Current perspectives on the role of telemedicine in the management of Parkinson’s disease

Abstract

Parkinson's disease (PD) is a progressive neurological disorder that primarily affects older adults. The number of patients who receive specialty care continues to be limited, even though the benefits of seeing a movement disorder specialist for management of PD have been well established. Telemedicine has been suggested as a useful tool in addressing the problem of access to specialty care. As evidenced by the literature, it has been suggested that using telemedicine to treat PD is feasible and economically advantageous for both patients and providers. A high level of interest exists on both sides, and a high level of patient and provider satisfaction has been reported. The quality of care provided to patients with PD via telemedicine is comparable to inperson care based on objective measures. Additionally, telemedicine can increase access to care for certain patient populations. The current shortcomings of telemedicine that limit widespread use of the technology include technological barriers, limitations of the virtual exam, limited patient access to technology, weaknesses of current research, ongoing difficulties negotiating reimbursement for virtual visits, and licensing difficulties. We propose an ideal telemedicine system for PD set up as a remote clinic to ensure consistency across patient encounters. This clinic would have adequate support staff to conduct the physical exam, organize patient scheduling and discharge instructions, and coordinate ancillary services for patients including physical therapy, occupational therapy, psychological services, speech and language therapy, and social services. The future of telemedicine for the treatment of PD is promising, but broader research is needed to understand the challenges of patients living with PD. New portable technologies for monitoring symptoms and delivering treatment will continue to change the landscape, but it will still be some time before these technologies can be streamlined into virtual care without the need for in-person assessments and adjustments.

Adopting Virtual Visits for Parkinson's Disease Patients During the COVID-19 Pandemic in a Developing Country

“…The application (Zoom) currently used was easily used by the patients with a short time of setting up; however, delayed audio connection at the time of logging in was a common technical challenge. The current study showed time and cost saving similar to that in previous studies (2,5). Despite less money being saved as compared to that in other studies, due to the depreciation of the local currency and the fact that most patients lived in the same governorate (68.4%), the money saved was substantial for the patients, given their low socioeconomic level.…”

“…This study included ideal aspects of telemedicine, such as easy-to-use technology, combined use of synchronous and asynchronous programs, and previous in-person visits. However, other aspects, such as the use of high-resolution devices, support by technology experts, and high-speed Internet connectivity, were inadequate (2,5).…”

“…The motor examination was conducted during the virtual visit, including finger tapping, hand movements, and leg agility for bradykinesia, tremor assessment (during rest, posture, and action), and arising from chairs and gait, while rigidity and postural instability could not be examined virtually. The feasibility of virtual visits was calculated as the ratio of successful visits to that of the scheduled visits (5,6).…”

“…Several studies have demonstrated the feasibility, timesaving ability, cost-efficiency, high satisfaction level, and comparable outcomes of virtual visits and in-person visits (4)(5)(6)(7). However, these studies have reported major limitations, including incomplete neurological examination, reimbursement of physicians, the inability of older and less educated patients to use it, and technological obstacles, especially those with limited access to optimum Internet services (2).…”

Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease

“…Regular, consistent follow-up visits are possible through telemedicine without the need for the patient to travel and are associated with an increased sense of security and comfort for the patient by allowing him or her to remain at home. 54 Behavioral health follow-up visits, particularly those to ensure medication adherence or discuss medication adjustments, have been successfully conducted virtually. 55 Virtual follow-up visits may also be associated with a lower no-show rate, in relation to in-person follow-up visits.…”