Feasibility and usability of a digital health technology system to monitor mobility and assess medication adherence in mild-to-moderate Parkinson's disease

Collection of the digital data from the neurological examination

This review presents the status quo of how far the digitalization of elements of the neurological examination has progressed. Our focus was on studies that assessed the examination conducted in person, rather than through telemedicine platforms. Five hundred and twenty studies were included in this systematic review. The digital tools covered ten elements of the neurological examination: gait (173, 33%), motor system (149, 29%), eyes (85, 16%), cognitive functions (53, 10%), sensory system (47, 9%), balance (35, 7%), other movements (24, 5%), other cranial nerves (24, 5%), coordination (10, 2%), and autonomic nervous system (9, 2%). Most of the tools were portable (442, 85%), and in 215 studies (41%) the devices were wearable. The cost of the digital tools used was described and discussed in 167 (32%) studies. Most devices (61%) had a low complexity, and half required high additional analytic effort.

The experience and perception of wearable devices in Parkinson's disease patients: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder, affecting over 8.5 million people worldwide, with symptoms that severely impact patients' quality of life. While treatments like levodopa and deep brain stimulation help manage symptoms, they require frequent adjustments and have limitations. Wearable devices offer real-time monitoring of motor and non-motor symptoms, enabling personalized treatment, but challenges related to comfort, usability, and patient adherence hinder their widespread adoption. Many individuals with PD experience discomfort, emotional distress, or interface difficulties, reducing long-term adherence. This study synthesizes qualitative research on patients' experiences with wearables to identify key usability barriers and improve device design for better clinical integration.

METHODS

Following the Joanna Briggs Institute methodology for qualitative systematic reviews, we searched PubMed, Web of Science, Embase, Cochrane Library, CINAHL, CNKI, WanFang, and VIP databases up to March 3, 2025. Additional gray literature and reference lists were examined manually. Included qualitative studies underwent comprehensive assessment, integration, and analysis.

RESULTS

Nine studies were included, identifying four main themes and eleven sub-themes. The four primary themes were physiological experience, psychological Responses, social Interaction, and Expectation.

CONCLUSION

This meta-synthesis reveals the dual role of wearable devices in managing Parkinson's disease, improving patient autonomy and disease control while presenting challenges in comfort, reliability, and emotional well-being. The findings emphasize the need for personalized, context-sensitive devices that adapt to fluctuating PD symptoms, address privacy concerns, and seamlessly integrate into clinical practice to improve clinical outcomes and patient adherence.

Modernizing the Staging of Parkinson Disease Using Digital Health Technology

Due to the complicated nature of Parkinson disease (PD), a number of subjective considerations (eg, staging schemes, clinical assessment tools, or questionnaires) on how best to assess clinical deficits and monitor clinical progression have been published; however, none of these considerations include a comprehensive, objective assessment of all functional areas of neurocognition affected by PD (eg, motor, memory, speech, language, executive function, autonomic function, sensory function, behavior, and sleep). This paper highlights the increasing use of digital health technology (eg, smartphones, tablets, and wearable devices) for the classification, staging, and monitoring of PD. Furthermore, this Viewpoint proposes a foundation for a new staging schema that builds from multiple clinically implemented scales (eg, Hoehn and Yahr Scale and Berg Balance Scale) for ease and homogeneity, while also implementing digital health technology to expand current staging protocols. This proposed staging system foundation aims to provide an objective, symptom-specific assessment of all functional areas of neurocognition via inherent device capabilities (eg, device sensors and human-device interactions). As individuals with PD may manifest different symptoms at different times across the spectrum of neurocognition, the modernization of assessments that include objective, symptom-specific monitoring is imperative for providing personalized medicine and maintaining individual quality of life.

Robot-assisted exercise improves gait and physical function in older adults: a usability study

BACKGROUND

With increasing age, individuals are more likely to experience physical disabilities, functional declines, and mobility limitations. Wearable robots or exoskeletons are relatively new technologies that can help address these issues, reduce healthcare costs, and support home healthcare, decreasing the burden of chronic disease. The purpose of this study was to investigate the usability of Bot Fit after task-specific physical activities and functional gait training, as well as to examine the effects of a wearable hip exoskeleton, Bot Fit, on gait, physical function, and muscle strength in older adults living in residential care facilities.

