Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 11, 2025
Date Accepted: Apr 8, 2025
Effectiveness of Telemedicine Interventions on Motor and Non-Motor Outcomes in Parkinson’s Disease: A Systematic Review and Network Meta-Analysis
ABSTRACT
Background:
Parkinson’s disease (PD) presents motor and non-motor challenges that significantly affect quality of life. Telemedicine has emerged as a promising approach to deliver interventions, including exercise (eExercise), cognitive training (eCognitive), and teleconsultations (eVisits), yet their comparative effectiveness remains unclear.
Objective:
To evaluate the effectiveness of telemedicine interventions on motor and non-motor outcomes in PD and compare the efficacy of eExercise, eCognitive, and eVisits.
Methods:
A systematic review and network meta-analysis were conducted by searching PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Web of Science through November 2024. Randomized controlled trials comparing telemedicine interventions with usual care were included. Outcomes assessed included total motor symptoms, quality of life, cognitive function, depressive and anxiety symptoms, fear of falling, 6-minute walk test, walking velocity, balance ability, and time-up-and-go.
Results:
Twenty-three studies involving 1330 participants were included. Telemedicine significantly improved total motor symptoms (SMD= -0.61), cognitive function (SMD= 0.58), depressive symptoms (SMD= -0.46), anxiety symptoms (SMD= -0.57), fear of falling (SMD= -0.48), and 6-minute walk test performance (mean difference=18.98 meters). The network meta-analysis revealed that eExercise was most effective for improving total motor symptoms (SMD= -1.01) and 6-minute walk test performance. eCognitive was most effective for enhancing quality of life (SMD= 0.39), cognitive function (SMD= 1.02), and reducing depressive (SMD= -1.28) and anxiety symptoms (SMD= -1.07). eVisits had limited impact across outcomes.
Conclusions:
Telemedicine is effective for improving motor and non-motor outcomes in PD. eExercise is optimal for motor function and physical performance, while eCognitive is most effective for psychological and cognitive challenges. These findings highlight the importance of tailoring telemedicine programs to address specific therapeutic needs in PD management. Clinical Trial: PROSPERO CRD42024628687; https://www.crd.york.ac.uk/PROSPERO/#recordDetails
Citation
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