Efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in Parkinson’s disease: a multicenter randomized controlled trial

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Abstract

BACKGROUND

The implementation of regular prolonged, and effective rehabilitation in people with Parkinson’s disease is essential for ensuring a good quality of life. However, the continuity of rehabilitation care may find barriers related to economic, geographic, and social issues. In these scenarios, telerehabilitation could be a possible solution to guarantee the continuity of care.

AIM

To investigate the efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in people with Parkinson’s disease, compared to at-home self-administered structured conventional motor activities.

DESIGN

Multicenter randomized controlled trial.

SETTING

Five rehabilitation hospitals of the Italian Neuroscience and Rehabilitation Network.

POPULATION

individuals diagnosed with Parkinson’s disease.

METHODS

Ninety-seven participants were randomized into two groups: 49 in the telerehabilitation group (non-immersive virtual reality-based telerehabilitation) and 48 in the control group (at-home self-administered structured conventional motor activities). Both treatments lasted 30 sessions (3-5 days/week for, 6-10 weeks). Static and dynamic balance, gait, and functional motor outcomes were registered before and after the treatments.

RESULTS

All participants improved the outcomes at the end of the treatments. The primary outcome (mini-Balance Evaluation Systems Test) registered a greater significant improvement in the telerehabilitation group than in the control group. The gait and endurance significantly improved in the telerehabilitation group only, with significant within-group and between-group differences.

CONCLUSIONS

Our results showed that non-immersive virtual reality-based telerehabilitation is feasible, improves static and dynamic balance, and is a reasonably valuable alternative for reducing postural instability in people with Parkinson’s disease.

CLINICAL REHABILITATION IMPACT

Non-immersive virtual reality-based telerehabilitation is an effective and well-tolerated modality of rehabilitation which may help to improve access and scale up rehabilitation services as suggested by the World Health Organization’s Rehabilitation 2030 agenda.

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Most cited references 45

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Diagnostic Criteria for Parkinson Disease

Douglas Gelb, Eugene J. Oliver, Sid Gilman (1999)

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Normative data for the Montreal Cognitive Assessment in an Italian population sample.

Fabrizia Falco, Rossella Bisogno, Pietro Siano … (2015)

The Montreal Cognitive Assessment (MoCA) is a rapid screening battery, also including subtests to assess frontal functions such as set-shifting, abstraction and cognitive flexibility. MoCA seems to be useful to identify non-amnestic mild cognitive impairment (MCI) and subcortical dementia; it has high sensitivity and specificity in distinguishing MCI from mild Alzheimer's Disease. Previous studies revealed that certain items of MoCA may be culturally biased and highlighted the need for population-based norms for the MoCA. The aim of present study was to collect normative values in a sample of Italian healthy subjects. Four hundred and fifteen Italian healthy subjects (252 women and 163 men) of different ages (age range 21-95 years) and educational level (from primary to university) underwent MoCA and Mini Mental State Examination (MMSE). Multiple linear regression analysis revealed that age and education significantly influenced performance on MoCA. No significant effect of gender was found. From the derived linear equation, a correction grid for MoCA raw scores was built. Inferential cut-off score, estimated using a non-parametric technique, is 15.5 and equivalent scores were computed. Correlation analysis showed a significant but weak correlation between MoCA adjusted scores with MMSE adjusted scores (r = 0.43, p < 0.001). The present study provided normative data for the MoCA in an Italian population useful for both clinical and research purposes.

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The clinically important difference on the unified Parkinson's disease rating scale.

Lisa M Shulman, Ann L Gruber-Baldini, Karen E Anderson … (2010)

