Teleneurorehabilitation among person with parkinson's disease in India: The initial experience and barriers to implementation

• Published in: Annals of the Indian Academy of Neurology 2021-07, Vol.24 (4), p.536-541
• Main Authors: Garg, Divyani, Majumdar, Ritu, Chauhan, Sonal, Preenja, Ravi, Parihar, Jasmine, Saluja, Alvee, Dhamija, Rajinder
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; mds-updrs; Movement disorders; Neurodegenerative diseases; non-motor symptoms scale; Original; Pandemics; Parkinson's disease; pdq-8; Rehabilitation; Telemedicine; telerehabilitation
• ISSN: 0972-2327; 1998-3549
• DOI: 10.4103/aian.AIAN_127_21

Objective: We aimed to assess the feasibility of teleneurorehabilitation (TNR) among persons with Parkinson's disease (PD), considering difficulties imposed by the COVID-19 pandemic in access to healthcare, particularly in low-resource settings. The feasibility of TNR in India has not been formally assessed so far. Methods: We conducted a single-center, prospective cohort study at a tertiary center in India. Persons with PD with Hoehn & Yahr (H&Y) stages 1-2.5, who were not enrolled into any formal exercise program, were offered TNR as per a predesigned program for 12 weeks. Baseline and post-intervention assessment included Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), part II and III, Parkinson's Disease Questionnaire (PDQ)-8 and Non-Motor Symptoms Scale (NMSS). We assessed adherence to TNR and problems expressed by patients/caregivers by means of open-ended surveys addressing barriers to rehabilitation. Results: We recruited 22 for TNR. Median age (interquartile range [IQR]) was 66.0 (44.0-71.0) years; 66.7% were H&Y stage 2.0. One patient died of COVID-19-related complications. Of the remaining 21, 14 (66.7%) had adherence of ≥75%; 16/21 (76.2%) patients had problems with attending TNR sessions as the family shared a single phone. Slow Internet speed was an issue among 13/21 (61.9%) of the patients. Other issues included lack of rapport, migration to distant hometowns and motor-hand impairment. Conclusion: Multiple challenges were faced in implementing a telerehabilitation program among persons with PD, exacerbated by the COVID-19 pandemic. These barriers were present at various levels: recruitment, adherence issues and maintenance. Future TNR programs must address these concerns.