Connectome-based prediction of problematic use of social media in adolescents: Findings from the ABCD study.

For people with Parkinson's, exercise can improve balance, reduce falls, improve sleep, reduce risk of depression and cognitive decline and may possibly slow disease progression. The role of physiotherapy in the treatment of falls and freezing of gait is well established but the role of early physiotherapy in the absence of recurrent falls and gait freezing is uncertain. A case for this can be made as people with early Parkinson's are less physically active than healthy controls and fewer than 50% reach recommended levels of physical activity. In addition gait changes occur early in Parkinson's so intervention at this stage may be beneficial. Furthermore, physiotherapist-supervised exercise may be more effective than self-supervised exercise. Telerehabilitation (TR) describes remote delivery of therapy services such as assessment, monitoring and training using telecommunications technology which may include use of telephone, video calls and online media. It may be individual or group, real time or use recordings, and be delivered with or without physiotherapist supervision. It may, or may not, involve use of other technologies such as virtual reality or wearable activity monitors. It may have some advantages over face-to-face therapy including reduced travel time for staff and patients, reduced infection risk and lower cost. Moreover, telerehabilitation is acceptable to people with Parkinson's and is feasible and safe. A recent review of telerehabilitation by videoconferencing for balance and gait concluded that efficacy was uncertain and found no studies using wearable technology to measure outcomes. We wanted to assess preliminary efficacy and acceptability of telerehabilitation for people with early Parkinson's (without recurrent falls or gait freezing and within 4 years of diagnosis). Specifically we wanted to investigate preliminary efficacy of an individualized physiotherapy intervention delivered by a videoconference platform to people with early Parkinson's in increasing physical activity levels and improving motor function and quality of life compared to usual care. Usual care was physician advice. A variety of outcomes measures were used and we aimed to identify potential primary outcome measures for a definitive trial. Here we report a randomized controlled feasibility trial with the primary objective of reporting feasibility outcomes for a future definitive trial. We also report a preliminary exploratory analysis of clinical outcomes at baseline (before the intervention) and at 3 and 6 months with estimation of effect size where appropriate. We also report outcomes of a qualitative process evaluation.