Telehealth, Wearable Sensors Show Life Quality Gains in Small Study
Telehealth, together with wearable sensors that accurately monitor symptoms like tremor, may help to improve quality of life for people with Parkinson’s disease, a small, single-center study suggests.
Patients in the study also expressed comfort with online health checkups and the sensory device used, but many still preferred in-person care.
Study findings were in “Tailoring the use of wearable systems and telehealth for Parkinson’s disease,” published as a “correspondence” in the journal Parkinsonism & Related Disorders.
Wearable health technologies and telehealth have revolutionized the way people take care of their health, partly by monitoring and improving their exercise habits, sleep patterns, heart rhythms, as well as calories consumed.
Both approaches may help in monitoring Parkinson’s disease, especially during periods of limited medical services, resulting from restrictions on personal contact due to the COVID-19 pandemic or because patients live in remote areas.
A team led by researchers at the University of British Columbia (UBC), Southern Medical Program in Canada investigated the use of wearable health technologies and telehealth to monitor and support people with Parkinson’s disease.
The study involved a single center at UBC Okanagan, serving 1,875 Parkinson’s patients spread over an area of 215,000 square kilometers (about 83,000 square miles).
“Even prior to the pandemic, telehealth helped deliver specialized care to patients living in remote and rural settings,” Daryl Wile, MD, a movement disorder specialist, clinical investigator at the UBC program and the study’s lead author, said in a press release.
“But with the complex nature of Parkinson’s, we wanted to enhance these appointments to better understand how movements vary throughout a patient’s entire day,” he added.
Researchers identified a group of Parkinson’s patients with tremors or involuntary muscle movements (dyskinesia). Enrollment was conducted between May 2019 and March 2020. As the study was suspended during the COVID-19 pandemic, only 25 patients (mean age 70 years, 52% women) were included in the final analysis.
Participants were randomly assigned, by sealed envelope, to either usual in-person appointments (12 patients) or telehealth follow-up (13 patients) using the Kinesia 360 motor monitoring system. This system is based on sensors, worn on the wrist and ankle, along with a mobile application that continuously records data on tremor, slowness, dyskinesia, and mobility during waking hours.
Data is reviewed during telehealth appointments to identify peak times at which patients experience symptoms.
Those with in-person appointments were instructed to keep a record of their symptoms.
All study patients were assessed by a neurologist at its start (setting baseline measures), and again after six weeks, and at three and six months.
The main (primary) goal was changes in quality of life, as measured by the Parkinson’s Disease Quality of Life-39 summary index (PDQ-39 SI), with scores ranging from 0 to 100. Higher scores indicate a poorer quality of life.
At baseline, the PDQ-39 SI scores were comparable between both groups: a mean score of 29 for the telehealth and 25 for the in-person group.
Compared with the study’s start, PDQ-39 SI scores fell (indicating better quality of life) by a mean of 4.7 points in the telehealth group, while they worsened in the standard in-person group, as shown by an increase of 0.9 points.
“With the integration of accurate and reliable data from wearable devices, we were able to tailor a patient’s medication to better manage their symptoms throughout the day,” Wile said.
In a post-study survey, a mean of 54% of the patients in the telehealth group said they felt comfortable or very comfortable wearing the sensors.
Furthermore, 85% of telehealth patients expressed being comfortable or very comfortable speaking with their doctor virtually.
“There’s definitely a strong case to leverage multiple technologies to improve a patient’s quality of life and limit the added stress and cost associated with travel,” said Joshua Yoneda, the study’s co-author.
Still, 46% of these telehealth patients also said they would prefer to switch to in-person clinical follow-ups. A majority, 67%, of those with in-person visits said they wouldn’t switch to telehealth monitoring.
“From our patient responses we see value in further having participants cross over between face to face and telehealth modalities,” the researchers wrote.
“An individualized approach to selecting patients for telemedicine might consider the socioeconomic benefit of remote access to care, public health and safety concerns, and the patient’s comfort and familiarity with the required technology,” they added.