Telerehabilitation for the treatment of nocturnal hypokinesia in people with Parkinson’s disease: a pilot study

Introduction: Nocturnal hypokinesia (NH) (i.e., reduced bed mobility) is common in people with Parkinson's Disease (PwPD), significantly affecting sleep quality. Physiotherapy showed encouraging results to treat this symptom but was poorly investigated. Moreover, telerehabilitation could be useful to increase treatment capillarity and to overcome logistic limitations. In this pilot study we investigated preliminary feasibility, safety and effectiveness of a telerehabilitation program in mild-to-moderate PwPD with NH. Materials and methods: Sixteen PwPD with disease stage < 4, presence of NH and no cognitive impairment, were enrolled and 12 completed the study. Participants underwent a 6-week telerehabilitation program though a digital remote video call platform. The rehabilitation program included progressive exercises performed during both remote supervised sessions with a physiotherapist and self-conducted sessions through video-tutorials. PwPD were evaluated before (T0) and after the program (T1) using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I-IV, Parkinson's disease questionnaire 39 (PDQ-39), Parkinson's Disease sleep Scale (PDSS2), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Nocturnal Hypokinesia Questionnaire (NHQ). Results: Dropout rate was 25%. We found a significant improvement in PSQI score (p = 0.039, median difference: 2) and in item 2.9 of the MDS-UPDRS part II assessing NH (p = 0.026; median difference: 1). A tendency toward significance was found in NHQ score (p = 0.069). No significant adverse events were reported during treatment. Conclusion: Our pilot study showed that telerehabilitation could be a feasible, safe and effective option to improve NH and sleep quality in mild-to-moderate PwPD.