Evaluating the Impact of Telerehabilitation on Motor Disability and Quality of Life in Parkinson’s Disease: A Systematic Review and Meta-analysis
Mohamed Mamdouh1, Anas Zakarya Nourelden2, Ahmed Fathallah3, Osama Khalid Ahmed2, Adel Reda Abd Elwahab2, Mohammed Elkholy4, Ibrahim Kamal2
1Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt, 2Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 3Faculty of Medicine, Minia University, Minia, Egypt, 4The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America.
Objective:
This review explores the effectiveness of telerehabilitation in reducing motor disability, and changes in 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. Sedentary behavior exacerbates symptoms; however, exercise improves motor function and quality of life. Telerehabilitation, has proven effective in increasing exercise adherence in PD patients.
Design/Methods:
We searched Web of Science, Cochrane, PubMed, Scopus, and Embase for relevant articles till April 2024. We included randomized controlled trials and cohort studies comparing telerehabilitation to traditional techniques. The differences were presented using mean differences (MD) alongside 95% CI, after pooling studies using a random effects model.
Results:
This review included 44 articles with 1614 participants. Double-arm studies signaled no significant difference between telerehabilitation and in-person programs regarding UPDRS-III scores (MD: 0.69; 95%CI: -1.52, 2.91) except in studies with longer exercise duration where telerehabilitation was superior (MD: -1.32; 95%CI: -1.60, -1.05; P<0.00001). PDQ-39 score exhibited the same pattern, where the overall effect was not significant (MD: -1.61; 95%CI: -3.78, 0.55), but in longer-duration programs, telerehabilitation demonstrated a significant edge (MD: -5.45; 95%CI: -8.74, -2.15; P=0.001). 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; P=0.02). Single-arm analysis of telerehabilitation was conducted to quantify the absolute change in disability. UPDRS-III scores showed an improvement (MD: -2.58; P=0.016). Likewise, PDQ-39 scores decreased significantly (MD: -2.98; P=0.003). Both PDQ-8 scores (MD: -5.52) and TUG times (MD: -2.15) decreased significantly, while ABC scores improved (MD: 8.65%; P<0.001).
Conclusions:
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.
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