{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T06:28:06Z","timestamp":1794724086017,"version":"4.9.1"},"reference-count":58,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Nurobots"},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CAPES","award":["Funding Code 001"],"award-info":[{"award-number":["Funding Code 001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,29]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Telerehabilitation (TR) programmes are increasingly recognised for their feasibility and potential benefits, such as eliminating travel time, reducing costs and providing a more comfortable rehabilitation experience at home. However, the comparative efficacy of remote physiotherapy compared with traditional in-person sessions for individuals with Parkinson\u2019s disease (PD) remains uncertain. This study aims to evaluate the effects of TR compared with in-person physiotherapy in individuals with PD, focusing on both motor and non-motor outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a randomised, single-blind clinical trial with a mixed-methods approach. A total of 22 individuals diagnosed with PD will be randomly assigned to one of two groups. The experimental group will receive TR, consisting of remote physiotherapy sessions conducted once a week for 1\u2009hour over a 4-month period. The control group will receive the same interventions in person. Interventions will include global muscle strengthening exercises, balance training, gait and motor coordination exercises, and cognitive training. The primary outcome will be motor function, measured using part III of the Movement Disorder Society\u2013Unified Parkinson\u2019s Disease Rating Scale. Secondary outcomes will include cognition (Montreal Cognitive Assessment), gait (Functional Gait Assessment), mobility (Timed Up and Go Test) and quality of life (Parkinson\u2019s Disease Questionnaire). Data will be analysed using repeated measures analysis of variance to compare outcomes between groups across four assessment points (baseline, midpoint, postintervention and 2 months follow-up). Additionally, a qualitative phase will explore participants\u2019 perceptions and experiences regarding TR and in-person interventions, with assessments carried out 2\u2009months after the completion of the 24-week interventions, through semistructured interviews that will be analysed using Bardin\u2019s Content Analysis technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (approval number: 5.553.701). All participants will provide written informed consent before inclusion. Results will be disseminated through peer-reviewed publications, scientific conferences and communication with participants and healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>RBR-6h5knrj.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096285","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T05:00:11Z","timestamp":1764478811000},"page":"e096285","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Telerehabilitation for people with Parkinson\u2019s disease: protocol of a randomised clinical trial of mixed methods"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9455-0168","authenticated-orcid":false,"given":"Ra\u00edssa Souza","family":"Taveira","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3921-0163","authenticated-orcid":false,"given":"Liliane Santos de","family":"Vasconcellos","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2729-6318","authenticated-orcid":false,"given":"Clarissa Fernandes","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1935-090X","authenticated-orcid":false,"given":"Diogo Neres","family":"Aires","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1326-5297","authenticated-orcid":false,"given":"Adriel Kelvin","family":"Dias de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5840-8154","authenticated-orcid":false,"given":"Kaline de Oliveira Cariolando","family":"da Silva","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3320-9428","authenticated-orcid":false,"given":"Luciana Prot\u00e1sio de","family":"Melo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana Souza","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"2026111421224016000_15.11.e096285.1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3390\/ijerph17010031","article-title":"The Impact of Mind-Body Exercises on Motor Function, Depressive Symptoms, and Quality of Life in Parkinson\u2019s Disease: A Systematic Review and Meta-Analysis","volume":"17","author":"Jin","year":"2020","journal-title":"IJERPH"},{"key":"2026111421224016000_15.11.e096285.2","unstructured":"Capato TTC , Domingos JMM , Almeida LRS . Vers\u00e3o em Portugu\u00eas da Diretriz Europeia de Fisioterapia para a Doen\u00e7a de Parkinson. Omnifarma 2015."},{"key":"2026111421224016000_15.11.e096285.3","unstructured":"World Confederation for Physical Therapy . Description of physical therapy, 2011. Available: http:\/\/www.wcpt.org\/sites\/wcpt.org\/files\/files\/PS_Description_PT_Sept2011_FORMATTED_edit2013.pdf"},{"key":"2026111421224016000_15.11.e096285.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(07)70057-0"},{"key":"2026111421224016000_15.11.e096285.5","unstructured":"American College of Sports Medicine . ACSM\u2019s guidelines for exercise testing and prescription. 9th edn. Baltimore, MD: Wolters Kluwer Lippincott Williams & Wilkins, 2014."},{"key":"2026111421224016000_15.11.e096285.6","unstructured":"Keus S , Munneke M , Graziano M , et al . European physiotherapy guideline for parkinson\u2019s disease. 