Long-term Neurological Conditions Research Articles

The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data.

Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.

AUTOMATED DETECTION OF PARKINSON’S DISEASE BASED ON HYBRID CNN AND QUANTUM MACHINE LEARNING TECHNIQUES IN MRI IMAGES

Parkinson’s disease (PD) is a long-term neurological condition that causes severe neuronal degeneration in the motor cortex. Because of the constraints of medical applications determining the severity of PD, forecasting its development can be difficult. Recently research has focused on artificial intelligence to automatically diagnose PD from MRI images. The proposed study aims (a) to incorporate automated method for augmentation of the MRI images using the deep convolutional generative adversarial networks (DCGAN), (b) to perform feature extraction and classification by employing the pre-trained models such as VGG16, Xception, and InceptionV3 models, (c) to develop a hybrid model by fusing the InceptionV3 features and classification using QSVM model. A total of 60 real-time MRIs of normal (N = 30) and PD (N = 30) patients were included in this study. To increase the dataset, the proposed study employed the DCGAN approach. Thus, the dataset for this study was increased to 1000 (normal and PD) images. Automatic feature extraction and classification were performed utilizing different pre-trained models such as VGG16, Xception, and InceptionV3. Among the pre-trained models InceptionV3 architecture provided high accuracy of 74% compared to other models. The proposed work developed a hybrid model by fusing InceptionV3 features and a quantum support vector machine (QSVM) for the detection of PD and healthy groups. The proposed model attained a prediction accuracy of 87.5% and high precision of 95%, respectively. Additionally, the hybrid architecture provided high recall and F1-measure of 84% and 89%, respectively. The hybrid model provided lowest false negative and false positive of 4 and 1, respectively. Therefore, the hybrid model could be an effective diagnostic tool for the automated prediction of PD.

Smart Societal Optimization-based Deep Learning Convolutional Neural Network Model for Epileptic Seizure Prediction

ABSTRACT Epilepsy is a long-term neurological condition that disrupts brain function in people of all ages, epilepsy is a condition that is analysed through the brain signals via electroencephalogram (EEG) signal. To analyse epilepsy using spatial and temporal data, various machine-learning-based techniques are used. However, most of the techniques suffer from inaccuracy issues in dealing with the dynamic and raw EEG signal. In this research, an intelligent societal optimisation-driven classifier is introduced based on convolutional neural networks (CNN) for epileptic seizure prediction using EEG signals. To boost predictive accuracy, we extract frequency band features from the EEG signal utilising wavelet decomposition. The frequency band features form the feature vector, is provided smart societal optimisation- CNN such that the prediction performance is enhanced through the optimal tuning of the CNN with the smart societal optimisation. Smart societal optimisation is proposed by integrating the behaviour of the Lobos wolf and the Moggie. The smart societal optimisation-based CNN attains 87.673% accuracy, 84.949% sensitivity91.274%specificity for the K-Fold-10 for CHB-MIT scalp EEG database.

Impact of prenatal, neonatal, and postnatal factors on epilepsy risk in children and adolescents: a systematic review and meta-analysis

Abstract Background Epilepsy is a common, long-term neurological condition. Several previous case-control, cohort and cross-sectional studies have highlighted the role of prenatal, delivery and postnatal factors in the onset of epilepsy. In this systematic review, we evaluate the impact of these factors on the development of epilepsy in children and adolescents. Methods We searched PubMed and Google Scholar for literature on the relationship between prenatal, delivery and postnatal factors and the occurrence of epilepsy. The research was performed according to the PRSIMA 2020 flowchart and checklist. Data were extracted and pooled according to the ReviewManager 5.3 software using a random-effects model. Sensitivity analysis and subgroup analysis were used to evaluate the source of heterogeneity. Results We identified 25 reports, including 45,044 cases with confirmed epilepsy and 2,558,210 controls. Premature birth is significantly associated with the risk of epilepsy (pooled OR = 4.36 [95% CI: 1.26–15.09], P = 0.02). Smoking during pregnancy significantly increases this risk by 28% (pooled OR = 1.28 [95% CI:1.1–1.49], P = 0.002). Furthermore, maternal epilepsy confers a pooled OR of 2.06 [95% CI:1.26–3.36]. Eclampsia is linked to a 16.9-fold increased risk of epilepsy. In addition, both pregnancy metrorrhagia and maternal infection are significantly associated with the epilepsy risk (pooled OR = 2.24 [95% CI: 1.36–3.71] and 1.28 [95% CI: 1.17–1.41], respectively). For delivery conditions, cord prolapse (pooled OR = 2.58 [95% CI: 1.25–5.32]), prolonged labor (> 6 h) (OR = 6.74 [95% CI: 3.57–12.71]) and head trauma (pooled OR = 2.31 [95% CI: 1.54–3.48]) represent a meaningful risk of epilepsy occurrence. Moreover, birth complications (OR = 3.91 [95% CI: 2.43–6.29]), low birth weight (pooled OR = 1.83 [95% CI: 1.5–2.23]) and male birth (pooled OR = 1.18 [95% CI: 1.06–1.32]) are associated with an elevated risk of epilepsy in childhood and adolescence. Conclusions Epilepsy in children and adolescents can be attributed to a multitude of intricate factors, notably those during pregnancy, delivery and the postnatal period. These findings highlight the crucial role of prenatal and postnatal care in reducing the impact of these factors on epilepsy occurrence.

