A telemedicine intervention to improve physical function in patients with PD

描述（由申请人提供）： 项目背景/理由。帕金森病（PD）是第二大常见的神经退行性疾病，影响超过一百万美国人。PD的主要临床表现是运动性的，其限制了功能移动性，导致工作困难、照顾家庭成员、管理家庭以及整体独立性和生活质量（QOL）下降。越来越多的数据表明，运动对PD患者有巨大的益处。运动计划不仅被证明可以改善运动功能和降低福尔斯的风险，而且还可以改善整体生活质量，并可能改善疾病的病理过程。然而，涉及在患有PD的人的家中进行监督的程序对于广泛推广来说是昂贵的，并且涉及患有PD的人旅行到中心地点的程序不仅由于难以到达该地点而导致随着时间的推移的不依从性，而且还排除了大量患有PD的人的参与，这些人只是居住在离通常建立这种程序的较大中心太远的地方。项目目标。拟议研究的总体目标是评估一种新的以家庭为基础的方法的有效性，为PD患者提供安全锻炼计划的已知益处。一个成功的基于家庭的锻炼计划，包括实时的，但从受过训练的人员远程监督，不仅可以避免上述限制，而且还可能保持，以相对较低的成本，长期坚持这样的锻炼计划，从而持续的好处。具体而言，我们将确定为期一年的家庭锻炼计划，以使用智能手机技术（Mobile-PAL）进行远程实时指导和监督为中心，是否会降低PD患者的福尔斯率，并改善PD患者的力量、身体功能和QOL。项目方法。我们建议对通过Mobile-PAL系统提供的运动计划进行一项随机对照试验，评估对跌倒率、身体功能和生活质量的影响。社区居住的轻度至中度PD患者将被随机分配到一组，该组接受12个月的实时远程运动指导和监督，或一组在一年内定期通过智能手机接受健康教育信息。锻炼组将参加一个修改后的版本的锻炼计划，以前被证明是有效的，其中包括伸展，加强和平衡练习。所做的修改是为了使该程序适应患者在自己家中可以安全地完成而无需亲自监督的程序。远程监督将通过患者和物理治疗师之间的实时视频聊天定期提供。这使得治疗师可以在患者在家进行练习时与患者一起完成练习。此外，结果评估将通过患者与经过培训的研究助理之间的实时视频聊天在物理治疗师的监督下远程进行。

DESCRIPTION (provided by applicant): Project Background/Rationale. Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting over one million Americans. The cardinal clinical manifestations of PD are motoric, which limit functional mobility leading to difficulty working, caring for family members, managing a household, and overall decreased independence and quality of life (QOL). A wealth of growing data indicates tremendous benefits of exercise for patients with PD. Not only have exercise programs been shown to improve motor function and reduce the risk of falls, but also improve overall QOL and possibly the very course of the disease pathology. However, programs that involve supervision in the home of people with PD are expensive to roll out widely, and programs that involve people with PD traveling to a central site not only result in non-compliance over time because of difficulty getting to the site, but als rule out the involvement of a large number of people with PD who simply live too far from larger centers where such programs are typically established. Project Objectives. The overall goal of the proposed research is to evaluate the effectiveness of a novel home-based approach to providing the known benefits of a safe exercise program to people with PD. A successful home-based exercise program that included real-time, but remote supervision from trained personnel could not only avoid the above-mentioned limitations, but also potentially maintain, at relatively low cost, long-term adherence to such exercise programs and thus sustained benefits. Specifically, we will determine whether a one-year in-home exercise program, centered around remote, real-time instruction and supervision using a smartphone technology (Mobile-PAL), will reduce the rate of falls, and improve strength, physical function and QOL, in patients with PD. Project Methods. We propose to conduct a randomized controlled trial of an exercise program delivered via the Mobile-PAL system, evaluating effects on fall rate, physical functioning, and QOL. Community-dwelling people with mild to moderate PD will be randomized either to a group that receives remote exercise instruction and supervision in real-time for 12 months or a group that receives health education information by smartphone at regular intervals over the year. The exercise group will participate in a modified version of exercise programs previously shown to be effective, which includes stretching, strengthening, and balance exercises. The modifications made are to adapt the program to that which can be done safely by the patient in their own home without in-person supervision. Remote supervision will be provided at regular intervals via a real-time video chat between the patient and the physical therapist. This allows the therapist to walk through the exercises with the patient as he performs them in his home. In addition, outcome assessments will be conducted remotely via a real-time video chat between the patient and a trained research assistant under the supervision of the physical therapist.