At-home, online physical therapy aid Parkinson’s motor function
Elderly patients adhered better to home program
Supervised exercises at home may safely improve motor function and quality of life in people with mild to moderate Parkinson’s disease, a study in China suggests.
The benefits were seen both with sessions conducted by a physical therapist at patients’ homes and with telerehabilitation using an application with predetermined exercises. Patient adherence and effectiveness in elderly patients were superior in the home physical therapy program, however.
“Home-based exercise is crucial for preserving or enhancing patient function, thereby mitigating the risk of falls and preventing disability, holding promise as a novel approach to future rehabilitation services,” the researchers wrote.
The study, “Home physical therapy versus telerehabilitation in improving motor function and quality of life in Parkinson’s disease: a randomized controlled trial,” was published in BMC Geriatrics.
Parkinson’s disease is caused by the progressive degeneration of nerve cells that produce dopamine, a brain chemical messenger involved in motor control. The loss of these neurons impairs dopamine signaling and leads to motor symptoms such as tremors, slowed movement, and impaired balance, all which make daily activities more difficult and reduce a patient’s quality of life.
Physiotherapy under the supervision of a specialist, such as balance and strength exercises, treadmill training, and cueing, which are signs the therapist provides to guide a patient’s movement, is part of disease management.
Comparing programs
Here, researchers compared telerehabilitation to home physical therapy on the impact on motor symptoms and quality of life in people with mild to moderate Parkinson’s.
A total of 190 patients, ages 60 to 80, were recruited at the Peking Union Medical College Hospital in Beijing and were randomly assigned to home therapy (100) or telerehabilitation (90). Those in the home therapy group had a mean age of 70 and 60% were women. Those on telerehabilitation had a mean age of 69 and 50% were women.
At the baseline, or start of the study, those on home therapy had significantly worse scores on the Unified Parkinson’s Disease Rating Scale motor section score (UPDRS3) and on the UPDRS part 2 that assesses activities of daily living.
Both groups received regular training that featured balance and gait training, strength and stretching exercises, and aerobic exercise — walking or biking — in sessions that lasted 40 to 60 minutes, five times a week for four weeks. The exercise program was adjusted once a week for a progressive increase in exercise intensity and difficulty.
The home therapy group had rehabilitation services at home three times a week and performed two sessions independently according to the therapist’s instructions. The telerehabilitation group was instructed to use a mobile application that included training plans, instructions, tips, demonstration videos, and a platform to submit adverse events.
Both groups saw a significant easing of motor symptoms after four weeks, meaning a decrease in the UPDRS3 score (by 3.2 points in the home physical therapy group and 1.87 points in the telerehabilitation group). They also saw improvements in balance, gait, functional performance, which is repeatedly rising from a chair and returning to the seated position as quickly as possible, activities of daily living, and quality of life. Step length and step velocity also improved with both approaches. The risk of falls was significantly reduced.
The scientists then used a threshold of age 70 to compare younger to older patients. In older patients, the decrease in UPDRS3 score was greater with home physical therapy than with telerehabilitation. Similar differences were seen in balance, risk of falls, step velocity, and knee extension strength. No significant differences were seen in younger patients.
Significantly more patients on home physical therapy participated in at least half the sessions than those on telerehabilitation (98% vs. 87.8%). Seven patients on home therapy and five on telerahabilitation reported adverse events, which included fatigue, pain, and dizziness. No serious adverse events related to the exercise plan were reported.
“Therefore, [home physical therapy] may be more suitable for older patients with lower compliance and [telerehabilitation] can be introduced to more patients via the internet,” wrote the researchers, who said the study’s limitations included the short duration of the exercise plan, which “may not adequately capture the potential benefits of the intervention,” and the lack of weekly supervision by a physiotherapy professional in the telerehabilitation group.
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