Person‐centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review

AbstractIntroductionPeople living with long‐term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions.MethodsA systematic review of the literature was undertaken evaluating multisectoral integrated care interventions in people living with Parkinson's disease (PD), Multiple Sclerosis (MS) and Huntington's disease (HD). Strength of evidence was rated for the different outcomes.ResultsA total of 15 articles were included, reporting on 2095 patients and caregivers, finding that integrated care can improve people's access to resources and reduce patients' depression. UK studies indicated improvements in patients' quality of life, although the international literature was inconclusive. Few programmes considered caregivers' outcomes, reporting no difference or even worsening in depression, burden and quality of life. Overall, the evidence showed a mismatch between people's needs and outcomes measured, with significant outcomes (e.g., self‐management, continuity of care, care experience) lacking. Successful programmes were characterised by expert knowledge, multisectoral care coordination, care continuity and a person‐centred approach.ConclusionsThe impact of integrated care programmes on people living with LTNCs is limited and inconclusive. For a more person‐centred approach, future studies need to assess integrated care from a service‐user perspective.Patient and Public ContributionThirty people living with LTNCs were involved in this review, through defining research questions, validating the importance of the project, and increasing the researchers' understanding on what matters to service users. A patient and public involvement subgroup of representatives with lived experience on PD, MS and HD identified the need for more person‐centred integrated care, with specific concerns over care fragmentation, care duplication and care continuity. This was key to data analysis and formulating the characteristics of successful and unsuccessful integrated care programmes from the perspective of service users. The discrepancy between service users' needs and the outcomes assessed in the literature point to user‐driven research as the solution to address what matters to patients and caregivers.

The Utility of Methylphenidate for Fatigue in Long-Term Neurological Conditions: A Meta-analytical Review.

Fatigue is a chronic and debilitating symptom of many long-term neurological conditions (LTNCs). Although methylphenidate provides some promise in alleviating fatigue in other clinical groups, little work has explored its potential utility within LTNCs. The current systematic review and meta-analysis evaluates the utility of methylphenidate for symptoms of fatigue in LTNCs. Five databases (PsycINFO, MEDLINE, Embase, Scopus, and Cochrane Library) were searched for relevant articles from their inception to February 2022. A purpose-developed evaluation tool was used to assess each study's research quality (QuEST:F). Of the 1698 articles identified, 11 articles were included within this review (n = 370). Meta-analytical findings reported an overall significant benefit of methylphenidate for symptoms of fatigue across a mixed neurological sample ( g = -0.44; 95% confidence interval, -0.77 to -0.11). Subgroup analyses identified a significantly greater benefit ( P < 0.001) of methylphenidate for fatigue in LTNCs with static pathogenic trajectories (eg, traumatic brain injury) (number needed to treat = 2.5) compared with progressive conditions (eg, multiple sclerosis) (number needed to treat = 40.2). Methylphenidate may pose an effective intervention for the treatment of fatigue in a number of LTNCs. Nonetheless, given the quality of the current evidence base, there exists a clear need for further robust assessment of the utility of methylphenidate-with a focus on subgroup-specific variability.

Exploring the barriers and facilitators to volunteering as an intervention for those with long-term neurological conditions: How make therapeutic volunteering possible?

