Objective: To demonstrate that a novel physical therapy (PT) telerehabilitation program is feasible, reduces falls, increases balance confidence, & improves objective measures of gait/balance/postural stability falls in individuals with PD.

Background: In PD, gait dysfunction & postural instability lead to falls, a major source of morbidity, reduced quality of life, & loss of independence. PT has been proven to improve gait/balance & reduce falls in patients with PD, but access is limited & multiple sessions are often needed [1]. Telemedicine, the delivery of care using telecommunications technology, provides an avenue to reduce the burden of in-person appointments & facilitates access to more advanced specialty care for patients [2].

Methods: We developed a staged telerehabilitation program for individuals with PD (Hoehn & Yahr Stage 3 or lower) & a history of recurrent falls. Participants will receive 4 virtual PT home visits via live video teleconferencing with neurologic-trained physical therapists with expertise in gait/balance issues in PD. At each visit, if safe, participants will advance to more challenging exercises, such as compensatory stepping reactions, dual-tasking, postural exercises, bed mobility exercises, & exercises that promote multi-joint mobility. In-person evaluations are done at baseline & at exit to compare the impact on objective outcome measures, including: reported falls, 6-min & 10-meter walk tests, Activities-Specific Balance Confidence Scale, Five-Times Sit-to-Stand test, & Mini-Best test.

Results: One year after the launch of this intervention, up to 25 patients will have completed the program, which is in line with literature-supported exercises that have shown benefit in PD. All of the above outcome measures have been recently recommended by the Academy of Neurologic Physical Therapy’s Parkinson Evidence Database to Guide Effectiveness (PD-EDGE) task force for both clinical care & research. This research is funded by a Parkinson’s Foundation Community Grant.

Conclusions: Falls are a major source of disability, morbidity, & mortality in patients with PD, & frequent PT presents a major burden for most patients. In order to improve access to neurologic-trained physical therapists with PD expertise, showing feasibility & preliminary efficacy of this pilot PT telerehabilitation program is an important step in changing care models aimed to reduce falls in PD.

References: (1) Shen X, Wong-Yu IS, Mak MK. Effects of exercise on falls, balance, & gait ability in Parkinson’s disease: A meta-analysis. Neurorehabil Neural Repair. 2016;30(6):512-527. (2) Dorsey ER, Achey MA, Beck CA, Beran DB, Biglan KM, Boyd CM, Schmidt PN, Simon R, Willis AW, Galifianakis NB, Katz M, Tanner CM, et al. National randomized controlled trial of virtual house calls for people with Parkinson’s disease: interest & barriers. Telemed J E Health. 2016 Jul; 22(27)590-598.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/a-novel-telerehabilitation-strategy-to-prevent-falls-in-parkinsons-disease-pd/