JMIR Publications

ABSTRACT

Background:

The global integration of telehealth into the management of Parkinson’s disease (PD) addresses critical gaps in healthcare access, especially for patients with limited mobility in underserved regions. Despite accelerated adoption during the COVID-19 pandemic, evidence regarding telehealth’s multidimensional efficacy remains inconsistent. Previous meta-analyses reported conflicting outcomes for quality of life (QOL), motor symptoms, and neuropsychiatric comorbidities.

Objective:

To quantitatively synthesize the effects of telehealth interventions across six core PD domains: (1) QOL, (2) depression, (3) anxiety, (4) motor symptoms, (5) activities of daily living (ADL), and (6) cognition.

Methods:

PubMed, Embase, Cochrane Library, Scopus, and Web of Science were systematically searched until June 21, 2024. In adherence to PRISMA guidelines, English-language randomized controlled trials (RCTs) evaluating telehealth interventions for PD were included. Study quality was assessed using the Cochrane risk-of-bias tool. A dual analytical approach was applied using random-effects models based on conceptual assumptions of heterogeneity: for studies providing a single effect size, meta-analysis was performed with the Hartung-Knapp-Sidik-Jonkman (HKSJ) correction; for studies with multiple dependent effect sizes, a three-level random-effects meta-analysis with t-distribution inference was implemented, accounting for sampling, within-study, and between-study variance. Effect sizes were expressed as standardized mean differences (SMD) with 95% confidence intervals (CIs). Heterogeneity was quantified using the τ² statistic; prediction intervals were not calculated due to the limited number of studies. Prespecified subgroup analyses examined intervention types (digital vs. traditional telehealth) and follow-up durations. Sensitivity analyses and assessments for small-study effects (multilevel Egger’s tests, funnel plots) were conducted.

Results:

Fifteen RCTs (765 participants) demonstrated significant telehealth benefits: Quality of life showed significant improvement for SF-36/BBQ scales (SMD=0.39, 95%CI: 0.06 to 0.72; P= .031) and marginal improvement for PDQ scales (SMD=-0.42, 95%CI: -0.88 to 0.03; P= .067), with telephone interventions outperforming digital approaches (P= .002). Depression symptoms were robustly reduced (SMD=-0.64, 95%CI: -0.93 to 0.34; P= .0003), particularly with traditional telehealth (P= .0006). Anxiety levels significantly decreased (SMD=-0.64, 95%CI: -0.92 to 0.35; P= .003) with negligible heterogeneity (I2=0%). Motor symptoms improved (SMD=-0.46, 95%CI: -0.69 to 0.24; P= .001), and activities of daily living showed substantial impairment reduction (MD=-4.55, 95%CI: -6.70 to 2.40; P< .01). Cognition was significantly enhanced (SMD=1.12, 95%CI: 0.03 to 2.20; P= .045) though with moderate heterogeneity (I2=52.3%) and significant publication bias (P< .0001). Traditional telehealth showed superior efficacy for QOL and depression. Follow-up duration did not significantly moderate effects. Sensitivity analyses confirmed robustness across domains except cognition, where analysis was limited by insufficient studies.

Conclusions:

Telehealth interventions significantly enhance multiple PD domains, with traditional (telephone/tablet-based) approaches demonstrating particular advantages for QOL and depression. Digital interventions showed more limited efficacy. These findings support telehealth as a multifaceted management tool for PD, although cognition outcomes require further investigation.