Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review

Abstract

Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a progressive alteration of the motor and non-motor function. PD influences the patient's daily living and reduces participation and quality of life in all phases of the disease. Early physical exercise can mitigate the effects of symptoms but access to specialist care is difficult. With current technological progress, telemedicine, and telerehabilitation is now a viable option for managing patients, although few studies have investigated the use of telerehabilitation in PD. In this systematic review, was investigated whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed. The usage of telerehabilitation technologies in the management of cognitive impairment was not addressed.Method: An electronic database search was performed using the following databases: PubMed/MEDLINE, COCHRANE Library, PEDro, and SCOPUS for data published between January 2005 and December 2019 on the effects of telerehabilitation systems in managing motor and non-motor symptoms. This systematic review was conducted in accordance with the PRISMA guideline and was registered in the PROSPERO database (CRD42020141300).Results: A total of 15 articles involving 421 patients affected by PD were analyzed. The articles were divided into two categories based on their topic of interest or outcome. The first category consisted of the effects of telerehabilitation on gait and balance (3), dexterity of the upper limbs (3), and bradykinesia (0); the second category regarded non-motor symptoms such as speech disorders (8) and dysphagia (0). Quality of life (7) and patient satisfaction (8) following telerehabilitation programs were also analyzed, as well as feasibility and costs.Conclusion: Telerehabilitation is feasible in people affected by PD. Our analysis of the available data highlighted that telerehabilitation systems are effective in maintaining and/or improving some clinical and non-clinical aspects of PD (balance and gait, speech and voice, quality of life, patient satisfaction).Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020141300.

Impact of COVID-19 Pandemic on (Health) Care Situation of People with Parkinson’s Disease in Germany (Care4PD)

“…However, our data indicate that although technical options were accessible in most PwP (even those with p-LTC, who additionally might not only need technical options but also care staff support to use the technology), acceptance and use of this technique was rather low in both groups. Although telemedicine approaches have been shown to be effective [ 60 , 61 ] and are widely recommended for PwP [ 16 , 32 , 62 ], even by the International Parkinson and Movement Disorder Society [ 1 ], our findings are congruent with previous studies documenting that even high levels of satisfaction with telemedicine did not translate into a sustained interest or use of this health care approach [ 2 , 12 ]. Extensive promotion of remote or virtual care modes that have been found to be as effective as in-person communication [ 63 ] or alternative offerings (e.g., conducting more house calls by medical and/or therapeutical staff, cross-sectoral approaches with PD nurse specialists as in other countries that are only rarely deployed in Germany so far [ 64 ]) should be focused on in the future.…”

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

“…The a priori criterion of no falls was matched in our cohort, indicating the high safety of our telerehabilitation program in mild-to-moderate PD patients. Moreover, there was no report of any other AE, in line with the results of previous studies underlying the safety of remote rehabilitation in PD patients ( 33 ). Dropout rate and adherence to the program were considered as measures of feasibility.…”

“…In the literature, the efficacy of physiotherapy on motor symptoms is widely demonstrated ( 7 ). Moreover, preliminary studies showed efficacy of non-conventional remote administered rehabilitation strategies, including dance or virtual reality training, on motor and non-motor outcomes in PD patients ( 33 ). Our study confirms this extended knowledge to the efficacy of remote administered physiotherapy program on motor symptoms of PD, as measured by the MDS-UPDRS-III score.…”

Secondary Impact of COVID-19 Pandemic on People with Parkinson’s Disease—Results of a Polish Online Survey

“…Numerous studies indicated a high level of satisfaction with this form, its high efficiency, and cost-effectiveness. Overall, it was mostly well received [ 6 , 7 , 8 , 44 ]. Therefore, we expected more responses to the online questionnaire, given that no contact required, possibility of completing the questionnaire at any time of the day existed and a reward of a set of exercises was offered.…”

“…Access to physicians and physiotherapists was restricted. In response to the situation, the role of telemedicine (used in general to diagnose, consult and heal, also in the meaning of telerehabilitation) increased [ 5 , 6 , 7 ] and its effectiveness was confirmed even before the pandemic [ 8 , 9 , 10 ].…”