Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson’s disease. Protocol for a longitudinal, randomized clinical trial

Abstract

Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.

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.…”

A Holter for Parkinson's Disease Motor Symptoms: STAT-ONTM

“…Integration of the telemedicine in the management of PD could be useful to remotely monitor the PD motor complications, facilitate the access to care, complement, or replace the in-office consultations specially when these are not possible for geographical reasons, improving the detection of patients who are candidates to a device-aided therapy and facilitate the monitoring of device-aided therapies [57][58][59]. Moreover, the STAT-ON™ can be used as a part of a multidisciplinary telemedicine intervention with the aim of reducing the risk of some complications such as falls [60]. Even the information of the STAT-ON™ can be complementary to the other devices [61] and all together useful for making decisions about the treatment of the patient with PD.…”