目的：

（1）研究不同H&Y（Hoehn-Yahr）分期老年帕金森病 (Parkinson’s Disease，PD)患者平衡功能障碍、跌倒风险、肌力、异常步态及生活质量现状，并分析运动功能对患者生活质量的影响，为针对性康复训练提供有益指导。

（2）比较基于个体化运动处方指导的治疗师上门康复和APP督导的远程康复对老年PD患者的康复有效性、可行性与安全性，并探索针对老年PD患者居家康复服务的最佳模式。

方法：

（1）研究一为横断面观察性研究，筛选2020年4月至2023年12月在北京协和医院康复医学科门诊就诊的PD患者。分别采用统一帕金森病评定量表第3部分（Unified Parkinson’s Disease Rating Scale Part III，UPDRS-III）、Berg平衡量表（Berg Balance Scale，BBS）、五次起坐试验 （Five Times Sit to Stand Test, FTSST）、计时起立行走试验 （Timed Up& Go Test, TUGT）、可穿戴式步态分析仪、冻结步态问卷 （Freezing of Gait Questionnaire，FOGQ）、下肢等速肌力测试仪评估患者的运动功能。采用39项帕金森病生活质量问卷（The 39-item Parkinson’s Disease Questionnaire，PDQ-39）评估患者的生活质量。所有评估均在药物开期状态下进行。统计并分析不同分期PD患者运动功能与生活质量之间的相关性。

（2）研究二为前瞻性随机对照研究，按照随机分配原则将患者分为远程康复组和上门康复组。远程康复组在APP督导下进行居家康复训练，上门康复组在康复治疗师的上门指导下进行居家康复训练。训练时长为每次40-60分钟，每周5次，持续4周。主要结局指标为UPDRS-III评分，次要结局指标包括BBS、TUGT、FTSST、FOGQ、UPDRS-II、步态、肌肉力量及生活质量。观察并比较两组患者治疗前后组内及组间运动功能与生活质量的变化差异。

结果：

（1）研究一：最终共纳入243例患者，平均年龄为69.33岁。H&Y III期患者的PDQ-39评分与FOGQ相关性较高（r=0.653，p<0.001），H&Y I期（r=0.471，p<0.001）和H&Y II期患者（r=0.386，p<0.001）中两者呈正相关。此外，H&Y III期患者FOGQ与身体活动维度相关性较高（r=0.694，p<0.001），H&Y I期（r=0.431，p<0.001）和H&Y II期（r=0.434，p<0.001）患者中两者呈正相关。H&Y III期患者所有运动功能评分与PDQ-39评分均显著相关（p<0.05）。

（2）研究二：两组患者UPDRS-Ⅲ、BBS、TUGT、FTSST、FOGQ、步长、步速、足离地角度、UPDRS-Ⅱ和PDQ-39治疗前、后组内差异均有统计学意义。年长老年人组中上门康复组UPDRS-Ⅲ评分的改善幅度（-3.38±5.33分）显著大于远程康复组（-1.45±3.05分）（P=0.021），但年轻老年人组两组间UPDRS-Ⅲ评分变化没有显著的组间差异（P=0.416）。在BBS、TUGT、步速、膝关节伸展平均力矩及总功中观察到相同变化。上门康复组和远程康复组分别各有7例（7%）患者和12例（13%）患者未完成日常康复训练计划。

结论：

（1）研究一：早中期PD患者的运动功能与生活质量相关，其中步态是主要因素，尤其影响患者身体活动、日常生活行为和交流功能。不同疾病分期患者的生活质量受运动功能的影响不同，其中H&Y III期患者的运动功能与生活质量及其多个维度显著相关。

（2）研究二：上门康复和远程康复在PD患者中是有效且安全可行的。然而，与远程康复相比，上门康复在年老患者中表现出更高的有效性和患者依从性。

Objective:

(1) To investigate the characteristics of balance dysfunction, fall risk, muscle strength, abnormal gait, and quality of life in elderly Parkinson's Disease (PD) patients at different Hoehn-Yahr (H&Y) stages, and the association between motor function and quality of life, to provide effective guidance for targeted rehabilitation training.

(2) To compare the differences of effectiveness, feasibility and safety between home physical therapy guided by therapists and telerehabilitation supervised via an APP with individualized exercise prescriptions in elderly PD patients, and to explore the optimal home-based rehabilitation service for elderly PD patients.

Methods:

(1) Study 1 is a cross-sectional observational study, recruiting PD patients who visited the Department of Rehabilitation Medicine at Peking Union Medical College Hospital from April 2020 to December 2023. The motor functions of the patients were assessed using the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III), Berg Balance Scale (BBS), Five Times Sit to Stand Test (FTSST), Timed Up and Go Test (TUGT), Freezing of Gait Questionnaire (FOGQ), wearable gait analyzer, and lower limb isokinetic muscle strength tester. The quality of life of the patients was evaluated using the 39-item Parkinson’s Disease Questionnaire (PDQ-39). All assessments were conducted during the medication “on” state. The correlation between motor function and quality of life in PD patients at different stages was statistically analyzed.

(2) Study 2 is a prospective randomized controlled trial, in which patients were randomly assigned to either a home physical therapy (HPT) group or a telerehabilitation (TR) group. Both groups underwent rehabilitation training sessions lasting 40-60 minutes each, five times per week, for a duration of four weeks. The TR group conducted their home-based training under the supervision of an APP, while the HPT group received guidance from a physiotherapist. The primary outcome measure was UPDRS-III score. Secondary outcome measures included the BBS, TUGT, FTSST, FOGQ, UPDRS-II, gait, muscle strength, and quality of life. Changes within each group before and after treatment, as well as differences between the two groups, were observed and compared.

Results:

(1) Study 1: A total of 243 patients with a mean age of 69.33 years were finally included. PDQ-39 scores correlated higher with FOGQ in H&Y stage III patients (r = 0.653, p < 0.001), and positively correlated with FOGQ in H&Y stage I (r = 0.471, p < 0.001) and H&Y stage II patients (r = 0.386, p < 0.001). In addition, the FOGQ correlated more with mobility domain in H&Y stage III patients (r = 0.694, p < 0.001), and both were positively correlated in H&Y stage I (r = 0.431, p < 0.001) and H&Y stage II (r = 0.434, p < 0.001) patients. All motor function scores correlated with PDQ-39 scores in H&Y stage III patients (p<0.05).

(2) Study 2: There were statistically significant within-group differences in UPDRS-III, BBS, TUGT, FTSST, FOGQ, step length, step speed, pre-swing angle, UPDRS-II, and PDQ-39 before and after treatment in both groups. The decrease in the UPDRS-Ⅲ score was significantly greater in the HPT group (-3.38±5.33 points) than in the TR group (-1.45±3.05 points) in the older age group (P = 0.021), but there was no significant between-group difference in the younger age group (P = 0.416). Similar changes favoring the HPT group were observed in the BBS, TUGT, step velocity, and extension average torque. 7 (7%) patients in the HPT group and 12 (13%) patients in the TR group did not complete their daily exercise plan.

Conclusion:

(1) Study 1: Motor function correlated with quality of life in early to mid-stage PD patients, and gait was the main factor, especially affecting mobility, activities of daily life and communication. Quality of life in patients at different disease stages were variously affected by motor function, and multiple dimensions were significantly associated with motor function in patients at H&Y stage III.

(2) Study 2: Both HPT and TR have demonstrated significant effectiveness, safety, and feasibility in the management of PD Patients. However, the HPT program exhibited greater effectiveness among older patients and higher patient compliance compared to TR.