Feasibility and efficacy of a multidisciplinary telemedicine intervention program to reduce falls and improve quality of life in Parkinson’s disease

Abstract

Objective: To evaluate the feasibility and effectiveness of a multidisciplinary telemedicine intervention program to reduce falls and improve quality of life (QoL) in patients with Parkinson’s disease (PD).

Background: Falls in PD are very frequent, increase comorbidity, mortality, and socio-health costs, and decrease QoL. Many patients with PD, and especially those living in rural areas, have limited access to multidisciplinary interventions.

Methods: Ongoing, single-center, longitudinal, randomized, two-group study, involving patients with idiopathic PD, high risk of falls, without severe cognitive impairment, and without access to other multidisciplinary care services. Both groups were followed for 8months in the Neurology Unit of the Hospital Universitario de Burgos. The control group received the usual best clinical practice, and the study group received weekly remote Occupational Therapy sessions and monthly teleconsultations with neurologists and nurses for 4 months. Falls were recorded through a fall’s diary, motor and non-motor symptoms were assessed with the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), wearable sensors (STAT-On), Non-Motor Symptoms Scale (NMSS), Beck Depression Inventory (BDI-II), Lille Apathy Scale (LARS), Freezing of Gait Questionnaire (FOGQ) and Mini Balance Evaluation System Test (Mini-BESTest), and quality of life was assessed with EUROHIS-QOL 8 scale (WHOQOL8).

Results: The clinical data of the first 41 PD patients were analyzed, males (48.8%) and 21 females (51.2%), with a mean age69.17±9.55 years old. There were no significant differences between both groups in the incidence of falls. Significant improvements were found in the study group compared to the control group in NMSS (p=0.024), BDI-II (p=0.0001), LARS (p=0.0001), FOGQ (p=0.019), total score of the MDS-UPDRS (p=0.042), Mini-BESTest (p=0.0001), and WHOQOL 8 (p=0.001).

Conclusions: Although the incidence of falls were not reduced, multidisciplinary telemedicine intervention was feasible and effective in reducing motor and non-motor symptoms including depression, and apathy, and in improving patient’s QoL. Multidisciplinary telemedicine interventions represent an adjuvant clinical tool favoring greater equity in the distribution of resources and easier access to specialized health care in PD.

José Luis Garrido-Labrador

Assistant Lecturer in Computer Languages and Systems

PhD in Machine Learning, researching in semi-supervised learning and restricted set classification. Assistant Lecturer in Computer Languages and Systems at Universidad de Burgos.