Johnson Joshua K, Longhurst Jason K, Gevertzman Michael, Jefferson Corey, Linder Susan M, Bethoux Francois, Stilphen Mary
Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, United States.
JMIR Form Res. 2024 Jul 31;8:e54599. doi: 10.2196/54599.
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.
The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care.
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-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. 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.
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 One patient (TR-only) was withdrawn due to a non-study-related injurious fall. Regardless of 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 except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score).
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 terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode.
ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747.
帕金森病（PD）患者通过经常锻炼可以改善其整体活动能力并参与日常活动。尽管需要个性化定制的锻炼方案，但PD患者在寻求能为其提供服务的物理康复专业人员时往往面临障碍。远程康复（TR）可能有助于为PD患者提供必要的个性化康复服务。
本研究旨在评估TR对PD患者的可行性，并与面对面护理相比探索临床结果。
这是一项在2家门诊神经康复诊所进行的试点随机对照试验，有3个研究组：诊所+TR组、仅TR组和常规护理（UC）组。使用基于网络的应用程序并可选择移动应用程序来实施TR。每周进行1小时的干预，共4周，诊所+TR组和UC组为面对面干预，仅TR组为虚拟干预。为UC组提供纸质版家庭锻炼方案，为诊所+TR组和仅TR组通过基于网络的平台提供。通过招募和留用成功率以及调查中患者和治疗师的满意度来评估可行性。在组间和组内分析中使用表现和患者报告的指标来探索临床结果。
在389名筛查的患者中，68名（17.5%）符合纳入标准，20名（符合条件者的29.4%）被纳入研究（诊所+TR组，n = 6；仅TR组，n = 6；UC组，n = 8）。1名患者（仅TR组）因与研究无关的受伤跌倒而退出。无论分组如何，患者和治疗师在所有评估的方面，包括总体满意度和安全性，对护理提供方式的总体评价均为“良好”或“非常良好”。在所有组的分析中，出院时的临床结果没有差异。组内差异（从基线到出院）除UC组（5次坐立时间更快，迷你平衡评估系统测试平衡得分更高）和诊所+TR组（迷你平衡评估系统测试平衡得分更高）外，一般也不显著。
无论分组如何，患者和临床医生的满意度都很高，且临床结果在组间无显著差异，这表明TR对早中期PD患者是可行的。未来需要更大样本量的试验来测试临床有效性。随着更大规模的试验纳入具有不同特征（如年龄、疾病进展、护理者支持、技术获取和能力等方面）的患者，它们可以开始确定将患者与TR的最佳利用相匹配的机会，作为治疗过程的一部分。
ClinicalTrials.gov NCT06246747；https://clinicaltrials.gov/study/NCT06246747
