Telehealth for Parkinson disease patients during the COVID-19 pandemic: the TeleParkinson study

Lima, Danielle Pessoa; Gomes, Vlademir Carneiro; Viana Júnior, Antonio Brazil; Assis, Francisco Mateus Carvalho de; Oliveira, Pedro Henrique Avelino; Cunha, Letícia Chaves Vieira; Braga, Isabelly Cavalcante; Marques, Miriam Lindsay Silva; Assunção, Jézica de Sousa; Damasceno, Adeline Louise Lopes; Barbosa, Ana Lara Guerra; Moreira, Arthur Holanda; Rocha, Maria Eduarda Quidute Arrais; Porto, Maria Eduarda Mendes Pontes; Chaves, Érica Carneiro Barbosa; Oliveira, Liliane Maria de; Roriz Filho, Jarbas de Sá; Sobreira Neto, Manoel Alves; Braga Neto, Pedro

doi:10.1055/s-0042-1758751

Acessibilidade / Reportar erro

Brasil

Arquivos de Neuro-Psiquiatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Neuro-Psiquiatr. 80 (10) • 2022 • https://doi.org/10.1055/s-0042-1758751 copy

Telehealth for Parkinson disease patients during the COVID-19 pandemic: the TeleParkinson study

Telesaúde para pacientes com doença de Parkinson durante a pandemia de COVID-19: o estudo TeleParkinson

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Telemedicine allows Parkinson disease (PD) patients to overcome physical barriers to access health care services and increases accessibility for people with mobility impairments.

Objective

To investigate the feasibility indicators of a telehealth intervention for PD patients, including patient recruitment, attendance, technical issues, satisfaction, and benefits on levels of physical activity and sleep.

Methods

We conducted a single-center, single-arm study of telehealth video consultations using WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA). Also, we collected the feasibility indicators as the primary endpoints. All the patients in the study were previously evaluated in person by the same team.

Results

Patient recruitment, attendance, and technical issues rates were 61.3%, 90.5%, and 13.3%, respectively, with good scores of patient acceptance and satisfaction with the study intervention. The telehealth intervention improved physical activity, including the number of walks for at least 10 continuous minutes (p = 0.009) and the number of moderate-intensity activities lasting at least 10 continuous minutes (p = 0.001). The Pittsburgh sleep quality index (PSQI) scores also improved for one of its components: perceived sleep duration (p < 0.001) and for total Pittsburgh score (p < 0,001). The average travel time saving was 289.6 minutes, and money-saving was R$106.67 (around USD 18; almost 10% of the current minimum wage in Brazil).

Conclusions

Direct-to-patient telehealth video consultations proved to be feasible and effective and had a positive impact on physical activity levels and sleep in PD patients.

Keywords
Parkinson Disease; Feasibility Studies; Telemedicine; Sleep

Variable			Values
Sex	Male		63 (58.9%)
Sex	Female		44 (41.1%)
Age			65.7 ± 17.1
Education	Illiterate		10 (9.3%)
	Incomplete primary education (1–8 years)		48 (44.9%)
	Complete primary education (9 years)		7 (6.5%)
	Incomplete secondary education (10–11 years)		3 (2.8%)
	Complete secondary education (12 years)		20 (18.7%)
	Incomplete tertiary education		7 (6.5%)
	Complete tertiary education		7 (6.5%)
	Graduate education		5 (4.7%)
Disease duration			10 ± 6.7
Antiparkinsonian drugs		Levodopa	101 (94.4%)
		Pramipexole	51 (47.7%)
		Amantadine	27 (25.2%)
		Entacapone	25 (23.4%)
		Rasagiline	15 (14%)
		Extended-release levodopa	32 (29.9%)
		Levodopa equivalent dose	1060.5 ± 880.4
Medications used	Antihypertensive drugs		45 (42.1%)
	Antidepressants		44 (41.1%)
	Benzodiazepine		22 (20.6%)
	Statins		23 (21.5%)
	Vitamin D		23 (21.5%)
	Calcium		19 (17.8%)
	Oral antidiabetics		22 (20.6%)
	Atypical antipsychotics		14 (13.1%)
	Bisphosphonate		12 (11.2%)
Number of medications used			5.9 ± 3
Visual hallucination			34 (32.7%)
Motor fluctuation			65 (63.1%)
Urge incontinence			44.7%
Constipation			37 (35.2%)
Impulse-control disorders			22 (21.2%)
SE ADL			70.3 ± 25.8
Dyskinesia			51 (49%)

Variables	Values
Antiparkinsonian drug adjustments	63 (58.9%)
Request of laboratory tests	65 (60.7%)
Vitamin D supplementation	38 (35.5%)
Physical rehabilitation care	31 (29.0%)
Laxative medications	31 (29.0%)
Antidepressant medications	23 (21.5%)
Pharmacological treatment of insomnia	20 (18.7%)
Request of bone densitometry	34 (31.8%)
Calcium supplementation	22 (20.6%)
Request of brain imaging	17 (15.9%)
Pharmacological treatment of urge incontinence	14 (13.1%)
Average duration of teleconsultation	64.33 ± 23.97

