Telerehabilitation Versus Conventional Therapy in Parkinson’s Disease: Evidence from Randomized Controlled Trials

Title: Telerehabilitation Versus Conventional Therapy in Parkinson’s Disease: Evidence from Randomized Controlled Trials

Authors: Ana Leticia Fornari Caprara, Jamir Pitton Rissardo, Jorge Patino, Andrew McGarry, and Ian Walker

Conference: 2026 International Congress of Parkinson's Disease, Seoul, Korea

Objective
To compare the effects of telerehabilitation and conventional rehabilitation on motor function and quality of life (QoL) in patients with Parkinson’s disease (PD).

Background
Telerehabilitation typically involves the remote delivery of physical therapy, exercise coaching, and functional training through video‑based platforms. It has emerged as an alternative model of providing rehabilitation for PD, potentially overcoming barriers related to access, mobility, and cost. However, its comparative effectiveness relative to conventional in‑person rehabilitation remains debated.

Design/Methods
A systematic review and meta‑analysis were conducted using PubMed to identify randomized controlled trials (RCTs) comparing telerehabilitation with conventional rehabilitation in adults with PD. The measured outcomes were motor (MDS UPDRS‑III) and QoL (PDQ‑39/PDQ‑8). Pooled analyses were performed using inverse‑variance methods. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Random‑effects models were applied in the presence of significant heterogeneity.

Results
Six RCTs encompassing 283 participants evaluated QoL outcomes, and four RCTs with 249 participants assessed motor outcomes. Meta‑analysis of MDS UPDRS‑III scores showed no statistically significant difference between telerehabilitation and conventional therapy (MD 1.66 points, 95% CI −7.87 to 11.18; I2= 94%) [Figure 1]. For QoL, pooled analysis demonstrated no significant advantage of either intervention (SMD −0.32, 95% CI −1.06 to 0.43; I2 = 71%) [Figure 2]. Across individual trials, telerehabilitation achieved outcomes comparable to conventional rehabilitation.

Conclusions
Evidence from RCTs suggests that telerehabilitation provides benefits in motor function and QoL similar to those of conventional rehabilitation in PD. Despite substantial heterogeneity, telerehabilitation appears to be a viable alternative to in‑person therapy, particularly for patients with limited access to traditional care. However, its applicability in real‑world settings may be limited by insurance policy coverage, which can restrict access to or reimbursement for remote rehabilitation services. Further large‑scale, standardized RCTs are needed to refine optimal delivery models.

Citation
Caprara AL, Rissardo JP, Patino J, McGarry A, Walker I. Telerehabilitation Versus Conventional Therapy in Parkinson’s Disease: Evidence from Randomized Controlled Trials. Mov Disord 2026;41(Suppl_1):S1364.
Figure 1. Forest plot of pooled MD of motor outcomes.
Figure 2. Forest plot of pooled SMD of quality of life outcomes.

Smell as a Diagnostic Signature: Systematic Review and Meta-Analysis of UPSIT Accuracy in Distinguishing Parkinson’s Disease from Essential Tremor

Title: Smell as a Diagnostic Signature: Systematic Review and Meta-Analysis of UPSIT Accuracy in Distinguishing Parkinson’s Disease from Essential Tremor

Authors: Mya C. Schiess, Juan D. Martinez-Lemus, Jamir Pitton Rissardo, Jorge Patino, Ana Leticia Fornari Caprara, Andrew McGarry, and Ian Walker

Conference: 2026 International Congress of Parkinson's Disease, Seoul, Korea

Objective
To evaluate the diagnostic performance of the University of Pennsylvania Smell Identification Test (UPSIT) in differentiating Parkinson’s disease (PD) from essential tremor (ET) using published PubMed-indexed studies.

Background
Hyposmia is a common nonmotor feature of PD and is typically absent or mild in ET. Olfactory testing, particularly UPSIT, has emerged as an accessible, noninvasive adjunct to improve diagnostic accuracy, especially in early tremor‑predominant presentations where clinical overlap is frequent.

Design/Methods
A systematic review and meta-analysis was performed using PubMed‑indexed articles only. Inclusion criteria were: (1) studies employing UPSIT, (2) direct comparison between PD and ET, and (3) sufficient data to extract sensitivity and specificity. Studies assessing other parkinsonian syndromes were excluded. Diagnostic accuracy measures were extracted from eligible publications and aggregated from the data compiled. MetaDTA was utilized for data synthesis. HSROC curves were generated to summarize the sensitivity and specificity of each study.

Results
Seven studies met the inclusion criteria, comprising 454 PD patients and 239 ET patients [Figure 1]. Pooled analysis demonstrated a sensitivity of 78% (95% CI: 74–82%) [Figure 2] for detecting PD‑associated olfactory dysfunction and a specificity of 91% (95% CI: 86–94%) [Figure 3] for distinguishing PD from ET. Most studies reported specificity ≥90%, indicating the strong discriminatory value of UPSIT in the differential diagnosis of tremor. Variability in sensitivity was observed, likely reflecting disease stage and cutoff definition. Most studies showed a high risk of bias due to nonrandom patient selection and unblinded olfactory testing.

Conclusions
UPSIT demonstrates high specificity and moderate sensitivity for differentiating PD from ET, supporting its role as a practical adjunct in the diagnostic evaluation of tremor syndromes. Marked olfactory impairment strongly favors PD over ET, particularly when motor features are equivocal. UPSIT should be interpreted in conjunction with clinical assessment and alongside biomarkers rather than as a standalone diagnostic tool.