Volunteering may have therapeutic benefits, but little is known about its requirements and potential for people with neurological conditions (pwNC). Two separate focus groups were conducted in Darmstadt, Germany: one group consisting of six pwNC and another group consisting of four health care professionals and three volunteering service providers. The focus groups were audio-recorded, transcribed and data were managed using NVivo12. The thematic analysis was applied. Four main themes were identified: (1) Impact of volunteering, (2) Individualisation, (3) Developmental space and (4) Funded supported volunteering. According to the findings, volunteering can be used as a strategy to enhance physical, mental and social well-being in disease management for people with long-term neurological conditions. Facilitators for accessibility of therapeutic volunteering; involvement of pwNC.

Palliative care for people with long term neurological conditions: practices and reflections based on comprehensive care

The care for people with Long Term Neurological Conditions (LTNC) isn´t recognized as a major practice in Palliative Care (PC) scientific production; in daily basis, the assistance is focused on hygiene´s care and clinical observation. However, from the perspective of PC, the health professionals´ role is to promote the dignity of the human person. The concept of LTNC covers neurological diseases with a prognosis of long-time life with significant disabilities, end-of-life stage that is difficult to identify, with many symptoms and physical and cognitive impairments. In this paper, we considered the following situations: persistent vegetative state, minimal consciousness state and locked-in syndrome. This is a theoretical study of a qualitative nature, which aims to describe a new kind of PC practice with this population, based on first author PHD study. The concept of Comprehensive Care is the main theoretical framework for the paper. It is proposed a practice reconstruction based on the person´s biography occurs by several perspectives, especially through sensory stimuli related to prior patient´s occupational repertoire. Along with the detailed evaluation, the therapist does a careful and continuous monitoring, proposing activities, giving special attention to their reactions, being able to discriminate what pleases or not, and expanding the possibilities of encounter of people with LTNC and the environment which surround them. Therapist should also provide support and guidance to the family, which is in a vulnerable situation. Regardless of neurological reactions presented by the patients this practice helps reconstructing the meanings of the daily life of person with so severe disability. Sensory stimuli are shown as potential tools for a rehabilitation practice. Memory, history, identity, dignity, and subjectivity qualify the assistance for people with LTNC.

The Metabolic Role of Ketogenic Diets in Treating Epilepsy.

Epilepsy is a long-term neurological condition that results in recurrent seizures. Approximately 30% of patients with epilepsy have drug-resistant epilepsy (DRE). The ketogenic diet (KD) is considered an effective alternative treatment for epileptic patients. The aim of this study was to identify the metabolic role of the KD in epilepsy. Ketone bodies induce chemical messengers and alterations in neuronal metabolic activities to regulate neuroprotective mechanisms towards oxidative damage to decrease seizure rate. Here, we discuss the role of KD on epilepsy and related metabolic disorders, focusing on its mechanism of action, favorable effects, and limitations. We describe the significant role of the KD in managing epilepsy disorders.

Experiences of people living with long-term neurological conditions and using telerehabilitation during the COVID-19 lockdown in Switzerland: explorative interviews

Abstract Background Therapy interventions were disrupted by the first lockdown during the COVID-19 pandemic in Switzerland. An instant change to telerehabilitation had to be implemented by physiotherapists. Aim Exploration of experiences of individuals living with a long-term neurological condition receiving telerehabilitation physiotherapy interventions during the first lockdown. Method Persons with a long-term neurological condition were recruited from the outpatient clinic of a local hospital in the German-speaking part of Switzerland during February and March 2021. Semi-structured individual interviews with a phenomenological perspective were audio-recorded, transcribed verbatim and analyzed using reflexive thematic analysis. Results 4 persons, 2 with multiple sclerosis and 2 with stroke (aged 44–75), were interviewed. There were 3 main themes, of which 2 had 3 subthemes: 1) Living with a neurological condition during a pandemic (daily life without and within a pandemic, symptoms, feelings and attitudes influenced by the pandemic); 2) Therapy experiences (therapeutic relationship, remote therapy, therapy experiences after the first lockdown); and 3) Family and social environment. Synchronous interventions such as live video sessions or live online groups were favored when compared to telephone calls or asynchronous digital interventions. However, for participants, it was equally important to explain how the pandemic influenced them in general. Conclusion Individuals interviewed appreciated having received therapy during the lockdown, favoring synchronous interventions. However, there are still many unanswered questions about how best to support these populations, and evidence-based recommendations are needed.