Variable		n (%)
Patient adherence to nonpharmacological health recommendations
	1	20 (20.4%)
	0.75	33 (33.7%)
	0.5	33 (33.7%)
	0.25	9 (9.2%)
	0	3 (3.1%)
Patient adherence to prescribed medications
	1	62 (63.3%)
	0.75	24 (24.5%)
	0.5	6 (6.1%)
	0.25	2 (2%)
	0	4 (4.1%)
Are patients exercising for at least 30 minutes, 3 times a week, post intervention?
	Yes	58 (59.2%)
	No	40 (40.8%)

Variable	Baseline	Post virtual appointment	p	ES
PSQI total score	12.1 ± 3.6 / 12 (9–15)	10.7 ± 3.6 / 11 (8–13)	< 0.001a	d = 0.44
Component 1- Sleep quality	1.5 ± 0.8 / 1 (1–2)	1.4 ± 0.8 / 1 (1–2)	0.216b	r = 0.24
Component 2- Sleep onset latency	1.9 ± 1 / 2 (1–3)	1.6 ± 1.3 / 2 (0–3)	0.067b	r = 0.28
Component 3 - Sleep duration	1.7 ± 1.3 / 2 (0–3)	1.1 ± 1.3 / 1 (0–3)	< 0.001b	r = 0.63
Component 4 - Sleep efficiency	2.9 ± 0.6 / 3 (3–3)	2.9 ± 0.4 / 3 (3–3)	0.299b	r = 0.43
Component 5 - Sleep disorders	2.3 ± 0.8 / 2 (2–3)	2.1 ± 0.7 / 2 (2–3)	0.066b	r = 0.31
Component 6 - Hypnotic drug use	1.5 ± 1.5 / 1 (0–3)	1.3 ± 1.4 / 0 (0–3)	0.607b	r = 0.12
Component 7- Daytime repercussion	1.7 ± 1 / 2 (1–3)	1.7 ± 1 / 1 (1–3)	0.532b	r = 0.10
ESS score	11.2 ± 5.9 / 11 (6–16)	10.1 ± 7.4 / 8 (3–17)	0.567b	d = 0.09

PAQ- SV	Baseline	Post virtual appointment	p	ES
1a. How many days in the last week did you WALK for at least 10 continuous minutes at home or at work, as a form of transportation to get from one place to another, for leisure, for pleasure or as a form of exercise? (Say the number of days)	2.6 ± 2.8 / 2 (0–5)	4 ± 3.8 / 4 (0–7)	0.009	0.42
1b. On days when you walked for at least 10 continuous minutes, how much time in total did you spend walking each day? (In minutes)	18.5 ± 29.1 / 6 (0–30)	17.7 ± 19.4 / 15 (0–30)	0.888	0.02
2a. On how many days in the past week, have you performed MODERATE activities for at least 10 continuous minutes, such as cycling lightly on the bike, swimming, dancing, doing light aerobics, playing recreational volleyball, carrying light weights, doing housework at home, at yard or garden like sweeping, vacuuming, gardening, or any activity that moderately increased your breathing or heartbeat (PLEASE DO NOT INCLUDE WALK) (Say the number of days)	2.1 ± 2.7 / 0 (0–4)	3.5 ± 2.7 / 3 (0–7)	0.001	0.49
2b. On the days that you have done these moderate activities for at least 10 continuous minutes, how much time in total have you spent doing these activities each day? (In minutes)	18.2 ± 30.4/0 (0–30)	23 ± 24.7/20 (0–30)	0.064	0.32
3a. On how many days in the past week, have you performed STRONG activities for at least 10 continuous minutes, such as running, doing aerobics, playing football, cycling fast, playing basketball, doing housework	0.7 ± 1.8/0 (0–0)	0.7 ± 1.7/0 (0–0)	0.74	0.05
3b. On how many days in the past week, did you do VIGOROUS activities for at least 10 continuous minutes, such as running, doing aerobics, playing football, cycling fast, playing basketball, doing heavy housework at home, in the yard or digging in the gardening, carrying heavy weights or any activity that has greatly increased your breathing or heartbeat. (Say the number of days)	8.6 ± 22.6/0 (0–0)	5.8 ± 14.4/0 (0–0)	0.274	0.28
4a. How much time in total do you spend sitting on a weekday? (in minutes)	335.4 ± 285.9/300 (120–480)	354.1 ± 285.4 /300 (180–480)	0.782	0.03
4b. How much time in total do you spend sitting on a weekend day? (in minutes)	346.5 ± 304.3/300 (120–480)	361.1 ± 286.2/300 (180–480)	0.91	0.0

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence, Danielle Pessoa Lima (e-mail: dra.daniellelima@gmail.com).