To determine the estimates of minimal, moderate, and large clinically important differences (CIDs) for the Unified Parkinson's Disease Rating Scale (UPDRS). Cross-sectional analysis of the CIDs for UPDRS total and motor scores was performed on patients with Parkinson disease (PD) using distribution- and anchor-based approaches based on the following 3 external standards: disability (10% on the Schwab and England Activities of Daily Living Scale), disease stage (1 stage on the Hoehn and Yahr Scale), and quality of life (1 SD on the 12-Item Short Form Health Survey). University of Maryland Parkinson Disease and Movement Disorders Center, Patients Six hundred fifty-three patients with PD. A minimal CID was 2.3 to 2.7 points on the UPDRS motor score and 4.1 to 4.5 on the UPDRS total score. A moderate CID was 4.5 to 6.7 points on the UPDRS motor score and 8.5 to 10.3 on the UPDRS total score. A large CID was 10.7 to 10.8 points on the UPDRS motor score and 16.4 to 17.8 on the UPDRS total score. Concordance among multiple approaches of analysis based on subjective and objective data show that reasonable estimates for the CID on the UPDRS motor score are 2.5 points for minimal, 5.2 for moderate, and 10.8 for large CIDs. Estimates for the UPDRS total score are 4.3 points for minimal, 9.1 for moderate, and 17.1 for large CIDs. These estimates will assist in determining clinically meaningful changes in PD progression and response to therapeutic interventions.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Phys Rehabil Med

Journal ID (iso-abbrev): Eur J Phys Rehabil Med

Journal ID (publisher-id): EJPRM

Title: European Journal of Physical and Rehabilitation Medicine

Publisher: Edizioni Minerva Medica

ISSN (Print): 1973-9087

ISSN (Electronic): 1973-9095

Publication date (Electronic): 17 October 2023

Publication date Collection: December 2023

Volume: 59

Issue: 6

Pages: 689-696

Affiliations

deptNeurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences , IRCCS San Raffaele Roma , Rome, Italy; IRCCS Fondazione Don Carlo Gnocchi ONLUS , Milan, Italy; deptDepartment of Brain and Behavioral Sciences , University of Pavia , Pavia, Italy; deptMovement Analysis Research Unit , IRCCS Mondino Foundation , Pavia, Italy; deptDepartment of Human Sciences and Promotion of the Quality of Life , San Raffaele University , Rome, Italy; deptUnità di Neuroriabilitazione, ICS Maugeri SB IRCCS Veruno, Veruno , Novara, Italy; deptDepartment of Biomedical and Neuromotor Sciences (DIBINEM) , Alma Mater University of Bologna , Bologna, Italy; deptUnit of Occupational Medicine , IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna, Italy; deptLaboratory of Healthcare Innovation Technology , IRCCS San Camillo Hospital , Venice, Italy; IRCCS Bonino-Pulejo , Messina, Italy

[‡ ]Members are listed at the end of the paper.

Author notes

[* ]Corresponding author: Francesca Baglio, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy. E-mail: fbaglio@ 123456dongnocchi.it

Authors’ contributions: Michela Goffredo, Marco Franceschini, and Rocco S. Calabrò conceived the design of the work. Andrea Turolla, Sara Federico, Giorgio Maggioni, Federica Zeni, Sanaz Pournajaf, Matteo Cioeta, Cristina Tassorelli, Roberto De Icco, Francesca Baglio, Johanna Jonsdottir acquired the data. Stefania Proietti and Michela Goffredo analyzed the data. Michela Goffredo, Rocco S. Calabrò drafted the manuscript. Giorgio Maggioni, Federica Zeni, Cristina Tassorelli, Roberto De Icco, Francesca Baglio, Johanna Jonsdottir revised it critically for important intellectual content. All authors contributed to interpreting data for the work. All authors read and approved the final version of the manuscript.

Article

Publisher ID: 7954

DOI: 10.23736/S1973-9087.23.07954-6

PMC ID: 10795069

PubMed ID: 37847247

SO-VID: 9a3666ec-41e1-409f-a06a-07bd35d3428a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.

History

Date accepted : 28 September 2023

Date revision received : 19 May 2023

Date received : 02 March 2023

Funding

Funded by: Italian Ministry of Health

Award ID: RCR-2022-23682290

Efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in Parkinson’s disease: a multicenter randomized controlled trial

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Abstract

BACKGROUND

AIM

DESIGN

SETTING

POPULATION

METHODS

RESULTS

CONCLUSIONS

CLINICAL REHABILITATION IMPACT

Related collections

Karger: Neurology and Neuroscience

Most cited references 45

Diagnostic Criteria for Parkinson Disease

Normative data for the Montreal Cognitive Assessment in an Italian population sample.

The clinically important difference on the unified Parkinson's disease rating scale.

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