Objective: This pilot study was designed to use Objective Measurement (OM) of symptoms of Parkinson’s Disease (PD) to identifying the proportion of people with PD in a community who could benefit from a change in therapy and to measure the benefit obtained from optimising therapy using OM.

Background: It is common practice in medicine to titrate therapy according to target ranges of objectively measured parameters. OM of motor function is now available for routine clinical care in PD. For it to be beneficial in guiding therapy, there must be evidence that decisions made with guidance from OM leads to better outcomes. Implicit also is the notion that there are specific values from these measurements that indicate whether control of symptoms is already optimal or requires therapeutic change to improve outcomes. This study was designed as a pilot to design a formal comparison of current standard of care with that guided by objective measurement.

Methods: OM was provided by the Parkinsons Kinetigraph (PKG: Global Kinetics CorporationTM, Australia) and target ranges that separate “controlled” PD symptoms from “uncontrolled” PD symptoms were established by consensus of a panel of four neurologists experienced in treating PD and interpreting the PKG prior to commencing the study1. The population of Northern Tasmania is circumscribed and most PD subjects in the region are managed by one Movement Disorder clinic. Approximately 40% (n=103) of this clinic agreed to participated in this study.

Results: The PKG motor scores of 78% of participants were outside the target for optimum control and changes in oral therapy were recommended in 74%, Advanced Therapy in 12% and treatment was contraindicated in 9%. Changes in oral therapy, were followed by further OM and clinical consultation to establish whether scores had reached target range: if so subjects left the study, otherwise further changes of therapy were recommended (unless contraindications were present). At the end of the study, 48% were in target (22% at outset and a further 26% by treatment change and not including those referred for advanced Therapy- 19%). Advanced Therapy had not previously been discussed in these subjects. Contraindications prevented therapy change in 17%. In those in whom oral therapy was changed, total UPDRS and PDQ39 improved (effect size =8 and 10 respectively. MOCA scores also improved significantly.

Conclusions: This study suggests that many people in a representative cohort of PD would benefit from objective assessment and treatment of their PD features against a target. It provides support for a formal comparison of current standard of care with that guided by OM.

References: 1. Farzanehfar, P., Braybrook, M., Kotschet, K. & Horne, M. Objective Measurement in Clinical Care of Patients with Parkinson’s disease: an RCT using the PKG. 20th International Congress of Parkinson Disease and Movement Disorders. Berlin, Germany (2016).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/objective-measurement-in-routine-care-of-people-with-parkinsons-disease-improves-outcomes/