Teleneurorehabilitation and Motor and Nonmotor Symptoms and Quality of Life in Parkinson Disease

Importance To our knowledge, no randomized clinical trials have compared the efficacy and safety of teleneurorehabilitation (TNR) with in-person rehabilitation in Parkinson disease (PD) during the COVID-19 pandemic lockdown. Objective To assess the efficacy and safety of TNR among patients with PD during the COVID-19 lockdown. Design, Setting, and Participants The TELEPARK single-center, assessor-blinded, randomized clinical trial was conducted over 11 months from September 2020 to July 2021, with follow-up after 12 weeks. Final data could be analyzed on July 1, 2024. Patients aged 18 years or older diagnosed with idiopathic PD with Hoehn and Yahr stage 1 to 2.5, Mini-Mental State Examination score of 24 or higher, and who possessed a smartphone allowing videocalling were eligible for inclusion and randomized to in-person or TNR therapy. Intervention The in-person group received physiotherapy, aerobic, and breathing exercises for 30 minutes in person once a week for 4 weeks and then once every 2 weeks for 8 weeks. The TNR group received in-person sessions on day 1, followed by supervised sessions via videocalling once a week for the first 4 weeks, then once every 2 weeks for 8 weeks. Main Outcome and Measures The primary outcome was mean change in the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale III (MDS-UPDRS III) postintervention score from baseline. Mean changes in postintervention MDS-UPDRS II and III, Non-Motor Symptom Scale (NMSS), Parkinson’s Disease Questionnaire-8 Summary Index (PDQ8-SI), 6-minute walk test (6MWT), and functional reach test (FRT) scores from baseline between groups was assessed using unpaired t tests. Results A total of 63 participants (28 in-person and 35 TNR) were analyzed. Mean (SD) ages in the in-person and TNR groups were 60.50 (7.08) years and 62.80 (12.46) years, respectively. Twelve of 28 patients in the in-person group (42.9%) and 16 of 35 patients in the TNR group (45.7%) were female. Mean (SD) MDS-UPDRS III scores were significantly lower following TNR (pre-TNR: 35.17 [17.72] vs post-TNR: 28.6 [19.7]; P = .001). Mean (SD) change in postintervention MDS-UPDRS III scores was not significantly different between the 2 groups (TNR: −6.74 [11.07] vs in-person: −7.54 [10.52]; P = .39). Median changes in NMSS and PDQ8-SI scores were similar between the groups. Conclusions and Relevance TNR is safe and effective in improving motor and nonmotor symptoms and quality of life among Indian patients with PD.