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Telerehabilitation in People With Parkinson's Disease (TEMPO)

Primary Purpose

Parkinson's Disease

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
VRRS Tablet (Khymeia s.r.l., Noventa Padovana, Italy)
Conventional rehabilitation
Sponsored by
IRCCS San Raffaele Roma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease focused on measuring Parkinson, Telerehabilitation, Activities of daily living, Quality of life, Belance, Compliance

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: age between 30 and 80 years; diagnosis of Parkinson's Disease according to the "Movement Disorders Society's diagnostic criteria"; Hoehn & Yahr (H&Y) score between 2 and 3 (ON-state); absence of dyskinesias assessed by the MDS-UPDRS with a score to items 4.1 and 4.2 ≤ 2; absence of cognitive impairment measured by the MoCA total score ≥ 18; stabilized drug treatment; have access to the Internet for TR; have a caregiver available during rehabilitation sessions in TR; have sufficient cognitive and linguistic level to understand and comply with study procedures; sign informed consent. Exclusion Criteria: having any cognitive problems or low compliance that prevent using the TR system; other neurological pathologies, psychiatric complications or personality disorders; musculoskeletal diseases that impair movement; presence of dyskinesias assessed by the MDS-UPDRS with a score to items 4.1 and 4.2 > 2; presence of cognitive impairment measured by the MoCA total score < 18; severe cognitive or linguistic deficits (inability to understand and comply with study procedures); presence of blurred or low vision problems; hearing and speech impairment affecting participation in the system; absence of signature of the informed consent.

Sites / Locations

  • San Raffaele Cassino
  • IRCCS San Raffaele RomaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Experimental Group (EG)

Control Group (CG)

Arm Description

The Experimental Group (EG) will carry out 30 sessions (3-5 days/week, for 6-10 weeks) of motor, speech, and cognitive rehabilitation exercises using the VRRS Tablet home TR system (Khymeia srl, Noventa Padovana, Italy).

The Control Group (CG) will carry out 30 sessions (3-5 days/week, for 6-10 weeks) of conventional rehabilitation treatments (including physiotherapy, occupational therapy, speech therapy, psychotherapy) without the use of any technological devices.

Outcomes

Primary Outcome Measures

Change in the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) - part II
MDS-UPDRS is a multimodal scale assessing impairment and disability consisting of 4 parts. Part II assessed motor experiences of daily living (Range 0-52). A higher score indicated more severe symptoms of PD.