1st edn. Nijmegen, The Netherlands: KNGF\/ParkinsonNet, 2014. Available: http:\/\/www.fizioterapeitiem.lv\/attachments\/article\/307\/4_eu_guideline_parkinson_201412-development.pdf"},{"key":"2026111421224016000_15.11.e096285.7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/mdc3.12849","article-title":"Physical Activity, Exercise, and Physiotherapy in Parkinson\u2019s Disease: Defining the Concepts","volume":"7","author":"Bou\u00e7a-Machado","year":"2020","journal-title":"Mov Disord Clin Pract"},{"key":"2026111421224016000_15.11.e096285.8","article-title":"Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context","volume":"36","author":"Caetano","year":"2020","journal-title":"Cad Saude Publica"},{"key":"2026111421224016000_15.11.e096285.9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1357633X18792805","article-title":"Application of telehealth intervention in Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"26","author":"Chen","year":"2020","journal-title":"J Telemed Telecare"},{"key":"2026111421224016000_15.11.e096285.10","doi-asserted-by":"publisher","DOI":"10.1258\/jtt.2011.101208"},{"key":"2026111421224016000_15.11.e096285.11","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzae045","article-title":"Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association","volume":"104","author":"Lee","year":"2024","journal-title":"Phys Ther"},{"key":"2026111421224016000_15.11.e096285.12","article-title":"Effectiveness of a Home-Based Balance Training System Using Visual Feedback for People with Parkinson\u2019s Disease","volume":"19","author":"P\u00e9rez-Robledo","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026111421224016000_15.11.e096285.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.116930"},{"key":"2026111421224016000_15.11.e096285.14","doi-asserted-by":"publisher","DOI":"10.1258\/135763306775321371"},{"key":"2026111421224016000_15.11.e096285.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7136.978"},{"key":"2026111421224016000_15.11.e096285.16","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2026111421224016000_15.11.e096285.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"2026111421224016000_15.11.e096285.18","unstructured":"Dean AG , Sullivan KM , Soe MM . OpenEpi: Open Source Epidemiologic Statistics for Public Health, 2013. Available: http:\/\/www.openepi.com\/Menu\/OE_Menu.htm"},{"key":"2026111421224016000_15.11.e096285.19","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23145"},{"key":"2026111421224016000_15.11.e096285.20","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22340"},{"key":"2026111421224016000_15.11.e096285.21","unstructured":"Dallal GE . Randomization, 2013. Available: www.randomization.com"},{"key":"2026111421224016000_15.11.e096285.22","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1093\/ptj\/81.8.1400","article-title":"Spinal Movement and Performance of a Standing Reach Task in Participants With and Without Parkinson Disease","volume":"81","author":"Schenkman","year":"2001","journal-title":"Phys Ther"},{"key":"2026111421224016000_15.11.e096285.23","doi-asserted-by":"crossref","unstructured":"Yang Y , Wang Y , Zhou Y , et al . Reliability of functional gait assessment in patients with Parkinson disease: Interrater and intrarater reliability and internal consistency. Medicine (Baltimore) 2016;95. doi:10.1097\/MD.0000000000004545","DOI":"10.1097\/MD.0000000000004545"},{"key":"2026111421224016000_15.11.e096285.24","doi-asserted-by":"crossref","first-page":"476","DOI":"10.15309\/19psd200216","article-title":"Valida\u00e7\u00e3o para Portugu\u00eas da Functional Gait Assessment em doentes com Parkinson","volume":"20","author":"Bacelar P,","year":"2019","journal-title":"Psicol Sa\u00fade Doenc"},{"key":"2026111421224016000_15.11.e096285.25","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20130596"},{"key":"2026111421224016000_15.11.e096285.26","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/30.4.299"},{"key":"2026111421224016000_15.11.e096285.27","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1002\/mds.21216","article-title":"Independent validation of SCOPA\u2013psychosocial and metric properties of the PDQ\u201039 Brazilian version","volume":"22","author":"Carod\u2010Artal","year":"2007","journal-title":"Mov Disord"},{"key":"2026111421224016000_15.11.e096285.28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"2026111421224016000_15.11.e096285.29","first-page":"345","article-title":"Estudos de adapta\u00e7\u00e3o do Montreal Cognitive Assessment (MoCA) para a popula\u00e7\u00e3o portuguesa","volume":"9","author":"Freitas","year":"2010","journal-title":"Aval Psicol"},{"key":"2026111421224016000_15.11.e096285.30","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1212\/WNL.0b013e3181fc29c9","article-title":"The MoCA: well-suited screen for cognitive impairment in Parkinson disease","volume":"75","author":"Dalrymple-Alford","year":"2010","journal-title":"Neurology (ECronicon)"},{"key":"2026111421224016000_15.11.e096285.31","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-014-1995-y"},{"key":"2026111421224016000_15.11.e096285.32","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/80.9.896"},{"key":"2026111421224016000_15.11.e096285.33","unstructured":"Dutra MC , Cabral AL , Carvalho GD . Tradu\u00e7\u00e3o para o portugu\u00eas e valida\u00e7\u00e3o do teste Timed Up and Go. Psychology (Irvine) 2016."},{"key":"2026111421224016000_15.11.e096285.34","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20090126"},{"key":"2026111421224016000_15.11.e096285.