Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease

Abstract

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ2 = 5.08, p = 0.024, χ2 = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

Keywords: (tele)rehabilitation; Parkinson's disease; exergaming; object manipulation; perception; virtual reality.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Cikajlo, Hukić and Zajc.

Figures

Figure 1

CONSORT flow diagram.

Figure 2

Participants at exergaming in home (left) and hospital (right) environment. Both groups used the same 10Cubes game and LMC. The telerehabilitation system for the home group recorded the data locally and transferred afterwards to the server.

Figure 3

The outcomes of the clinical tests Box and Blocks Test (BBT), Unified Parkinson's disease rating scale (UPDRS) part III, and Jebsen Hand Function Test (JHFT) for the home and hospital (URI) groups before the commencement of the training and post-assessment.

Figure 4

Shows the outcomes of the seven sub-tests of the Jebsen Hand Function Test for dominant/affected hand (WAL, writing a letter; CARDT, card turning; SOP, picking small objects; STCHK, stacking checkers; STFEED, stimulated feeding; MLO, moving light; MHO, moving heavy objects).

Figure 5

The outcomes of the Parkinson's Disease Questionnaire (PDQ-39) for the home group only.

Figure 6

The boxplots for the number of successfully placed cubes and the remaining time for home and hospital (URI) groups. The mean values for both groups per sessions are also presented.