A Novel Home-Based Telerehabilitation Program Targeting Fall Prevention in Parkinson Disease: A Preliminary Trial.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2024-02-01 Epub Date: 2024-01-05 DOI:10.1212/CPJ.0000000000200246

Mitra Afshari, Andrea V Hernandez, Jessica M Joyce, Alison W Hauptschein, Kristie L Trenkle, Glenn T Stebbins, Christopher G Goetz

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引用次数: 0

Abstract

Background and objectives: Falls in a person with Parkinson disease (PwP) are frequent, consequential, and only partially prevented by current therapeutic options. Notably, most falls in PwPs occur in the home or its immediate surroundings; however, our current strategies for fall prevention are clinic-centered. The primary objective of this nonrandomized pilot trial was to investigate the feasibility and preliminary efficacy of the novel implementation of home-based PD telerehabilitation (tele-physical/occupational therapy) focusing on fall risk reduction and home-safety modification.

Methods: Persons with mild-to-moderate PD who were identified as being at risk of falls by their movement disorders neurologist were recruited from a tertiary movement disorders clinic. After an initial in-person evaluation by the study physical and occupational therapists, 15 patients with PD (Hoehn and Yahr Stage 2 (n = 8) and Stage 3 (n = 7)) participated in 4 biweekly PT/OT televisits with care partner supervision over the course of 10 weeks. The Goal Attainment Scale (GAS) was implemented to assess progress toward individualized PT/OT goals established at baseline. Outcomes were assessed at the end of the intervention at 10 weeks and at a six-month follow-up.

Results: Participants completed all 120 protocol-defined televisits without dropouts and adverse events. At 10 weeks, mean composite PT and OT-GAS scores showed significant improvement from baseline (PT: p < 0.001, OT: p < 0.008), which continued at 6 months (PT: p < 0.0005, OT: p < 0.0005). Home-modification recommendations made through novel virtual home-safety tours were cumulatively met by participants at 87% at 10 weeks and 91% at 6 months.

Discussion: Home-based telerehabilitation is a promising new strategy toward fall prevention in PD. The GAS has the potential to serve as an effective and patient-driven primary outcome variable for rehabilitation interventions for heterogeneous PwPs to assess progress toward personalized goals.

Trial registration information: ClinicalTrial.gov identifier: NCT04600011.

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以预防帕金森病患者跌倒为目标的新型家庭远程康复计划：初步试验。

背景和目的：帕金森病患者（PwP）经常摔倒，后果严重，但目前的治疗方案只能部分预防。值得注意的是，帕金森病患者的跌倒大多发生在家中或其周围环境中；然而，我们目前的跌倒预防策略是以诊所为中心的。这项非随机试点试验的主要目的是调查基于家庭的帕金森病远程康复（远程物理/职业治疗）新方法的可行性和初步疗效，重点是降低跌倒风险和改善家庭安全：从一家三级运动障碍诊所招募经运动障碍神经科医生确认有跌倒风险的轻度至中度帕金森病患者。经过研究物理治疗师和作业治疗师的初步现场评估后，15 名帕金森氏症患者（Hoehn 和 Yahr 2 期（8 人）和 3 期（7 人））在护理伙伴的监督下参加了为期 10 周的 4 次双周物理治疗师/作业治疗师电视讲座。采用目标达成量表（GAS）来评估基线设定的个性化 PT/OT 目标的进展情况。结果在干预结束 10 周和随访 6 个月时进行评估：结果：参与者完成了方案规定的全部 120 次电视直播，无辍学和不良事件发生。10周时，PT和OT-GAS平均综合评分较基线有显著改善（PT：p < 0.001，OT：p < 0.008），6个月后仍有改善（PT：p < 0.0005，OT：p < 0.0005）。通过新颖的虚拟家庭安全之旅提出的家庭改造建议，参与者在 10 周和 6 个月分别有 87% 和 91% 的人采纳：基于家庭的远程康复是预防帕金森病患者跌倒的一项前景广阔的新策略。GAS有可能成为一种有效的、以患者为导向的康复干预主要结果变量，用于评估不同类型PwPs在实现个性化目标方面的进展：试验注册信息：ClinicalTrial.gov identifier：NCT04600011。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.