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.02.020"},{"key":"2026111421224016000_15.11.e096285.36","first-page":"408","article-title":"Instrumentos de avalia\u00e7\u00e3o do equil\u00edbrio corporal em idosos","volume":"4","author":"Figueiredo","year":"2007","journal-title":"Rev Bras de Cineantropometria e Desempenho Hum"},{"key":"2026111421224016000_15.11.e096285.37","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"2026111421224016000_15.11.e096285.38","first-page":"E105","article-title":"Effects of musical cueing on gait parameters and motor symptoms in Parkinson\u2019s disease: a systematic review","volume":"44","author":"Rodrigues","year":"2021","journal-title":"J Geriatr Phys Ther"},{"key":"2026111421224016000_15.11.e096285.39","first-page":"585","article-title":"Brain\u2013machine interface in chronic stroke rehabilitation: a controlled study","volume":"82","author":"Ramos-Murguialday","year":"2017","journal-title":"Ann Neurol"},{"key":"2026111421224016000_15.11.e096285.40","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzy131"},{"key":"2026111421224016000_15.11.e096285.41","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1093\/ptj\/pzab302","article-title":"Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline. From the American Physical Therapy Association","volume":"102","author":"Osborne","year":"2021","journal-title":"Phys Ther"},{"key":"2026111421224016000_15.11.e096285.42","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jphys.2019.08.003","article-title":"Home-based prescribed exercise improves balance-related activities in people with Parkinson\u2019s disease and has benefits similar to centre-based exercise: a systematic review","volume":"65","author":"Flynn","year":"2019","journal-title":"J Physiother"},{"key":"2026111421224016000_15.11.e096285.43","doi-asserted-by":"crossref","unstructured":"Tomlinson CL , Patel S , Meek C , et al . Physiotherapy versus placebo or no intervention in Parkinson\u2019s disease. Cochrane Database Syst Rev 2012;CD002817. doi:10.1002\/14651858.CD002817.pub2","DOI":"10.1002\/14651858.CD002817.pub3"},{"key":"2026111421224016000_15.11.e096285.44","doi-asserted-by":"crossref","DOI":"10.1186\/s40814-018-0243-2","article-title":"Physical therapy and deep brain stimulation in Parkinson\u2019s Disease: protocol for a pilot randomized controlled trial","volume":"4","author":"Duncan","year":"2018","journal-title":"Pilot Feasibility Stud"},{"key":"2026111421224016000_15.11.e096285.45","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X05279903"},{"key":"2026111421224016000_15.11.e096285.46","unstructured":"Creswell JW , Poth CN . Qualitative inquiry and research design: choosing among five approaches. 4th edn. Thousand Oaks, CA: Sage Publications, 2018."},{"key":"2026111421224016000_15.11.e096285.47","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/13.6.522"},{"key":"2026111421224016000_15.11.e096285.48","unstructured":"Bardin L . An\u00e1lise de Conte\u00fado. S\u00e3o Paulo: Edi\u00e7\u00f5es. 2011."},{"key":"2026111421224016000_15.11.e096285.49","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0268656","article-title":"Exploring patient experiences of participating in a real and sham dry cupping intervention for nonspecific low back pain: A qualitative study","volume":"17","author":"Almeida Silva","year":"2022","journal-title":"PLoS One"},{"key":"2026111421224016000_15.11.e096285.50","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026111421224016000_15.11.e096285.51","unstructured":"Lei Geral de Prote\u00e7\u00e3o de Dados Pessoais (LGPD), Lei n\u00ba 13.709, de 14 de agosto de 2018, Available: http:\/\/www.planalto.gov.br\/ccivil_03\/_ato2015-2018\/2018\/lei\/l13709.htm"},{"key":"2026111421224016000_15.11.e096285.52","unstructured":"Health Insurance Portability and Accountability Act of 1996 (HIPAA) . Public Law 104-191, Available: https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-104publ191\/html\/PLAW-104publ191.htm"},{"key":"2026111421224016000_15.11.e096285.53","unstructured":"ISO\/IEC 27001:2013 - Information technology \u2014 Security techniques \u2014 Information security management systems \u2014 Requirements, Available: https:\/\/www.iso.org\/standard\/54534.html"},{"key":"2026111421224016000_15.11.e096285.54","unstructured":"National Institute of Standards and Technology (NIST) . Special Publication 800-52 Rev. 2, Guidelines for the Selection, Configuration, and Use of Transport Layer Security (TLS) Implementations, Available: https:\/\/nvlpubs.nist.gov\/nistpubs\/SpecialPublications\/NIST.SP.800-52r2.pdf"},{"key":"2026111421224016000_15.11.e096285.55","unstructured":"Cloud Security Alliance . Security Guidance for Critical Areas of Focus in Cloud Computing v4.0, Available: https:\/\/cloudsecurityalliance.org\/artifacts\/security-guidance-v4\/"},{"key":"2026111421224016000_15.11.e096285.56","unstructured":"OWASP . Authentication Cheat Sheet, Available: https:\/\/cheatsheetseries.owasp.org\/cheatsheets\/Authentication_Cheat_Sheet.html"},{"key":"2026111421224016000_15.11.e096285.57","unstructured":"ISO\/IEC 27005:2018 - Information technology \u2014 Security techniques \u2014 Information security risk management, Available: https:\/\/www.iso.org\/standard\/75281.html"},{"key":"2026111421224016000_15.11.e096285.58","unstructured":"World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, Available: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-096285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T05:24:22Z","timestamp":1794720262000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-096285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":58,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,29]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2024-096285"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096285","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096285.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096285.supp2","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}