Parkinson’s disease and palliative care: a quality of care Delphi study

ObjectivesExtending palliative care services to those with long-term neurological conditions is a current aim of UK health policy. Lack of holistic guidelines for palliative and end-of-life care, and differing models...

Systemic infection drives urgent care needs and outcome in adults with long-term neurological conditions

It is estimated that 1 in 6 people are living with a long-term neurological condition (LTNC). Although it is likely that systemic infections are a common trigger for urgent tertiary care needs in LTNCs, there is a lack of data. Yet this is important since systemic infections are a modifiable risk factor, and hence the motivation for a formal evaluation. We undertook case note review of 155 consecutive unselected adult patients with LTNC receiving urgent care at a tertiary hospital between November and December 2019. Data were collected on presenting symptoms, diagnosis, length of stay, complications, and change in social needs. The most common LTNCs were neurocognitive disorders (n = 68, 44%), cerebrovascular disorders (n = 65, 42%), and epilepsy (n = 19, 12%). Respiratory infections were most common (n = 40, 62.5%), followed by urinary (n = 16, 25%), skin (n = 4, 6%), gastrointestinal (n = 3, 5%) and bone (n = 1, 1.5%). Systemic infection was the trigger for urgent care in 41.3% of patients and in multivariable regression was associated with an increased likelihood of admission (p < 10−5, OR = 7.8, Nagelkerke R2 = 0.37), longer length of stay (p = 0.03, β = 5.91, R2 = 0.06), and death (p = 0.045, OR = 4.3, Nagelkerke R2 = 0.22). Altered mental status was the presenting symptom most frequently associated with infection (p < 10−8, χ2 test). In conclusion, systemic infections are a major trigger of acute tertiary care needs in adults with LTNCs, and play a role in determining clinical outcome. Since systemic infections are preventable or can be treated if identified early, they may represent a modifiable target to improve quality of life, clinical outcomes and health service efficiency.

Inhibition of Chk2 promotes neuroprotection, axon regeneration, and functional recovery after CNS injury.

DNA double-strand breaks occur in many acute and long-term neurological conditions, including neurodegeneration, neurotrauma, and stroke. Nonrepaired breaks chronically activate the DNA damage response in neurons, leading to neural dysfunction and apoptosis. Here, we show that targeting of the central ATM-Chk2 pathway regulating the response to double-strand breaks slows neural decline in Drosophila models of chronic neurodegeneration. Inhibitors of ATM-Chk2, but not the parallel ATR-Chk1 pathway, also promote marked, functional recovery after acute central nervous system injury in rats, suggesting that inhibiting nonhomologous end-joining rather than homologous recombination is crucial for neuroprotection. We demonstrate that the Chk2 inhibitor, prexasertib, which has been evaluated in phase 2 clinical trials for cancer, has potent neuroprotective effects and represents a new treatment option to promote functional recovery after spinal cord or optic nerve injury.

Longitudinal Changes in Cognitive Functioning and Brain Structure in Professional Boxers and Mixed Martial Artists After They Stop Fighting.

This study compares longitudinal changes in cognitive functioning and brain structures in male fighters who transitioned to an inactive fighting status without any further exposure to repetitive head impacts (RHIs) and fighters remaining active with continual exposure to RHIs. Participants were recruited from the Professional Fighters Brain Health Study. At time point (TP)1, all fighters were active, with continual exposure to RHIs. At TP2, fighters were considered "transitioned" if they had no sanctioned professional fights and had not been sparring for the past 2 years. Fighters were considered "active" if they continued to train and compete. All fighters underwent cognitive testing and 3T MRI at both TPs. A subset of our fighters (50%) underwent blood sampling for the characterization of neurofilament light (NfL) levels at both TPs. Linear mixed-effect models were applied to investigate the potentially different longitudinal trajectories (interaction effect between group and time) of cognitive function measures, NfL levels, and regional thickness measures (derived from structural MRI) between transitioned and active fighters. Forty-five male transitioned fighters (aged 31.69 ± 6.27 years [TP1]; 22 boxers, 22 mixed martial artists, and 1 martial artist) and 45 demographically matched male active fighters (aged 30.24 ± 5.44 years [TP1]; 17 boxers, 27 mixed martial artists, and 1 martial artist) were included in the analyses. Significantly different longitudinal trajectories between transitioned and active fighters were observed in verbal memory (p FDR = 4.73E-04), psychomotor speed (p FDR = 4.73E-04), processing speed (p FDR = 3.90E-02), and NfL levels (p = 0.02). Transitioned fighters demonstrated longitudinally improved cognitive functioning and decreased NfL levels, and active fighters demonstrated declines in cognitive performance and stable NfL levels. Of 68 cortical regions inspected, 54 regions demonstrated a consistently changing trajectory, with thickness measures stabilizing on a group level for transitioned fighters and subtly declining over time for active fighters. After fighters' cessation of RHI exposure, cognitive function and brain thickness measures may stabilize and blood NfL levels may decline. This study could be a starting point to identify potential predictors of individuals who are at a higher risk of RHI-related long-term neurologic conditions.