Secondary Outcome Measures

Change in the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
MDS-UPDRS is a multimodal scale assessing impairment and disability consisting of 4 parts. Part I assessed non-motor experiences of daily living and has 2 components (Range 0-52). Part IA contained 6 questions and were assessed by the examiner (Range 0-24). Part IB contained 7 questions on non-motor experiences of daily living which were completed by the participant (Range 0-28). Part II assessed motor experiences of daily living (Range 0-52). It contained 13 questions completed by the participant. Part III assessed the motor signs of PD and was administered by the rater (Range 0-132). Part III contained 33 scores based on 18 items. For each question a numeric score was assigned between 0-4, where 0 = Normal, 1 = Slight, 2 = Mild, 3 = Moderate, 4 = Severe. MDS-UPDRS Total Score equals the sum of Parts I, II, and III (Range 0-236). A higher score indicated more severe symptoms of PD.
Change in the Parkinson's Disease Questionnaire-8 (PDQ-8)
The Parkinson's Disease Questionaire-8 is a short-form version, derived from the Parkinson's Disease Questionaire-39. It is a self-administered questionnaire, used to measure the quality of life in People with PD. It consists of 8 questions regarding the subject's disease symptoms, each item ranging from 0 to 4, and the responses consist of 0=Never, 1=Occasionally, 2=Sometimes, 3=Often, and 4=Always or cannot do at all, total score ranging from 0 (never have problems/issues) to 32 (always have problems or cannot do at all).
Change in the Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points.
Change in the Lee Silverman Voice Treatment LOUD assessment (LSVT/LOUD)
Maximum duration of sustained vocal phonation and variation of maximum fundamental frequency according to the LSVT/LOUD assessment protocol.
Change in the Timed Up and Go test (TUG)
The TUG test assesses mobility, balance, walking ability, and fall risk in older adults. It is a measure of function with correlates to balance and fall risk. The participant is asked to get up from the chair she/he is sitting in, walk the marked distance of 3 meters and return to her/his seat again. The elapsed time is recorded in seconds.
Change in the Timed Up and Go Dual task test (TUG-D)
The TUG-D test is a dual-task dynamic measure for identifying individuals who are at risk for falls. It evaluates balance with a simultaneous cognitive and motor task. The cognitive task of the test is serial triple subtraction while the TUG test is a motor task. Balance performance will be recorded in seconds.
Change in the mini-Balance Evaluation Systems Test (mini-BESTest)
The mini-BESTest is a shortened version of the Balance Evaluation Systems Test. It aims to target and identify 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. The test was shortened based on factor analysis to include dynamic balance only and to improve clinical utilization. It is 36 items scale that evaluates Balance with total score of 28.
Change in the 10-meter WalkTest (10mWT)
The 10mWT is a performance measure used to assess walking speed in meters per second over a short distance. It can be employed to determine functional mobility, gait, and vestibular function.
Change in the New Freezing of Gait Questionnaire (NFOG-Q)
The New Freezing of Gait Questionnaire (NFOG-Q) is a self-reported questionnaire consisting of 9 items that measure freezing of gait (FOG). The NFOG-Q is the renewed version of the FOG-Q, which originally consisted of 6 items. The total score ranges from 0 to 24, and higher scores denote more severe FOG.
Change in the Activities-specific Balance Confidence scale (ABC)
Activities-specific balance confidence (ABC) scale is a structured questionnaire that measures an individual's confidence during ambulatory activities without falling or experiencing a sense of unsteadiness. It consists of 16 questions gauging the individual's confidence while doing activities. The items are scored on a 0-100% scale. Items are totalled and then averaged. The higher the average score the higher the confidence with balance and the less likely risk there is for falling.

Full Information

First Posted
October 3, 2022
Last Updated
June 23, 2023
Sponsor
IRCCS San Raffaele Roma
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1. Study Identification

Unique Protocol Identification Number
NCT05773885
Brief Title
Telerehabilitation in People With Parkinson's Disease
Acronym
TEMPO
Official Title
Home Telerehabilitation Based on Serious Games for Continuity of Care in People With Parkinson's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 1, 2022 (Actual)
Primary Completion Date
September 30, 2023 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
IRCCS San Raffaele Roma

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Although TeleRehabilitation (TR) is widely accepted as an appropriate model for the provision of professional health services in the field of physiotherapy, with already established standards, guidelines and policies, there are still few studies in the literature on the use of TR as a rehabilitation tool in people with Parkinson's Disease (PD). Therefore, further studies on the efficacy of TR in the management of motor and non-motor symptoms of PD are needed. The study TEMPO aims at assessing the efficacy (in terms of autonomy in carrying out the activities of daily life) of a home TR program based on serious games in people with PD compared to conventional day-hospital treatment.
Detailed Description
The scientific literature has shown that appropriate exercise can decrease some non-motor symptoms of PD such as fatigue, depression, apathy, and cognitive impairment, and it can positively affect motor performance. However, access to rehabilitation centers is often difficult, with logistic and economic barriers for those not living near a specialized hospital. In recent years, the use of technologies has considerably progressed, and, with the development of telemedicine systems, remote treatments have become a viable option for the management of patients with PD. The TR has the potential to optimize the timing, intensity, and personalization of rehabilitation intervention and offers the opportunity for a flexible implementation of treatment protocols and the ability to monitor patient progress in real-time. In particular, for patients with neurological degenerative pathologies, who need periodical and tailored rehabilitation for the whole life, the TR has proved feasible and effective. The recent systematic review by Vellata found that the literature on TR in people with PD is limited. The published studies on TR for PD showed that it is feasible and effective in maintaining and/or improving some clinical and non-clinical aspects of PD such as: balance and walking, speech and voice, quality of life, patient satisfaction. However, although TR is widely accepted as an appropriate model for the provision of professional health services in the field of physiotherapy, with already established standards, guidelines and policies, there are still few studies in the literature on the use of TR as a rehabilitation tool in people with Parkinson's disease. In this context, the efficacy of TR in the management of motor and non-motor symptoms of PD has to be further investigated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease
Keywords
Parkinson, Telerehabilitation, Activities of daily living, Quality of life, Belance, Compliance

