Advantages and Difficulties of Telemedicine in Parkinson’s Analyzed in Review Study

Telemedicine has the potential to become a critical component of healthcare in people with Parkinson’s disease, but larger studies are required to determine its role, a review study contends.

The study, “Current perspectives on the role of telemedicine in the management of Parkinson’s disease,” was published in the journal Smart Homecare Technology and TeleHealth.

While it has been established that Parkinson’s patients benefit significantly from specialty care, the number of patients who receive this type of care is still limited, and people in rural areas or in developing countries face even greater challenges to access it.

Telemedicine offers advanced clinical resources and expertise to patients who otherwise would not have access to specialized care. It allows healthcare professionals to evaluate, diagnose, treat, and follow patients at a distance using telecommunications technology.

While it may not be the most appropriate method to make an initial diagnosis of Parkinson’s disease, several studies have suggested that telemedicine is as effective as — and more convenient and economically advantageous than — in-person follow-up visits, for both patients and healthcare providers.

Researchers now have evaluated the advantages and constraints of telemedicine in Parkinson’s disease management in the U.S. after the establishment of a patient-provider relationship and a definitive diagnosis through an in-person appointment.

After an extensive search of published studies, researchers identified and further analyzed 13 suitable studies (conducted between 2006 and 2017) that focused on video conference, also known as virtual visits, as a form of telemedicine.

Ask questions and share your knowledge of Parkinson’s Disease in our forums.

The team found that telemedicine has several advantages in Parkinson’s management, both in an at-home and nursing home setting.

Telemedicine has elevated feasibility — more than 90 percent of telemedicine visits were found to be completed as scheduled — saves time and money, and shows high satisfaction among Parkinson’s patients and healthcare providers (more than 85 percent of those participating were satisfied).

Also, patient satisfaction increased over time, suggesting that as technology advances, less technical problems are occurring in virtual visits.

The researchers noted that a modified version of the Unified Parkinson’s Disease Rating Scale (UPDRS) — a valid measure of disease severity — was developed to simplify virtual assessment of disease status, and to exclude the need of hands-on assessment, which may improve virtual assessment.

Notably, patients followed-up with telemedicine showed similar clinical improvements to those followed-up with in-person appointments, suggesting that “treatment outcomes for telemedicine, based on improvement in motor functioning, are objectively as good as they are for in-person care,” researchers said.

However, they noted that current published studies have some limitations, and that there is an urgent need for larger and long-term studies involving patients of all races and educational status, and with more severe disability.

The widespread use of telemedicine is limited by technological barriers, as patients with no access to high-speed internet or who live too far from centers with that technology, are unable to get this type of care. Also, some studies have suggested that current video conferencing quality may not allow clinicians to effectively access subtle motor dysfunctions.

“It remains unclear whether the home assessment is more accurate because it reflects a patient’s natural environment, or if an office assessment is more accurate because clinicians can see the patients more clearly,” the team wrote.

Bureaucracy- and legal-related issues, such as difficulties in negotiating reimbursement for virtual visits with insurance companies and in medical licensing throughout the U.S., also are two major barriers for telemedicine visits.

The authors believe that an ideal telemedicine program should be based on the development of a remote clinic with the resources to have reliable video conferencing.

Although telemedicine will not replace the traditional “hands-on” examination, “we are closer than ever to making virtual visit assessment as good as in-person examination with wider access to care, increased convenience for patients, and seamless communication between members of the treatment team,” they concluded.