Efficacy on Non-motor and Motor symptoms and Quality of Life using a multidisciplinary telemedicine program in high-risk fall patients with Parkinson´s disease.
Esther Cubo Delgado1, Alvaro Garcia-Bustillo2, Alvar Arnaiz3, Florita Valiñas2, Marta Allende2, Jose Miguel Ramirez-Sanz3, Jose Luis Garrido-Labrador3, Alicia Olivares-Gil3, Jose Francisco Diez-Pastor3, Jose Maria Trejo2, Jeronimo Gonzalez-Bernal3, Josefa Gonzalez-Santos3
1Fundacion Burgos Investigacion Salud CIF G09254616, 2Hospital Universitario Burgos, 3University of Burgos
Objective:

This study aims to evaluate the efficacy of a multidisciplinary telemedicine (TM) program to improve lifestyles, the burden of motor and non-motor symptoms (NMS),  and quality of life (QoL) in  fall patients with Parkinson´s disease (PD) and high risk of fall.  

Background:
Falls in PD are very frequent, with devastating consequences, worse QoL, increasing comorbidity, and social isolation. Telerehabilitation has shown promising effects on motor symptoms, but the effectiveness of a multidisciplinary TM intervention in addition to standard clinical care on NMS, QoL and lifestyle remains unclear
Design/Methods:

Longitudinal, randomized study. PD Patients with high risk of falling and restricted access to multidisciplinary care were included (NCT04694443). A multidisciplinary TM program plus standard care was allocated to the study group for 4 months and compared to controls (in-office visits, standard care). TM included occupational therapy, nutrition, and PD clinical management.  After discontinuing TM, both groups were compared at 8 months. Gait and PD motor severity were assessed using wearable sensors, MDS-UPDRS, Mini-Best and Freezing of gait questionnaire (FOGQ); quality of life (EuroHis-QoL8) and NMS (NMSS), Apathy Severity (LARS) and Depression/Anxiety Scale (BDI-II). Clinical information at baseline vs. 4 and 8-months visits were compared using parametric/non-parametric tests as needed.

Results:

51 PD patients, 48.6 % males, median Hoehn Yhar stage 2 (1;3), mean age 68.6 + 9.7 years were included. At 4 months, compared to controls, patients on TM had an improvement in the MDS-UPDRS II (p=0.01), Mini-Best (p<0.0001) FOGQ (p=0.01); EuroHis-QoL8 (p=0.004); LARS (p<0.0001) and BDI-II scores (p=0.004). After discontinuing TM at 8 months, FOG (p=0.01), and Mini-Best (p=0.001) scores were better in the TM group compared to controls.

Conclusions:
A multidisciplinary TM intervention alongside with standard care improves gait, QoL and NMS in PD patients with a high risk of falling. Long-term benefits on gait were observed more likely attributed to lifestyle modifications
10.1212/WNL.0000000000202177