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
This study is a multicentre, single-blind (evaluator), Randomized Controlled Trial (RCT)
Masking
Outcomes Assessor
Masking Description
The outcome assessor will be blind to the study protocol
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Experimental Group (EG)
Arm Type
Experimental
Arm Description
The Experimental Group (EG) will carry out 30 sessions (3-5 days/week, for 6-10 weeks) of motor, speech, and cognitive rehabilitation exercises using the VRRS Tablet home TR system (Khymeia srl, Noventa Padovana, Italy).
Arm Title
Control Group (CG)
Arm Type
Active Comparator
Arm Description
The Control Group (CG) will carry out 30 sessions (3-5 days/week, for 6-10 weeks) of conventional rehabilitation treatments (including physiotherapy, occupational therapy, speech therapy, psychotherapy) without the use of any technological devices.
Intervention Type
Device
Intervention Name(s)
VRRS Tablet (Khymeia s.r.l., Noventa Padovana, Italy)
Intervention Description
The patients will carry out motor, speech, and cognitive rehabilitation exercises using the VRRS Tablet (Khymeia s.r.l., Noventa Padovana, Italy). The motor exercises will be performed using inertial sensors for the acquisition and processing of the movement performed by the patient. This data is shown to the patient with visual and auditory feedback in a serious games environment. The exercises will cover the rehabilitation of balance and lower limbs, for example Balance on one leg, March in place, Stand on tiptoe, Squat, etc. The physiotherapists involved in the study will define a protocol of exercises in TR mode customized according to the characteristics and needs of the patient. The exercises in the speech therapy and cognitive domains will be defined by the specialized staff based on the characteristics of the patient. The duration of the rehabilitation treatments is 9 hours per week.
Intervention Type
Other
Intervention Name(s)
Conventional rehabilitation
Intervention Description
The patients will carry out conventional rehabilitation treatments (including physiotherapy, occupational therapy, speech therapy, psychotherapy) without the use of any technological devices. The motor exercises will concern the rehabilitation of balance, trunk, and lower limbs and will be performed with a physiotherapist who will customize the treatment based on the characteristics and needs of the patient. The occupational therapy, speech therapy, psychotherapy treatments will be defined by the specialized staff based on the characteristics of the patient. The duration of the rehabilitation treatments is 9 hours per week.
Primary Outcome Measure Information:
Title
Change in the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) - part II
Description
MDS-UPDRS is a multimodal scale assessing impairment and disability consisting of 4 parts. Part II assessed motor experiences of daily living (Range 0-52). A higher score indicated more severe symptoms of PD.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1) and a follow-up (2 months after the end of the treatment, T2)
Secondary Outcome Measure Information:
Title
Change in the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
Description
MDS-UPDRS is a multimodal scale assessing impairment and disability consisting of 4 parts. Part I assessed non-motor experiences of daily living and has 2 components (Range 0-52). Part IA contained 6 questions and were assessed by the examiner (Range 0-24). Part IB contained 7 questions on non-motor experiences of daily living which were completed by the participant (Range 0-28). Part II assessed motor experiences of daily living (Range 0-52). It contained 13 questions completed by the participant. Part III assessed the motor signs of PD and was administered by the rater (Range 0-132). Part III contained 33 scores based on 18 items. For each question a numeric score was assigned between 0-4, where 0 = Normal, 1 = Slight, 2 = Mild, 3 = Moderate, 4 = Severe. MDS-UPDRS Total Score equals the sum of Parts I, II, and III (Range 0-236). A higher score indicated more severe symptoms of PD.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1) and a follow-up (2 months after the end of the treatment, T2)
Title
Change in the Parkinson's Disease Questionnaire-8 (PDQ-8)
Description
The Parkinson's Disease Questionaire-8 is a short-form version, derived from the Parkinson's Disease Questionaire-39. It is a self-administered questionnaire, used to measure the quality of life in People with PD. It consists of 8 questions regarding the subject's disease symptoms, each item ranging from 0 to 4, and the responses consist of 0=Never, 1=Occasionally, 2=Sometimes, 3=Often, and 4=Always or cannot do at all, total score ranging from 0 (never have problems/issues) to 32 (always have problems or cannot do at all).
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1) and a follow-up (2 months after the end of the treatment, T2)
Title
Change in the Montreal Cognitive Assessment (MoCA)
Description
The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the Lee Silverman Voice Treatment LOUD assessment (LSVT/LOUD)
Description
Maximum duration of sustained vocal phonation and variation of maximum fundamental frequency according to the LSVT/LOUD assessment protocol.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the Timed Up and Go test (TUG)
Description
The TUG test assesses mobility, balance, walking ability, and fall risk in older adults. It is a measure of function with correlates to balance and fall risk. The participant is asked to get up from the chair she/he is sitting in, walk the marked distance of 3 meters and return to her/his seat again. The elapsed time is recorded in seconds.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the Timed Up and Go Dual task test (TUG-D)
Description
The TUG-D test is a dual-task dynamic measure for identifying individuals who are at risk for falls. It evaluates balance with a simultaneous cognitive and motor task. The cognitive task of the test is serial triple subtraction while the TUG test is a motor task. Balance performance will be recorded in seconds.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the mini-Balance Evaluation Systems Test (mini-BESTest)
