Objective: To explore whether training success is determined by compliance as well as by cognitive function, depression and levodopa equivalent dosage (LEDD).

Background: Training compliance was recently identified as a key factor for rehabilitation success in Parkinson’s disease patients (PD). However, the impact of compliance and other clinical factors on the success of a home-based unsupervised touchscreen training is currently unknown.

Method: Twenty-one PD patients (HY I-IV, age 70±6) completed a two-week home-based unsupervised training program of the Swipe-Slide Pattern task in single (ST) and dual (DT) task using a touchscreen tablet. The application allowed the automatic recording of compliance (with 100% indicating the prescribed training dose). Cognitive function and depressive symptoms were assessed before training, using MoCA and the Geriatric Depression Scale (short form, GDSS), and the LEDD was also calculated. The time necessary to complete one pattern in ST and DT conditions was assessed pre- and post-training (ms). Changes over time were calculated as a learning index (LI) with lower scores indicating less benefits. Simple linear regression models analysed the association between the LI (%) and compliance (%), MoCA, GDSS and LEDD. The direct effect of compliance on the LI was analysed using separate mediation models, adjusting for MoCA, GDSS and LEDD.

Results: Compliance varied between 73 and 104%. Lower LI scores were significantly associated with lower compliance (ST: b=1.83, p=0.001; DT: b=4.08, p<0.001), and lower MoCA (ST: b=2.65, p=0.089; DT: b=6.27, p=0.017). In the DT condition, higher GDSS also predicted lower LI scores (b=-5.36, p=0.029). As well, compliance was significantly related to MoCA (b=0.161, p=0.047), though not to GDSS (p=0.138) and LEDD (p=0.673). After adjusting for the clinical factors, compliance still had a significant impact on the LI (p<0.010). The indirect effect of compliance on LI via the mediators was not significant (p>0.100).

Conclusion: PD patients with higher compliance and better cognitive function benefited more from unsupervised training at home. Interestingly, depression was also related to training benefits for the more complex DT performance. Even after adjusting for MoCA, LEDD and GDSS, compliance was still significantly related to training benefits, underscoring the importance of stimulating compliance to rehabilitation programs in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-association-between-compliance-and-the-effects-of-home-based-touchscreen-training-in-parkinsons-disease/