背景:患有帕金森病(PD)的个体在进行频繁运动时可以改善其整体活动能力和对日常活动的参与。尽管需要单独定制的练习,患有PD的人经常面临接触可以提供他们的物理康复专业人员的障碍。远程康复(TR)可以促进PD患者获得必要且个性化的康复。
目的:本研究的目的是评估TR对PD患者的可行性,并探讨与现场护理相比的临床结果。
方法:这是一项试点随机对照试验,在2个门诊神经康复诊所进行,有3个研究组:诊所+TR,仅TR,和常规护理(UC)。TR使用基于Web的应用程序和移动应用程序选项进行管理。每周进行一小时的干预,持续4周,诊所+TR和UC组以及几乎仅TR组的面对面。UC组以纸上的形式提供了家庭练习,并通过基于Web的平台为临床TR和仅TR组提供了家庭练习。通过招募和保留成功以及患者和治疗师满意度来评估可行性。如调查中所述。在组间和组内分析中,使用表现和患者报告的测量来探索临床结果。
结果:在筛查的389名患者中,68(17.5%)符合资格标准,20人(占符合条件的29.4%)入组(诊所+TR,n=6;仅TR,n=6;和UC,n=8)。一名患者(仅TR)因非研究相关的伤害性跌倒而退出。无论小组分配如何,在所有评估的结构中,患者和治疗师通常都将护理交付模式评为“良好”或“非常好”,包括总体满意度和安全性。在对所有群体的分析中,出院访视时的临床结局无差异.组内差异(从基线到出院)通常也不显着,除非UC组(更快的5次静坐时间和更高的迷你平衡评估系统测试平衡评分)和临床TR组(更高的迷你平衡评估系统测试平衡评分)。
结论:无论分组如何,患者和临床医生的满意度都很高,结合临床结局的组间差异,提示TR对于早期中度PD患者是可行的。未来需要更大样本的试验来测试临床有效性。随着更大的试验招募具有不同特征的患者(例如,就年龄而言,疾病进展,护理人员支持,技术接入和容量,etc),作为治疗发作的一部分,他们可以开始确定将患者与TR的最佳利用相匹配的机会.
背景:ClinicalTrials.govNCT06246747;https://clinicaltrials.gov/study/NCT06246747。
BACKGROUND: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD.
OBJECTIVE: The purpose of this
study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care.
METHODS: This was a pilot randomized controlled
trial conducted at 2 outpatient neurorehabilitation clinics with 3
study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses.
RESULTS: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non-
study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as \"good\" or \"very good\" across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score).
CONCLUSIONS: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode.
BACKGROUND: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/
study/NCT06246747.