Description
The mini-BESTest is a shortened version of the Balance Evaluation Systems Test. It aims to target and identify 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. The test was shortened based on factor analysis to include dynamic balance only and to improve clinical utilization. It is 36 items scale that evaluates Balance with total score of 28.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the 10-meter WalkTest (10mWT)
Description
The 10mWT is a performance measure used to assess walking speed in meters per second over a short distance. It can be employed to determine functional mobility, gait, and vestibular function.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Change in the New Freezing of Gait Questionnaire (NFOG-Q)
Description
The New Freezing of Gait Questionnaire (NFOG-Q) is a self-reported questionnaire consisting of 9 items that measure freezing of gait (FOG). The NFOG-Q is the renewed version of the FOG-Q, which originally consisted of 6 items. The total score ranges from 0 to 24, and higher scores denote more severe FOG.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1) and a follow-up (2 months after the end of the treatment, T2)
Title
Change in the Activities-specific Balance Confidence scale (ABC)
Description
Activities-specific balance confidence (ABC) scale is a structured questionnaire that measures an individual's confidence during ambulatory activities without falling or experiencing a sense of unsteadiness. It consists of 16 questions gauging the individual's confidence while doing activities. The items are scored on a 0-100% scale. Items are totalled and then averaged. The higher the average score the higher the confidence with balance and the less likely risk there is for falling.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1) and a follow-up (2 months after the end of the treatment, T2)
Other Pre-specified Outcome Measures:
Title
Gait analysis (GAIT)
Description
In a subgroup of subjects. Optical tracking system with reflective markers and force plates for measuring (according to a model used in gait analysis) spatio-temporal parameters, joints kinematics and kinetics (joint moments and foot-soil reaction forces) during a 10-meter-long path.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)
Title
Posturograghy (POSTURE)
Description
In a subgroup of subjects. Force plate posturography measurements: centre of pressure displacement and velocity parameters. Data will be collected under 2 different conditions: normal standing with eyes open, normal standing with eyes closed. Postural sway will be measured in the anteroposterior and mediolateral directions.
Time Frame
Session 1 (Baseline, T0), Session 30 (End of treatment, approximately 10 weeks,T1)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: age between 30 and 80 years; diagnosis of Parkinson's Disease according to the "Movement Disorders Society's diagnostic criteria"; Hoehn & Yahr (H&Y) score between 2 and 3 (ON-state); absence of dyskinesias assessed by the MDS-UPDRS with a score to items 4.1 and 4.2 ≤ 2; absence of cognitive impairment measured by the MoCA total score ≥ 18; stabilized drug treatment; have access to the Internet for TR; have a caregiver available during rehabilitation sessions in TR; have sufficient cognitive and linguistic level to understand and comply with study procedures; sign informed consent. Exclusion Criteria: having any cognitive problems or low compliance that prevent using the TR system; other neurological pathologies, psychiatric complications or personality disorders; musculoskeletal diseases that impair movement; presence of dyskinesias assessed by the MDS-UPDRS with a score to items 4.1 and 4.2 > 2; presence of cognitive impairment measured by the MoCA total score < 18; severe cognitive or linguistic deficits (inability to understand and comply with study procedures); presence of blurred or low vision problems; hearing and speech impairment affecting participation in the system; absence of signature of the informed consent.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Michela Goffredo, PhD.
Phone
+390652252319
Email
michela.goffredo@sanraffaele.it
First Name & Middle Initial & Last Name or Official Title & Degree
Sanaz Pournajaf, Dr.
Phone
+390652252319
Email
sanaz.pournajaf@sanraffaele.it
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michela Goffredo, PhD.
Organizational Affiliation
IRCCS San Raffaele Roma
Official's Role
Principal Investigator
Facility Information:
Facility Name
San Raffaele Cassino
City
Cassino
State/Province
Frosinone
ZIP/Postal Code
03043
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maria Francesca De Pandis, MD.
Email
maria.depandis@sanraffaele.it
First Name & Middle Initial & Last Name & Degree
Maria Gaglione, Dr.
First Name & Middle Initial & Last Name & Degree
Lorenza Leonardi, Dr.
First Name & Middle Initial & Last Name & Degree
Francesco Barbato, MD
First Name & Middle Initial & Last Name & Degree
Catia Apisa, Dr.
Facility Name
IRCCS San Raffaele Roma
City
Roma
ZIP/Postal Code
00163
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Astrid Van Rijn
Email
astrid.vanrijn@sanraffaele.it
First Name & Middle Initial & Last Name & Degree
Michela Goffredo, PhD
Email
michela.goffredo@sanraffaele.it
First Name & Middle Initial & Last Name & Degree
Marco Franceschini, MD
First Name & Middle Initial & Last Name & Degree
Fabrizio Stocchi, MD
First Name & Middle Initial & Last Name & Degree
Sanaz Pournajaf, Dr.
First Name & Middle Initial & Last Name & Degree
Matteo Cioeta, Ft.
First Name & Middle Initial & Last Name & Degree
Daniele Galafate, Dr.
First Name & Middle Initial & Last Name & Degree
Laura Vacca, MD
First Name & Middle Initial & Last Name & Degree
Paola Grassini, MD
First Name & Middle Initial & Last Name & Degree
Eleonora Annese, Dr.
First Name & Middle Initial & Last Name & Degree
Miriam Casali, Dr.

