At-home music based movement training on mood and wellbeing in people with Parkinson’s disease

INTERVENTION: Participants will engage in a set of exercises aimed at enhancing mobility, posture and balance, as well as overground walking. Each participant will engage in 30 minutes per session, 3 times per week for 6 weeks, and for the rest of the days, they will be asked to perform a subset of the same exercises and walk with rhythmic auditory stimulation (RAS).During the training session, they will be guided virtually by a physiotherapist to focus on the beats while performing activities and while walking to match their heel strike with the auditory beats.Each training session will begin with seated warm‐up activities followed by a set of exercises in sitting, standing and walking.• Seated warm up‐ heel taps, knee lifts and clapping in time with the beat. • Standing: march on spot, forward stepping, backward stepping, gradually add arm movements • Balance: tandem stance, sit to stand, stepping sideways • Overground walking: walking with RAS for about 15 minutes of the whole session. Adherence will also be encouraged through weekly calls. m‐Path application The m‐Path software application (www.mPath.oi) will be used to collect electronic responses from both the intervention and the control group. m‐Path is a free online application that participants can download on their smartphones. Participants will be explained by the project coordinator over a phone call on how to download and use this application. Participants will create an account, which will be linked to the primary researcher, to be able to receive the questions. Participants in the RAS plus usual care group will use this application to log the prescribed training exercises and any adverse events. Participants will be carefully explained what comprises logging exercises and adverse events, so t CONDITION: Neurological ‐ Parkinson's disease Parkinson’s disease; ; Parkinson’s disease Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: (2) adherence to the intervention:[(2) Adherence: adherence will be assessed as the number of sessions attended by the participants and expressed as a percentage of the total number of sessions and the analysis of the activity log from m‐Path application T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] (3) Adverse events [(3) adverse events: this will be recorded as a percentage of participants reporting any unintended event or complications caused by the intervention T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] The primary outcome measure of this trial is to assess feasibility. Feasibility Feasibility will be evaluated through review of study records at the end of the study (week 13) using the following indicators (1) participant recruitment rate;[ (1) participant recruitment rate: This will be measured by the number of participants recruited per month in relation to the recruitment advertisement, using enrollment log diary T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] INCLUSION CRITERIA: Participants will be included with (a) age of 18 years and above, (b) self‐reported idiopathic Parkinson’s disease, (c) community‐dwelling (at home), (c) mild to moderate disease severity (Modified Hoehn and Yahr stage I‐III), (d) ability to walk independently without physical assistance or an assistive device for at least 30 metres and stand without support for more than a minute,(e) patients on their regular dopamine medications, (f) has access to smartphone with high speed internet and being familiar with or have a support person familiar with mobile technology. SECONDARY OUTCOME: (4) attrition rate (this is a primary outcome measure)[(4) attrition rate: proportion of participants who withdraw from the study prior to its completion, by analysing the enrollment log diary T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] (5) retention rate (this is a primary outcome measure)[(5)retention rate: recorded as the percentage of participants who completes the trial and the outcome measures, analysis will be done from studying the activity log from m‐Path application T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Anxiety(non‐motor outcome measure)[Parkinson Anxiety Scale(PAS): A 12‐item self‐reported scale with three subscales, for assessing persistent anxiety, episodic anxiety and avoidance behaviour T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Balance and mobility(motor outcome measure)[Timed‐Up and Go Test (TUG): This test measures a participant’s time to stand up from the chair and walk at a normal pace over 3 metres, turn, walk back and sit down. It is used to assess mobility, balance and falls risk. For the remote administration of this test, a string with a pre‐determined length of 3 metres will be sent to the participants with plastic cups to mark the beginning and end of the walking distance. This remote administration of the TUG test has been used in a previous study, with reliability and feasibility shown in people with Parkinson’s disease. T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Cognition(non‐motor outcome measure)[Telephonic Montreal Cognitive Assessment (T‐MoCA): This assessment will be conducted via phone call. T‐MoCA is an adapted version of the MoCA designed for remote delivery as a rapid screening instrument for mild cognitive impairment T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Depression(non‐motor outcome measure)[Geriatric Depression Scale: A 15‐item self‐reported scale, selected due to its minimal focus on motor and somatic symptoms and due to its strong psychometric properties. T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Fatigue(non‐motor outcome measure)[Fatigue Severity Scale: A nine‐item questionnaire to assess the impact of fatigue on daily functioning, with each item rated from 1 (“completely disagree”) to 7 (“completely agree”) T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Motor symptoms (motor outcome measure)[Modified‐Unified Parkinson’s Disease Rating Scale (MDS‐UPDRS): A composite score of motor components (Part II: self‐reported motor experiences of daily living and Part IV: researcher‐rated assessment of motor complications) T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Non‐motor aspects of daily living (non‐motor outcome measure)[Modified‐Unified Parkinson’s Disease Rating Scale (MDS‐UPDRS): Non‐motor aspects of experiences of daily living (nM‐EDL) Part 1A and B, which assesses the non‐motor impact of PD on patients’ experiences of daily living T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Pain(non‐motor outcome measure)[King’s Parkinson’s Disease Pain Questionnaire(KPPQ): A 14‐item questionnaire assessing different types of pain, with items scored using a dichotomous (“yes” or “no”) format T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ] Sleep(non‐motor outcome measure)[Parkinson’s disease sleep scale 2(PDSS‐2): A 15‐item self‐reported scale that assesses sleep over the past week, with each item scored from 0(“never”) to 4 (“very often”), and with a maximum score of 60 T1(baseline), T2 (week 7) post intervention, and T3 (week 12) follow‐up ]