Citation
Schiess MC, Martinez-Lemus JD, Rissardo JP, Patino J, Caprara AL, McGarry A, Walker I. Smell as a Diagnostic Signature: Systematic Review and Meta-Analysis of UPSIT Accuracy in Distinguishing Parkinson’s Disease from Essential Tremor. Mov Disord 2026;41(Suppl_1):S1099-S1100.
Figure 1. HSROC plot of UPSIT for distinguishing PD from ET.
Figure 2. Forest plot of the sensitivity of UPSIT for distinguishing PD from ET.
Figure 3. Forest plot of the specificity of UPSIT for distinguishing PD from ET.

250. Accepted

249. Accepted

248. Accepted

247. Accepted

246. Accepted

Nonketotic hyperglycinemia

Nonketotic hyperglycinemia (glycine encephalopathy)

Pregnant complain
"frequent, continuous, rhythmic jerking of the fetus in utero before birth"
reflecting seizures that begin prenatally

Pathophysiology
- Defect mitochondrial glycine cleavage (GLDC/AMT)→ ↑glycine & ↑NMDAr activity

Presentation
First days w/ lethargy + intractable szs + jerks + hiccups + hypotonia
EEG burst-suppression evolving to hypsarrhythmia

Investigation
- FH
- Check Gluc, Na, Ca, Mg, ABG, lactate
- cEEG
- CSF:plasma glycine ratio, add NH3, lactate, plasma AA, urine organic acids, acylcarnitine profile
- bMRI
> spectroscopy→ glycine peak
> corpus callosum agenesis
- genetic panel

Management
- If persistent szs, treat empiric→ pyridoxine ± pyridoxal-5-phosphate and folinic acid

Infantile spasms

Infantile spasms

Definition
IS is time diagnosis
- Btw 3 to 18 months, peak 6 months
- 50% remission by age 3yo, 90% by age of 5yo

Important
↑risk→ TSC1&2 and down syndrome

Differentials
<3mo→ Ohtahara vs Sandifer
Evaluation
Prompt EEG and treatment delay→ assoc w/ worsens neurodevelopmental outcomes

245. Clinical utility of DaTscan in clinically uncertain parkinsonian syndromes: a systematic review and meta‑analysis

Article type: Literature Review
Article title: Clinical utility of DaTscan in clinically uncertain parkinsonian syndromes: a systematic review and meta‑analysis

Journal: Journal of Clinical Neuroscience
Year: 2026
Authors: Jamir Pitton Rissardo, Jorge Patino, Ana Letícia Fornari-Caprara, and Andrew McGarry

ABSTRACT
Background: Clinically uncertain parkinsonian syndromes (CUPS) pose diagnostic challenges, particularly in distinguishing degenerative from non‑degenerative etiologies. DaTscan (123I-ioflupane SPECT) is frequently used to clarify ambiguity, but the magnitude of its diagnostic impact across different initial clinical suspicions remains unclear. Methods: A systematic review of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library was conducted from January 2002 to February 2026, with no language restrictions. Studies reporting a diagnostic change after DaTscan were included. Two reviewers independently performed screening, data extraction, and quality assessment using ROBINS‑I tool. Proportions were pooled using a random‑effects model with Restricted Maximum Likelihood. Exact Clopper–Pearson intervals were calculated. Results: Seventy‑five observations comprising 2,232 patients were included. The pooled proportion of diagnostic revision was 0.32 (95 % CI 0.26–0.38; I2 = 80 %). Diagnostic changes were most frequent among patients initially suspected of vascular parkinsonism (0.53; 95 % CI 0.37–0.69; I2 = 55 %) and drug‑induced parkinsonism (0.38; 95 % CI 0.28–0.49; I2 = 38 %). Revisions also occurred in cases initially labeled as functional movement disorder (0.35; 95 % CI 0.23–0.49; I2 = 0 %), essential tremor (0.27; 95 % CI 0.18–0.38; I2 = 62 %), and Parkinson’s disease (0.22; 95 % CI 0.17–0.33; I2 = 92 %). Conclusions: DaTscan was associated with diagnostic revision in approximately one‑third of patients with CUPS, with the greatest impact in vascular and drug‑induced parkinsonism. These findings support a role for DaTscan as an adjunct to clinical assessment when diagnostic uncertainty persists.
Keywords: CUPS; Parkinsonism; 123I-Ioflupane; DAT; SPECT.

Full text available at:

DOI

Citation
Rissardo JP, Patino J, Fornari Caprara AL, McGarry A. Clinical utility of DaTscan in clinically uncertain parkinsonian syndromes: a systematic review and meta‑analysis. J Clin Neurosci 2026;154:2026:112305. doi: 10.1016/j.jocn.2026.112305.
Figure 1. PRISMA flowchart for the identification of included studies. Automated database filtering refers to database search and record-management functions used during literature retrieval and duplicate removal. No automated study-screening or eligibility-assessment tools were used; all screening decisions were performed independently by two reviewers.
Figure 2. Quality assessment of all eligible studies based on robvis.
Figure 3. Forest plot of pooled proportions of diagnostic change after DaTscan across primary diagnostic categories. Each point represents the study‑level pooled proportion for a diagnostic category, with horizontal bars denoting corresponding 95 % confidence intervals. The diamond at the bottom represents the overall pooled estimate.
Figure 4. Forest plot of diagnostic change proportions for patients initially suspected of ET. Each point represents the study‑level pooled proportion for diagnostic change, with horizontal bars denoting corresponding 95 % confidence intervals. The diamond at the bottom represents the overall pooled estimate.
Figure 5. Forest plot of diagnostic change proportions for patients initially suspected of PD. Each point represents the study‑level pooled proportion for diagnostic change, with horizontal bars denoting corresponding 95 % confidence intervals. The diamond at the bottom represents the overall pooled estimate.
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