The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial

Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomescompared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups:clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hourinterventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-onlygroup. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-onlygroups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys.Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR,n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non-study-related injurious fall. Regardlessof group allocation, both patients and therapists generally rated the mode of care delivery as "good" or "very good" across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant exceptin the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TRgroup (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in termsof age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunitiesfor matching patients to the optimal utilization of TR as part of the therapy episode.