Telerreabilitação como ferramenta para avaliação e tratamento de indivíduos com Doença de Parkinson

Abstract

Introduction: Parkinson's disease (PD) is one of the most prevalent progressive neurodegenerative disorders among older adults, leading to a wide range of motor and non-motor symptoms. Due to the impact on individual functionality, supervision and availability of family members and/or caregivers during in-person consultations and therapies are often necessary. In this context, telerehabilitation (TR) may represent a viable alternative for supporting individuals with PD and their caregivers. Objective: To investigate the effects of physiotherapy interventions delivered via telerehabilitation (TR) in individuals with Parkinson's disease (PD), focusing on motor and functional outcomes. Methods: The study was conducted in two studies, addressing the proposed objectives. Study 1: This phase consisted of a systematic review and protocol, including clinical trials involving adults diagnosed with PD who underwent TR interventions. The comparison (control) groups included: any in-person intervention (traditional/inperson physiotherapy), the use of exergames, non-physiotherapeutic remote interventions, minimal interventions (e.g., educational booklets/guidance), or no intervention at all. Primary outcomes were: motor function, gait capacity, gait stability, and postural balance. Secondary outcomes included: gait freezing, fall risk, quality of life, adverse events, and treatment adherence. Meta-analyses were conducted to assess the post-intervention effects. Study 2: This was a prospective longitudinal study. Data were collected remotely from individuals with PD participating in a therapeutic group, evaluating both motor and non-motor aspects of the disease at five time points over a one-year period. A mixed linear model was used to examine the influence of motor and non-motor variables on motor progression. Results and Conclusions: In Study 1, TR showed comparable results to control interventions in improving motor function, gait speed and stability, gait freezing, fall risk, and quality of life in individuals with PD. TR demonstrated benefits in improving postural balance, particularly in individuals under 70 years of age. Adherence to TR was similar to that of control interventions, and adverse events were minimal in both the experimental and control groups. Therefore, TR emerged as a beneficial alternative due to its potential for engagement and personalized care, especially for individuals with limited access to rehabilitation centers. In Study 2, TR outcomes indicated stability in gait, bradykinesia, mobility, and quality of life throughout the one-year follow-up. The study also identified both barriers and facilitators related to TR. Challenges included digital health literacy and access to technology, while key facilitators included low cost—particularly in video-based sessions—and reduced time and logistical burden associated with travel.