Adaptango Performance PRocess for Older Adults Community reHabilitation

Satisfaction will be assessed post-intervention only with an Exit Questionnaire balanced for gender and race. Participants will rate (extremely easy/very easy) and their overall satisfaction with the intervention. A higher score indicates better satisfaction.

The Alternate Uses Task (AUT) will be used to assess the patient's creativity by asking them to come up with as many alternate uses for an everyday object as possible in two minutes. Results are measured across four subscales: fluency- the number of alternative uses thought of originality - how unusual the uses given are; flexibility - the range of ideas in different categories; and elaboration-the level of detail given to an idea. Higher values in each subscale indicate higher levels of creativity.

The PDQ-39 is a patient-reported, disease-specific questionnaire used to assess health status and quality of life in Parkinson's disease over the preceding month. It consists of 39 items grouped into 8 distinct dimensions: mobility (10 items), activities of daily living (6 items), emotional well-being (6 items), stigma (4 items), social support (3 items), cognition (4 items), communication (3 items), and bodily discomfort (3 items). Each item is scored on a 5-point Likert scale indicating frequency: 0 (never), 1 (occasionally), 2 (sometimes), 3 (often), and 4 (always or cannot do at all).

The PDQ-39 Summary Index (PDQ-39 SI) is derived by calculating the mean of the 8 dimension scores.

Total index scores range from 0 to 100. Lower scores reflect a better health status/quality of life, while higher scores indicate a greater frequency and severity of health-related difficulties.

The Movement Disorder Society-Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a comprehensive 50-question clinical tool used to evaluate both motor and non-motor symptoms, severity, and progression of Parkinson's disease. Each item is scored from 0 (normal) to 4 (severe), with higher summed subscale scores indicating greater disability.

**Will you be reporting a paticular part of the scale, or are you reporting all? If so, we will need to entere separate parts with their respective scorings**

The number of sit-to-stand maneuvers completed in 30 seconds is used to measure leg strength and endurance. A higher score is better.

Measures the time it takes to rise from a chair, walk 3 meters, turn around, and return to the chair in the simple condition. In the Cognitive condition, one is required to simultaneously count backward by 3s from a number between 20 and 100; in the Manual condition, one is required to simultaneously pick up a cup of water and carry it while completing the task. A lower score is a better outcome.

The time it takes the participants to turn around in a complete circle. Lower times are better.

The number of steps the participant takes to turn around in a complete circle. Lower number of steps is better.

Participants are instructed to stand with one foot directly in front of the other, heel-to-toe, with eyes open and arms at their sides or crossed over the chest. The examiner assists the participant into position and begins timing with a stopwatch once the examiner releases their hand support. Timing is recorded in seconds and ceases if the participant moves their feet, reaches for support, opens their eyes (if an eyes-closed variant), or reaches the ceiling threshold

Mini-BESTest (Mini-Balance Evaluation Systems Test) is a validated, performance-based assessment used to evaluate balance, functional mobility, and fall risk. It includes 14 items across four domains, with each item scored from 0 to 2:

2 = Normal: Completes the task safely, quickly, and independently.

1 = Mild impairment: Completes the task with hesitation, slower movement, uneven weight shifts, or use of an assistive device.

0 = Severe impairment/Unable: Requires physical assistance or cannot complete the task safely.

Total Score Interpretation (0-28):

27-28: Normal balance; no significant deficits. 22-26: Mild balance impairment; monitoring or preventive exercise may be beneficial.

<22: Significant balance impairment, indicating increased balance dysfunction and fall risk.

DGI is an 8-item clinical assessment used to evaluate gait adaptability and balance during functional walking tasks. Each item is scored on a 4-point scale (0-3): 3 = normal performance; 2 = mild impairment; 1 = moderate impairment; 0 = severe impairment or inability to perform independently.

Total scores range from 0 to 24, with higher scores indicating better dynamic balance and mobility.

Scores of 22-24 indicate normal balance and safe ambulation; 19-21 indicate mild instability; scores <19 are associated with increased fall risk in older adults and individuals with neurological conditions.

Gait speed testing (Forward/Backwards/Fast): How quickly a person can walk a specific distance forward and Backwards using a stopwatch. Faster speeds (m/s) are better.

The Four Square Step Test (FSST) is a quick clinical tool used to measure dynamic balance, agility, and the risk of falls by having a person rapidly step over low obstacles-traditionally four canes arranged in a plus-sign configuration on the floor. Because the Four Square Step Test (FSST) is a timed test, it does not use a point-based scale. Instead, performance is measured solely by the number of seconds it takes to complete the pattern. Normal values for the Four Square Step Test (FSST) generally range from under 10 to 15 seconds for healthy adults. A completion time of under 15 seconds indicates a low risk for falls in older adults, while a time of 15 seconds or longer suggests an increased risk for multiple falls.

The MSPSS has 12 items that assess how social support factors are perceived by individuals. This scale has three subscales to evaluate support by family, friends, and significant others. Respondents rate statements on a scale of 1 (very strongly disagree) to 7 (very strongly agree).

Total scores range from 12 to 84, with higher scores being better and indicating an increased perception of social support.

The SF12 evaluates the level of activity and perceived physical and mental quality of life. The SF-12 uses a standardized system with scores ranging from 0 to 100, where the general population's average is 50, with higher scores indicating better health. Because it measures relative deviation, the numbers represent the following health levels:

Above 50: Better than average health. Exactly 50: Average health status. 40 to 50: Below average health (mild disability or impairment). 30 to 40: Moderate disability or impairment. Below 40: Severe impairment or disability.

The Impact on Participation and Autonomy (IPA) instrument will be used to assess the patient's self-perceived freedom and social involvement. Individual items are graded on a 0-4 scale. Subscale scores will be calculated for Autonomy Indoors (0-28), Autonomy Outdoors (0-20), Family Role (0-28), Social Relations (0-28), and Work/Education (0-24). Higher subscale totals directly reflect an increase in perceived limitations and restrictions of participation. A reduction in subscale values indicates a positive clinical response to treatment.