AI-assisted telerehabilitation in early Parkinson’s disease: a multicenter, randomized, multi-arm comparative trial

This exploratory, multicenter, randomized, rater-blinded, multi-arm comparative trial aimed to evaluate the feasibility and exploratory clinical signals of an AI-facilitated telerehabilitation system across different intervention durations in early-stage Parkinson’s disease (PD). One-hundred and twenty PD patients (Hoehn-Yahr stage ≤2.5) were randomized in a 1:1:1 ratio into short-term (1 month), medium-term (2 months), and long-term (3 months) training groups (15–30 min, 5 days/week). The primary outcome was the change in MDS-UPDRS Part III score from baseline to 3 months.

Secondary outcomes included change in cognition, mood, gait parameters, activity of daily living, and safety. Final analysis included 71 participants. No significant differences were observed between groups for the primary motor outcome at 3 months.

Post hoc responder analysis showed that the 3-month group had higher proportions reaching the exploratory cognitive responder threshold compared with the 1-month group. Exploratory correlations between MoCA changes and motor parameter changes were weak and did not remain statistically significant after false discovery rate correction. No falls or adverse events were recorded throughout the trial.

Because the primary endpoint was negative, attrition was high, no usual-care control was included, and the cognitive finding was limited to an exploratory post-hoc responder analysis, these findings do not permit causal inference and should be interpreted as hypothesis-generating, requiring further validation in larger, prespecified multi-arm comparative trials (Chinese Clinical Trial Registry Number: ChiCTR2500108323). The authors want to thank all the participants of this clinical trial and Xiangming Fan’s group (Institute of Software, Chinese Academy of Sciences) for technical assistance. Wen Su and Huimin Chen are funded by National High-Level Hospital Clinical Research Funding (BJ-2023-067 and BJ-2024-183).

Department of Neurology, Beijing Hospital, National Center of Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China Huimin Chen, Huijing Liu, Yueying Liu, Miaoxian Xie, Wenyi Kou, Xinxin Ma, Yunfei Long, Dongdong Wu, Wei Du, Jing He, Shuhua Li, Haibo Chen & Wen Su Parkinson’s Disease Center, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China Department of Neurology, Wenzhou Central Hospital, Wenzhou, Zhejiang, China Department of Neurology, Xinhua Hospital Affiliated to Dalian University, Dalian, Liaoning, China The authors declare no competing interests. Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

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