Tele-Rehabilitation for Boys with Duchenne Muscular Dystrophy in India Amidst the COVID-19 Pandemic: An Implementation Study
Abstract
Purpose: Duchenne muscular dystrophy (DMD) is X-linked progressive neuromuscular disorder of childhood onset which leads to loss of ambulation, followed by respiratory and cardiac muscle weakness. Physiotherapy is integral to the multidisciplinary care plan for boys with DMD. During the COVID-19 pandemic, Tele-medicine was increasingly used to provide healthcare to patients. The study aimed to assess the efficacy and feasibility of Tele-rehabilitation among ambulatory boys with DMD. Materials and Methods: Ambulatory boys aged 5 to 12 years with DMD were recruited using purposive sampling. The Tele-rehabilitation program was designed by a neuromuscular team and provided by a physiotherapist through telephonic video calls twice a month for three months. A compliance diary was provided to fill out at home after each session. The outcome was measured with a change in Medical Research Council (MRC) sum score and gower's times at 12 weeks using paired t- test. Results: 92 boys with DMD were enrolled and 66 (71%) boys completed the program and had follow-up at 12 weeks. The baseline MRC sum score was 38.2±3.7, and the gower's time was 9.2±6.7 seconds. At 12 weeks MRC sum score was 38.8±4.2, and gower's time was 8.59±7.7 seconds (p-value- 0.03 and p-value- 0.001), respectively. The Vigno's and Brook's scores didn't show a significant change. Compliance of >50% to the Tele-rehabilitation exercise programs was present in 89% of subjects. Conclusion: A short-term Tele-rehabilitation program was feasible with a high compliance rate and efficacious in motor strengthening among boys with DMD.
Keywords
Tele-Rehabilitation , DMD , Compliance , Exercise Program , COVID-19
References
- Abramson AS, Rogoff J. (1953). An approach to rehabilitation of children with muscular dystrophy. 1953; New York. p 123-124.
- Akkurt, L., Gürbüz, İ. A., Karaduman, A., And Yilmaz, Ö. T. (2019). Lower limb flexibility in children with Duchenne muscular dystrophy: effects on functional performance. Pediatric Exercise Science, 31(1), 42-46. [PubMed]
- Akulwar-Tajane, I., And Bhatt, G.D. (2021). Telerehabilitation: An Alternative Service Delivery Model for Pediatric Neurorehabilitation Services at a Tertiary Care Center in India. Int J Phys Med Rehabil, 9, S4.
- Alemdaroğlu, I., Karaduman, A., Yilmaz, Ö. T., And Topaloğlu, H. (2015). Different types of upper extremity exercise training in Duchenne muscular dystrophy: effects on functional performance, strength, endurance, and ambulation. Muscle & nerve, 51(5), 697-705. [PubMed]
- Angelini, C., And Peterle, E. (2012). Old and new therapeutic developments in steroid treatment in Duchenne muscular dystrophy. Acta myologica, 31(1), 9. [PubMed]
- Appleby, E., Gill, S. T., Hayes, L. K., Walker, T. L., Walsh, M., And Kumar, S. (2019). Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review. PloS one, 14(11), e0225150. [PubMed]
- Balaban, B., Matthews, D. J., Clayton, G.H., And Carry, T. (2005). Corticosteroid treatment and functional improvement in Duchenne muscular dystrophy: long-term effect. American journal of physical medicine & rehabilitation, 84(11), 843-850. [PubMed]
- Birnkrant, D. J., Bushby, K., Bann, C. M., Alman, B. A., Apkon, S. D., Blackwell, A., And Ward, L. M. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management. The Lancet Neurology, 17(4), 347-361. [PubMed]
- Birnkrant, D. J., Bushby, K., Bann, C. M., Apkon, S. D., Blackwell, A., Brumbaugh, D., And Weber, D. R. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. The Lancet Neurology, 17(3), 251-267. [PubMed]
- Birnkrant, D. J., Bushby, K., Bann, C. M., Apkon, S. D., Blackwell, A., Colvin, M. K., And Ward, L. M. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 3: primary care, emergency management, psychosocial care, and transitions of care across the lifespan. The Lancet Neurology, 17(5), 445-455. [PubMed] Birnkrant, D. J., Bushby, K., Bann, C. M., Apkon, S. D., Blackwell, A., Brumbaugh, D., And Weber, D. R. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. The Lancet Neurology, 17(3), 251-267. [PubMed]