Effects of Telehealth Interventions for People With Parkinson Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The global integration of telehealth into the management of Parkinson disease (PD) addresses critical gaps in health care 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: This study aimed 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 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, English-language randomized controlled trials evaluating telehealth interventions for PD were included. Study quality was assessed using the Cochrane Risk of Bias tool. A dual analytical approach using random-effects models was applied to address heterogeneity. Studies reporting a single effect size were analyzed using the Hartung-Knapp-Sidik-Jonkman correction. Studies with multiple dependent effect sizes were analyzed using a 3-level random-effects meta-analysis with t-distribution inference, accounting for sampling, within-study, and between-study variance. Effect sizes were expressed as standardized mean differences (SMD) with 95% CIs. Heterogeneity was quantified using the τ2; 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 tests, funnel plots) were conducted.

RESULTS: A total of 15 randomized controlled trials (765 participants) demonstrated significant telehealth benefits: QOL significantly improved on the Medical Outcomes Study 36-Item Short Form Health Survey and Brunnsviken Brief Quality of Life Scale (SMD 0.39, 95% CI 0.06-0.72; P=.03), with marginal improvement on the Parkinson Disease Questionnaire-8 (SMD -0.42, 95% CI -0.88 to 0.03; P=.07). Telephone-based interventions outperformed digital approaches (P=.002). Depression symptoms were significantly reduced (SMD -0.64, 95% CI -0.93 to 0.34; P<.001), particularly with traditional telehealth (P<.001). Anxiety also decreased significantly (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 ADL showed substantial impairment reduction (SMD -0.79, 95% CI -1.04 to -0.54; P=.002). 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<.001). Follow-up duration did not significantly moderate effects.

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.

TRIAL REGISTRATION: PROSPERO CRD42024520169; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024520169.