Effects of Telerehabilitation Versus Clinic-based Task-oriented Circuit Training in Parkinson's Patients

This randomized clinical trial aims to determine effects of Telerehabilitation versus clinic-based task-oriented circuit training on upper extremity functions and quality of life in Parkinson's patient.

Parkinson's disease is a neurodegenerative disorder that primarily affects the motor system. It is also affecting dexterity of upper limb. Working on its rehabilitation is important question these days. There is growing evidence that intensity and task-specificity of practice delivered by physical- (PT) may be effective and compliment to pharmacological and surgical treatments. Notably, task specific training improves the patient's abilities in ADL and increases levels of participation. This study aims to compare the effects of telerehabilitation and clinic-based task-oriented circuit training on upper extremity functions and quality of life in Parkinson's patients. Telerehabilitation offers increased accessibility, personalized care, and continuity of therapy. It provides therapy in a convenient way and allows for remote monitoring and feedback.

This randomized clinical trial will be conducted at Lahore general hospital and Sehat Medical complex, Lahore. Diagnosed cases of Parkinson's disease falling in Stage 1 and 2 according to Hoehn-Yahr Classification of Disability Scale with Cognition level according to mini-mental state examination (MMSE) score \>24 will be included. Sample will be selected by non-probability convenient sampling technique. Patients will be enrolled and assessed for eligibility criteria. Randomization will be done by sealed envelope method and allocated into two groups, one will get telerehabilitation based task-oriented circuit training TOCT-TR and other group will receive clinic-based task-oriented circuit training TOCT-CR. Patients will be blinded about intervention group. Interventions will be applied for 6 weeks. Pre and post treatment assessment will be done by assessor blinded to study. Thus, it will be double blinded study. Analysis will be done by SPSS 29 version. The findings can contribute to the growing evidence base supporting the use of telerehabilitation in Parkinson's disease management and guide future rehabilitation practices.

Eligibility Criteria:
Inclusion Criteria:

* Age group of 40-70 years.
* Both gender male and female.
* Diagnosed cases of Parkinson's disease
* Stage 1 and 2 Parkinson's according to Hoehn-Yahr Classification of Disability Scale
* Cognitive stability as defined by a mini-mental state examination (MMSE) score \>24.
* Availability of technical instruments for video-call (tablet, laptop, or computer/webcam) and ability to use them by patients and/or caregiver.
* Availability and motivation of patients to participate to a 6-weeks telerehabilitation program

Exclusion Criteria:

* Visual loss
* Hearing loss
* Any musculoskeletal disorder in which exercises are contraindicated. (Trauma, fracture, dislocation or subluxation etc.)
* Secondary neurological, orthopedic, or systemic disorders preventing independent standing and walking.
* Severe peripheral vestibular dysfunction
* Co-morbidity with non-stabilized major medical illnesses.
* Presence of freezing of gait (FOG).