Research Center on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-CHUS, Sherbrooke, Canada, 3Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada
Background: Rehabilitation in Parkinson´s disease (PD) has been shown effective in improving functional mobility and reducing falls. However, access to specialized rehabilitation for this elderly population is often compromised because of traveling distance, transportation issues and comorbidities.
Purpose: This study aimed to verify the feasibility of an innovative telerehabilitation intervention in PD patients and to determine if participation to the intervention improves functional capacity and quality of life.
Methods: This single-arm cohort study included patients who meet the following criteria: diagnosis of PD for at least 3 years, postural instability (score ≥ 1 on the MDS-UPDRS corresponding item), at least one fall in the last year, access to high speed internet and availability of a relative willing to collaborate during intervention sessions. We excluded persons unable to participate in an exercise program due to disabilities or comorbidities and those who had participated in rehabilitation in the last 6 months. Our telerehabilitation program includes two 60-minutes sessions per week for 8-weeks. The sessions were personalized for each participant according to their specific needs, as assessed by our specialized physiotherapist. Cognitive strategies and attentional capacities were used to facilitate functional activities, transfers and displacement, as well as balance, posture and mobility exercises. For communication between the physiotherapist and patient, we used a software platform (Tera +) based on a technological infrastructure that was developed and tested in studies conducted by our research team. Assessments were completed 1 week before (T1) and immediately after (T2) the intervention phase and 12 weeks after the end of the intervention (T3). Compliance with the intervention, adverse events and technical issues were documented. Walking speed, quality of life, dynamic stability, and fear of falling were assessed at each evaluation session.
Results: We present preliminary results for six consecutive participants who completed 88 sessions on a maximum expected number of 96 sessions. One participant fell during daily activities and had a fracture at week 4 of the intervention phase. The intervention was stopped and he could not be reassessed at T2. No session was stopped because of participant's inability to comply with exercises. Technical communication issues occurred during 8 sessions, leading to postponement of 6 sessions. Post-intervention assessment (T2), showed improvement in quality of life in four participants (median PDQ39 change score -16.3), and improvement in dynamic stability in five participants (median mini-BESTest change score 3). Fear of falling was decreased in five participants (median change score -10). Only three participants were reassessed at T3.
Conclusion(s): Our results suggest that telereabilitation is feasible in PD patients. A large proportion of the intervention sessions was carried out and no adverse event occurred. Technical issues happened mainly at the beginning of the project and were solved, indicating that sufficient training and technical support is mandatory. Improvement of multiple clinical variables seems clinically meaningful in most participants although our sample size is small.
Implications: Telerehabilitation may improve accessibility to rehabilitation services. Research must continue to compare the efficacy of telerehabilitation to on-site services.
Keywords: Parkinson's disease, telehealth, rehabilitation
Funding acknowledgements: Fondation de l´Hôtel-Dieu de Lévis and Ordre professionnelle de la Physiothérapie du Québec
Purpose: This study aimed to verify the feasibility of an innovative telerehabilitation intervention in PD patients and to determine if participation to the intervention improves functional capacity and quality of life.
Methods: This single-arm cohort study included patients who meet the following criteria: diagnosis of PD for at least 3 years, postural instability (score ≥ 1 on the MDS-UPDRS corresponding item), at least one fall in the last year, access to high speed internet and availability of a relative willing to collaborate during intervention sessions. We excluded persons unable to participate in an exercise program due to disabilities or comorbidities and those who had participated in rehabilitation in the last 6 months. Our telerehabilitation program includes two 60-minutes sessions per week for 8-weeks. The sessions were personalized for each participant according to their specific needs, as assessed by our specialized physiotherapist. Cognitive strategies and attentional capacities were used to facilitate functional activities, transfers and displacement, as well as balance, posture and mobility exercises. For communication between the physiotherapist and patient, we used a software platform (Tera +) based on a technological infrastructure that was developed and tested in studies conducted by our research team. Assessments were completed 1 week before (T1) and immediately after (T2) the intervention phase and 12 weeks after the end of the intervention (T3). Compliance with the intervention, adverse events and technical issues were documented. Walking speed, quality of life, dynamic stability, and fear of falling were assessed at each evaluation session.
Results: We present preliminary results for six consecutive participants who completed 88 sessions on a maximum expected number of 96 sessions. One participant fell during daily activities and had a fracture at week 4 of the intervention phase. The intervention was stopped and he could not be reassessed at T2. No session was stopped because of participant's inability to comply with exercises. Technical communication issues occurred during 8 sessions, leading to postponement of 6 sessions. Post-intervention assessment (T2), showed improvement in quality of life in four participants (median PDQ39 change score -16.3), and improvement in dynamic stability in five participants (median mini-BESTest change score 3). Fear of falling was decreased in five participants (median change score -10). Only three participants were reassessed at T3.
Conclusion(s): Our results suggest that telereabilitation is feasible in PD patients. A large proportion of the intervention sessions was carried out and no adverse event occurred. Technical issues happened mainly at the beginning of the project and were solved, indicating that sufficient training and technical support is mandatory. Improvement of multiple clinical variables seems clinically meaningful in most participants although our sample size is small.
Implications: Telerehabilitation may improve accessibility to rehabilitation services. Research must continue to compare the efficacy of telerehabilitation to on-site services.
Keywords: Parkinson's disease, telehealth, rehabilitation
Funding acknowledgements: Fondation de l´Hôtel-Dieu de Lévis and Ordre professionnelle de la Physiothérapie du Québec
Topic: Neurology: Parkinson's disease
Ethics approval required: Yes
Institution: Centre de recherche du CISSS de Chaudière-Appalaches
Ethics committee: Comité d'éthique de la recherche du CISSS de Chaudières-Appalaches
Ethics number: 2018-503
All authors, affiliations and abstracts have been published as submitted.
