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

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

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Sumário

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Antecedentes

A telemedicina permite que pacientes com doença de Parkinson (DP) superem barreiras físicas para acessar serviços de saúde e aumenta a acessibilidade para pessoas com mobilidade reduzida.

Objetivo Investigar indicadores de viabilidade de uma intervenção em telessaúde para pacientes com DP, incluindo recrutamento, atendimento, aderência, problemas técnicos, satisfação e benefícios nos níveis de atividade física e sono.

Métodos

Foi conduzido um estudo de centro e braço únicos baseado em consultas por telessaúde com utilização do WhatsApp (Meta Platforms, Inc., Menlo Park, CA, EUA). Foram calculados indicadores de viabilidade como desfechos primários.

Resultados

As taxas de recrutamento, atendimento e problemas técnicos foram 61,3%, 90,5% e 13,3%, respectivamente, com bons escores de aceitação e satisfação com a intervenção. A intervenção melhorou os níveis de atividade física, incluindo o número de passos por pelo menos 10 minutos contínuos (p = 0,009) e o número de atividades intensas e moderadas com duração de pelo menos 10 minutos contínuos (p = 0,001). O Índice de Qualidade do Sono de Pittsburgh melhorou nos seguintes componentes: duração percebida do sono (p < 0,001) e escore total (p < 0,001). A média do tempo de viagem médio poupado foi de 289,6 minutos, e a economia financeira foi de R$ 106,67 reais (por volta de USD 18; quase 10% do salário mínimo atual do Brasil).

Conclusões

As consultas por vídeo provaram ser viáveis e efetivas, com impacto positivo nos níveis de atividade física e sono de pacientes com DP.

Palavras-chave
Doença de Parkinson; Estudos de Viabilidade; Telemedicina; Sono

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

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