171 Systemic infections and acute admission in long-term neurological conditions

BackgroundPeople living with a long-term neurological condition (LTNC) make up nearly one-fifth of hospital admissions in the UK. Though LTNCs are diverse, the common trigger for deterioration is often systemic infection. More data on the problem is required to inform service planning.MethodsThe case notes of 157 consecutive patients with an LTNC presenting to University Hospital South- ampton for urgent care, were reviewed, as part of an ongoing and prospective service evaluation. Data was collected on mode of presentation, acute diagnosis, specialty input, length of stay, complications, and change in social needs.ResultsDementia (43%) and stroke (27%) were the most common LTNCs. Systemic infection was the trigger for admission in 52% of patients. The mode of presentation was most commonly deterioration in func- tional abilities and cognition. Mean length of stay was 5.7 days. Care needs increased in 11% of patients.ConclusionThis data provides a snapshot of the urgent care needs of people with LTNCs, which should help inform future service planning. In particular, the impact of systemic infection is significant and strate- gies to mitigate this are discussed.ritaramos.jc4@gmail.com

186 Published discussion of palliative care for patients with long term neurological conditions

IntroductionThere is a growing recognition of the need for palliative care services for people with long-term neurological conditions (LTNC). However, in order to provide optimal treatment, there is a need for discussion and teaching within the relevant specialties, and research needs to provide evidence to inform provision of best medical practice.MethodsWe use number of abstracts from neurological, geriatric and palliative care conferences as a marker of the level of discourse at a clinical and academic levels. We searched ABN, BGS (British Geriatric Society), and APM (Association for Palliative Medicine) conference abstracts from 2014–2019 for neuro- logical and palliative search terms as appropriate.ResultsWe searched 3,750 abstracts over 21 conferences using the pre-specified search terms. Overall, only 2.19% out of these abstracts related to palliative issues in LTNC (ABN 21/1612 (1.3%), BGS 12/1017 (1.1%), APM 48/1121 (4.4%)) α2 p=3.2x10–8. ‘Dementia’ and ‘Parkinson’s’ were the most commonly identified LNTCs in BGS abstracts (each 4/12), with MND (14/48) and ‘dementia’ (10/48) dominating the APM abstracts.DiscussionThere is a dearth of published research and discussion at academic meetings related to the palliative needs of patients with LTNC. We believe these are necessary to inform best medical practice, and to establish policies and guidelines to serve this vulnerable group, or to inform the ongoing national debate.richard.n.rees@ucl.ac.uk

193 Factors that promote well-being in 5 long-term neurological conditions: a patient and carer perspective

BackgroundNeurological long-term conditions (LTCs) are associated with decreased psychological well-being. Identifying factors that promote well-being is crucial for improving quality of life. Existing research has identified common well-being factors, but investigating patient/carer perspectives allows for personalised insight into less-recognised factors.AimsTo identify and analyse well-being factors across 5 neurological LTCs - Parkinson’s disease (PD), multiple sclerosis, (MS) motor neuron disease (MND), Huntington’s disease (HD) and epilepsyMethodsQualititative data was analysed from the NeuroLTC study for 1,490 participants who were asked what factors helped maintain their well-being. A total of 2405 well-being factors, identified from 846 free-text responses were categorised using inductive thematic analysis, and then analysed by condition. PD responses (n=387) were further analysed to determine whether patient gender or disease progression affected well-being factors cited.ResultsSocial support, exercise, lifestyle and supportive equipment were the most common well-being factors across all conditions. Less-recognised factors (patient attitude, diet, alternative therapies) were also noted. Response frequencies in MND were the most dissimilar to other conditions. In PD, analysis showed the evolution of relevant well-being factors over time, whereas no notable difference was found between factors cited by each gender.ConclusionThis study of patient/carer perspectives on well-being factors, found variation across neuro- logical conditions and disease progression (for PD). This could inform advice given by healthcare profes- sionals to promote patient well-being.ckipps@nhs.net

