Feasibility and utility of a clinician dashboard from wearable and mobile application Parkinson’s disease data

Abstract

Mobile and wearable device-captured data have the potential to inform Parkinson’s disease (PD) care. The objective of the Clinician Input Study was to assess the feasibility and clinical utility of data obtained using a mobile health technology from PD patients. In this observational, exploratory study, PD participants wore a smartwatch and used the Fox Wearable Companion mobile phone app to stream movement data and report symptom severity and medication intake for 6 months. Data were analyzed using the Intel® Pharma Analytics Platform. Clinicians reviewed participants’ data in a dashboard during in-office visits at 2 weeks, 1, 3, and 6 months. Clinicians provided feedback in focus groups leading to dashboard updates. Between June and August 2017, 51 PD patients were recruited at four US sites, and 39 (76%) completed the 6-month study. Patients streamed 83,432 h of movement data from their smartwatches (91% of expected). Reporting of symptoms and medication intake using the app was lower than expected, 44% and 60%, respectively, but did not differ according to baseline characteristics. Clinicians’ feedback resulted in ten updates to the dashboard during the study period. Clinicians reported that medications and patient reported outcomes were generally discernable in the dashboard and complementary to clinical assessments. Movement, symptoms, and medication intake data were feasibly translated from the app into a clinician dashboard but there was substantial attrition rate over 6 months. Further enhancements are needed to ensure long-term patient adherence to portable technologies and optimal digital data transfer to clinicians caring for PD patients.

Feasibility and Utility of mHealth for the Remote Monitoring of Parkinson Disease: Ancillary Study of the PD_manager Randomized Controlled Trial

“…The high level of system use and compliance of these more affected patients, as in previous studies, can be linked to factors including the simple and passive design of the patient’s app, which was basically providing a series of reminders for short motor and nonmotor tasks, the insight in the condition that the patients and their caregivers expect as a result of using the system, and the fact that the technology is considered an extension of prescribing clinicians and thus very important for better care. PD_manager was used as a PD Holter (ie, in a similar context as sensors used in recent studies [ 8 , 10 , 13 ]), and this complements the findings from previous research [ 3 - 5 , 9 ] that suggests that mHealth systems could be used both for short (1-2 weeks) and long-term (6 months) monitoring of PD patients.…”

“…It is aligned with the findings that there are no noteworthy variances in baseline characteristics (age, gender, education, disease duration, and severity) that can explain compliance even in larger studies [ 4 ]. Findings such as highest compliance of older participants in one study [ 9 ], which can be attributed to more severe disease status and increased need for better management, and a negative impact of patients’ and caregivers’ education in this study, which can be the result of the lack of direct feedback from the system leading to limited self-management value, are worthy of further exploration.…”

“…By including patients with moderate disease severity (H&Y of 3) and by exploring the determinants of their compliance, PD_manager complements most prior studies that recruited mostly patients mildly affected (H&Y of 2 or less) [ 4 , 9 - 11 , 13 ]. The high level of system use and compliance of these more affected patients, as in previous studies, can be linked to factors including the simple and passive design of the patient’s app, which was basically providing a series of reminders for short motor and nonmotor tasks, the insight in the condition that the patients and their caregivers expect as a result of using the system, and the fact that the technology is considered an extension of prescribing clinicians and thus very important for better care.…”

Digital Technology in Movement Disorders: Updates, Applications, and Challenges

“…In one study, a wrist-worn device was used by 63 individuals with PD and provided useful information to guide treatment plans for 50 (79%) of these individuals [ 62 ]. In another study, a smartwatch was paired with a smartphone application, and clinicians were involved in the iterative development of a clinician dashboard that could be used to inform changes in management [ 63 ]. Clinicians rated medication adherence and patient-reported outcomes as the most informative and sensor-derived measures as the least informative.…”

“…Nearly 10,000 participants participated in the original mPower application study and consented to broad sharing of their data; however, fewer than 10% contributed data on a minimum of 5 days over a 6-month period [ 9 ]. Similarly, in a study pairing a smartphone with a smartwatch, use declined steadily over the 6-month study period, and nearly a quarter of participants failed to complete the study [ 63 ]. Specifically, medication reporting declined by 34%, symptom reporting by 44%, and smartwatch streaming by 53% [ 106 ].…”