Objective: This work aims to provide real-world evidence for the feasibility of telemedicine in Parkinson’s disease (PD). Adherence data presented pertain to patients paying out of their pocket for a symptom monitoring device, accompanied by a mobile application.

Background: The COVID-19 pandemic is promoting telemedicine. The MDS Telemedicine Study Group recently published a related guide [1]. Physical examination in virtual visits could be further enhanced by using wearable sensors [2]. Most portable medical devices follow the Holter paradigm. Instead, user-friendly devices could be used for continuous patient monitoring, enabling a paradigm shift in PD treatment. However, to ensure the benefits, users need to realize them and be willingly adherent. Studies demonstrate the adherence of wearable devices [3], [4] and mobile apps [5]. However, there is lack of real-world data from using devices in everyday life.

Method: Fifty-two private physicians in Greece instructed 133 patients to wear a device for PD motor symptom telemonitoring for one week per month, during their hours awake. The device consists of wearables for wrists, shanks and torso [Figure 1], and an accompanying mobile app. Patients were also instructed to use the app for medication and nutrition adherence, messages to their physician, and symptom status [Figure 2]. Patients with at least one recording where included and their adherence was measured from the time of their first recording and up to 12 months forward. For each time point (months 1-12) the percentage of patients that have used the device at least once for the last three months was considered. The three months interval was considered a reasonable window to reduce variations.

Results: Throughout the 12 months, the adherence is always above 70% [Figure 3]. Regarding individual mobile app features, medication and nutrition are the most popular features [Table 1], which is important, considering the average patient age is 67 years.

Conclusion: The high adherence percentage is significant, considering the target population and the early stage of telemedicine in Greece. More real-world data are required to evaluate a longer-term adherence and assess the assumption that this new paradigm finally meets expectations of both patients and physicians, in terms of actual clinical outcomes, however, results presented herein, provide preliminary evidence supporting this assumption.

References: [1] Telemedicine in Your Movement Disorders Practice, available at: https://www.movementdisorders.org/MDS/About/Committees–Other-Groups/Telemedicine-in-Your-Movement-Disorders-Practice-A-Step-by-Step-Guide.htm, last accessed on 15 Mar 2022.
[2] Dorsey ER, Venkataraman V, Grana MJ, Bull MT, George BP, Boyd CM, Beck CA, Rajan B, Seidmann A, Biglan KM: Randomized controlled clinical trial of “virtual house calls” for Parkinson disease. JAMA Neurol 2013;70: 565–570.
[3] Cohen, S., Waks, Z., Elm, J.J. et al. Characterizing patient compliance over six months in remote digital trials of Parkinson’s and Huntington disease. BMC Med Inform Decis Mak 18, 138 (2018). https://doi.org/10.1186/s12911-018-0714-7
[4] Botros A, Schütz N, Camenzind M, et al. Long-Term Home-Monitoring Sensor Technology in Patients with Parkinson’s Disease-Acceptance and Adherence. Sensors (Basel). 2019;19(23):5169. Published 2019 Nov 26. doi:10.3390/s19235169
[5] Lakshminarayana, R., Wang, D., Burn, D. et al. Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson’s disease. npj Parkinson’s Disease 3, 2 (2017). https://doi.org/10.1038/s41531-016-0003-z.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-evidence-and-feasibility-of-telemedicine-for-parkinsons-disease/