Telehealth in long-term neurological conditions: the potential, the challenges and the key recommendations

Long-term neurological conditions (LTNCs) cause physical and psychological symptoms that have a significant impact on activities of daily living and quality of life. Multidisciplinary teams are effective at providing treatment for people with LTNCs; however, access to such services by people with disabilities can be difficult and as a result, good quality care is not universal. One potential solution is telehealth. This review describes the potential of telehealth to support people with LTNCs, the challenges of designing and implementing these systems, and the key recommendations for those involved in telehealth to facilitate connected services that can benefit patients, carers and healthcare professionals. These recommendations include understanding the problems posed by LTNCs and the needs of the end-user through a person-centred approach. We discuss how to work collaboratively and use shared learning, and consider how to effectively evaluate the intervention at every stage of the development process.

Disability and fieldwork: A personal reflection

This short Note offers a personal reflection about disability and fieldwork. It is not about how my disability, a long-term neurological condition, has affected my fieldwork. Rather, it is a series of thoughts about how my mobility issues might impact on my future fieldwork, but not only in a negative sense. The Note primarily discusses some of the ways that, potentially, my disability – which has changed how I interact with the world around me – might actually enhance my research and help to take it in new directions. I wrote the Note primarily for myself and for other researchers with disabilities, whether visible or hidden.

Stay mindfully active during the coronavirus pandemic: a feasibility study of mHealth-delivered mindfulness yoga program for people with Parkinson\u2019s disease

ImportancePatients with long-term neurological conditions, such as Parkinson’s disease (PD), are particularly vulnerable to the public health measures taken to combat the COVID-19 pandemic. The inaccessibility of center-based rehabilitation further aggravated their motor dysfunctions as well as mental distress, leading to exacerbation of motor and non-motor symptoms, high healthcare utilization and worsened health-related quality of life (HRQOL).ObjectiveThis study aimed to evaluate the feasibility, safety, and preliminary effects of the mHealth-delivered home-based mindfulness yoga program on functional balance, motor symptoms, mental health and HRQOL in patients with PD.Design, setting and participantsThis prospective, single-arm, non-randomized feasibility study adopted a sequential explanatory mixed-method design. Adults (aged ≥ 18) with a clinical diagnosis of idiopathic Parkinson’s disease (Hoehn and Yahr stage I to III) who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling.InterventionHome-based mindfulness yoga training were delivered via video-conferencing software (Zoom) in eight bi-weekly 90-min sessions.Main outcomes and measuresThis current study measured functional balance, motor symptoms, perceived balance confidence, perceived freezing of gait symptoms, anxiety and depression, mindfulness and HRQOL using a tele-assessment approach at baseline and 1-week post-intervention. All participants were invited to attend qualitative individual interviews to explore their experience of using online mindfulness yoga program as a lifestyle intervention for PD rehabilitation.ResultsAmong the ten patients, 80% completed the program with an adherence rate of 98.4%. All participants were able to learn and practice mindfulness yoga following the eight bi-weekly online mindfulness yoga training sessions, without any significant adverse events. Tele-assessment of outcomes were feasible and uneventful. Qualitative feedback revealed participants had a high preference of using the tele-rehabilitation approach to stay mindful and being active, both physically and socially, while confronting the changes brought by COVID-19 pandemic.Conclusions and relevanceThe mHealth-delivered home-based mindfulness yoga intervention was feasible, safe, and well-accepted among people with PD to relieve the burden brought by COVID-19 pandemic. Future studies should adopt a design with enhanced rigor, a comparison group, and enlarged sample size to evaluate the efficacy of the program in patients with long-term neurological conditions and/or physical impairments. We recommend a longer intervention duration of at least 8 weeks to enhance the psychophysiological effects.