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

Abstract

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.

Keywords: Meta-analysis; Motor activity; Parkinson disease; Telerehabilitation.