Telerehabilitation for early-stage Parkinson's disease: A randomized controlled feasibility trial of individualised real-time physiotherapy delivered via a videoconference platform

IntroductionExercise can improve outcomes for people with Parkinson's. Telerehabilitation (TR) may lower costs and maximise clinician time but its efficacy for gait and balance in early Parkinson's is uncertain. We conducted a randomized controlled feasibility trial of individualised real-time physiotherapy delivered via videoconference.MethodsWe recruited people with early (<4 years' duration) Parkinson's from 2 English NHS hospitals. The TR group had 1 × 60 min, 4 × 30 min video calls and 2 × 10 min calls. These calls occurred within 12 weeks of randomization. Experienced physiotherapists prescribed individualized exercises. The usual care group received standard exercise advice from their physician. Physical activity was measured using Fitbit Inspire. A qualitative process evaluation was undertaken.Results84 people were screened, 64 were eligible and 40 recruited. 21 and 19 were randomized to TR and usual care respectively. 90% of study instruments were completed per protocol.Median [interquartile range; IQR] change in Unified Parkinson's Disease Rating Scale (UPDRS) at six months was -3.5 [-8 to 2.5] for the TR group and 7 [0 to 17] for usual care, effect size (Cohen's D = -0.537). Median [IQR] change in weekly step count was 4215 [-8769 to 19664] for the TR group versus -2185 [-10764 to 3143] for usual care (Cohen's D = 0.198). Participants found the intervention acceptable. Most participants were confident in using the videoconference systems.ConclusionA definitive trial of TR for early Parkinson's is feasible. UPDRS and step count are suitable outcomes.