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26982525
Citation
Barbour PJ, Arroyo J, High S, Fichera LB, Staska-Pier MM, McMahon MK. Telehealth for patients with Parkinson's disease: delivering efficient and sustainable long-term care. Hosp Pract (1995). 2016;44(2):92-7. doi: 10.1080/21548331.2016.1166922.
Results Reference
background
PubMed Identifier
29757774
Citation
Cikajlo I, Hukic A, Dolinsek I, Zajc D, Vesel M, Krizmanic T, Blazica B, Biasizzo A, Novak F, Peterlin Potisk K. Can telerehabilitation games lead to functional improvement of upper extremities in individuals with Parkinson's disease? Int J Rehabil Res. 2018 Sep;41(3):230-238. doi: 10.1097/MRR.0000000000000291.
Results Reference
background
PubMed Identifier
28549757
Citation
Linares-Del Rey M, Vela-Desojo L, Cano-de la Cuerda R. Mobile phone applications in Parkinson's disease: A systematic review. Neurologia (Engl Ed). 2019 Jan-Feb;34(1):38-54. doi: 10.1016/j.nrl.2017.03.006. Epub 2017 May 23. English, Spanish.
Results Reference
background
PubMed Identifier
27366343
Citation
Magrinelli F, Picelli A, Tocco P, Federico A, Roncari L, Smania N, Zanette G, Tamburin S. Pathophysiology of Motor Dysfunction in Parkinson's Disease as the Rationale for Drug Treatment and Rehabilitation. Parkinsons Dis. 2016;2016:9832839. doi: 10.1155/2016/9832839. Epub 2016 Jun 6.
Results Reference
background
PubMed Identifier
34512495
Citation
Vellata C, Belli S, Balsamo F, Giordano A, Colombo R, Maggioni G. Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review. Front Neurol. 2021 Aug 26;12:627999. doi: 10.3389/fneur.2021.627999. eCollection 2021.
Results Reference
background

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Telerehabilitation in People With Parkinson's Disease

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