Physiotherapy, exercise and Parkinson’s disease: Models of sustainable service delivery

Abstract The aim of this thesis is to explore models of service delivery of physiotherapy and exercise for balance and gait which have the potential to be effective, acceptable to people with Parkinson’s disease and sustainable over the long-term. Three studies involving people with mild to moderate disease were conducted. A systematic review with meta-analysis showed that home-based exercise is effective in improving balance related activities (SMD 0.21, 95% CI 0.10 to 0.32) and gait speed (SMD 0.30, 95% CI 0.12 to 0.49) immediately after the intervention compared to control. Home-based and centre-based exercise of equivalent type and dose had similar effects on balance-related activities and quality of life. A randomised trial with an embedded qualitative study found that following five weeks of centre-based exercise, home-based exercise monitored via telehealth was feasible and acceptable, with high adherence (84%) and requiring less physiotherapy time than centre-based exercise. The qualitative study revealed people with Parkinson’s disease experiences of exercise were primarily influenced by the individualised exercise prescription and the support provided. There was no clear preference for the location of exercise but maintaining the motivation to exercise at home was challenging. The final study was a mixed methods study conducted during the COVID-19 pandemic. It provides a model for the successful implementation of telehealth in the clinical setting and recommendations for providing physiotherapy via telehealth. It showed that telehealth was useful to support people to exercise (108% of prescribed sessions completed) and maintain their physical activity when unable to attend centre-based programs. Taken together, the findings indicate that a hybrid model of physiotherapy service delivery incorporating both in-person and telehealth has potential to meet the exercise needs of people with mild to moderate Parkinson’s disease and be sustainable over the long term