Effectiveness of telerehabilitation in reducing motor disability and enhancing quality of life in parkinson's disease: a systematic review and meta-analysis.

OBJECTIVE

This review and meta-analysis explored the effectiveness of telerehabilitation in reducing motor disability and improving quality of life in patients with Parkinson's disease (PD).

BACKGROUND

PD is characterized by motor and non-motor symptoms. Motor function decline averages 3-5 points per year on the Unified Parkinson's Disease Rating Scale, Part III (UPDRS-III). Sedentary behavior worsens symptoms, while exercise improves motor function and quality of life. Telerehabilitation has proven effective in increasing exercise adherence in PD patients.

METHODS

We searched Web of Science, Cochrane, PubMed, Scopus, and Embase for relevant articles till June 2024, including studies that compared telerehabilitation to no exercise, traditional face-to-face rehabilitation, or any studies with no comparator group. Data were pooled using a random effects model, and differences were presented using mean differences (MD) alongside 95% confidence intervals (CI).

RESULTS

This review included 44 articles with 1614 participants. In assessing the quality of studies, four cohort/cross-sectional studies were rated fair, one good; one case-control study was good. Eight single-arm and four NRCTs were good, and the others were of fair quality. All 20 RCTs had a high risk of bias; one case report was deemed to have fair quality.Double-arm studies demonstrated no significant difference between telerehabilitation and in-person programs regarding UPDRS-III scores (MD: 0.69). Pooled Parkinson's Disease Questionnaire (PDQ)-39 scores exhibited the same non-significant pattern, but in longer-duration programs, telerehabilitation demonstrated a significant edge (MD:-5.45). Similarly, the difference between telerehabilitation and traditional exercise was not significant in PDQ-8 scores, nonetheless, TUG times were significantly shorter for telerehabilitation (MD: 1.17). In the single-arm analysis of telerehabilitation, UPDRS-III scores showed an improvement (MD:-2.58). Likewise, PDQ-39 scores decreased significantly (MD:-2.98). Both PDQ-8 scores (MD:-5.52) and Timed Up and Go Test (TUG) times (MD:-2.15) decreased significantly, while Activities-specific Balance Confidence (ABC) scores improved (MD: 8.65%).

CONCLUSION

Telerehabilitation decreases the progress in motor disability and improves the quality of life in PD patients, possibly due to increased exercise adherence, while costing less than in-person exercise.