METHODS

A total of 32 older adults living in residential care facilities were included in this uncontrolled study. All participants performed eight weeks of task-specific physical activities and functional gait training using Bot Fit, with three exercise sessions per week (24 sessions in total). They were assessed at three time points: pre-test (baseline, T0), mid-test (after the 12 exercise sessions, T1), and post-test (after the last exercise session, T2). Each assessment evaluated functional outcomes (10-m walk test [10MWT], timed up-and-go [TUG], 6-min walk test [6MWT], Berg balance scale [BBS], four-square step test [FSST], and geriatric depression scale-short form [GDS-SF]), as well as muscle strength of the lower extremities. After the post-test, the participants completed a questionnaire to evaluate Bot Fit usability.

RESULTS

A significant improvement was observed in all physical assessments, including the 10MWT, TUG, 6MWT, BBS, and FSST, from T0 to T2. It is noteworthy that 10MWT, TUG, and BBS also changed significantly from T0 to T1 and from T1 to T2. Muscle strength in hip flexion, hip extension, knee flexion, knee extension, ankle dorsiflexion, and ankle plantar flexion all improved significantly from T0 to T2, with knee flexion, knee extension, ankle dorsiflexion, and ankle plantar flexion showing significant improvements at all time points. Additionally, on the usability questionnaire, most participants provided positive feedback about their experience with Bot Fit.

CONCLUSION

The findings of this study suggest that task-specific physical activity and functional gait training with Bot Fit have several key advantages for improving gait, physical function, and muscle strength in older adults living in residential care facilities. The findings support the application of Bot Fit to physical activity and functional gait training to improve age-related declines in physical function and muscle strength and to provide important insights into future robot-assisted exercise devices.

TRIAL REGISTRATION

URL: https://register.

CLINICALTRIALS

gov/ . Unique identifier: NCT04610190 (10/26/2020).

SimulatorOrchestrator: A 6G-Ready Simulator for the Cell-Free/Osmotic Infrastructure

To the best of our knowledge, we offer the first IoT-Osmotic simulator supporting 6G and Cloud infrastructures, leveraging the similarities in Software-Defined Wide Area Network (SD-WAN) architectures when used in Osmotic architectures and User-Centric Cell-Free mMIMO (massive multiple-input multiple-output) architectures. Our simulator acts as a simulator orchestrator, supporting the interaction with a patient digital twin generating patient healthcare data (vital signs and emergency alerts) and a VANET simulator (SUMO), both leading to IoT data streams towards the cloud through pre-initiated MQTT protocols. This contextualises our approach within the healthcare domain while showcasing the possibility of orchestrating different simulators at the same time. The combined provision of these two aspects, joined with the addition of a ring network connecting all the first-mile edge nodes (i.e., access points), enables the definition of new packet routing algorithms, streamlining previous solutions from SD-WAN architectures, thus showing the benefit of 6G architectures in achieving better network load balancing, as well as showcasing the limitations of previous approaches. The simulated 6G architecture, combined with the optimal routing algorithm and MEL (Microelements software components) allocation policy, was able to reduce the time required to route all communications from IoT devices to the cloud by up to 50.4% compared to analogous routing algorithms used within 5G architectures.

Addressing the need for standardization of symptomatic medication documentation in Parkinson's disease clinical research: A call to action

People with Parkinson's disease (PD) are prescribed a variety of medications to mitigate symptoms and improve their quality of life. These symptomatic therapies cover a range of pharmacological classes, including classical dopaminergic treatments, other antiparkinsonian agents, and pharmacotherapies for non-PD conditions. Often, medications are prescribed for concomitant use and in increasing doses, particularly as the disease progresses. Documentation of these interventions in clinical trials is necessary to accurately capture medication usage, compare medication utilization across different studies, understand factors contributing to experimental therapeutic response, and analyze clinical trial data in a precise manner. At the present time, there is no current international standard for how these medications are documented within clinical trials. As a case example, we will highlight medication use documentation in a large international multicenter observational study commonly used as a reference for design of clinical trials. This review aims to raise awareness within the scientific community of the importance of proper medication documentation and the need for standardization to harmonize prescriptive practices, improve treatment interpretability, and perform consistently robust analyses from clinical trials data.

Movement Disorders and Smart Wrist Devices: A Comprehensive Study

In the medical field, there are several very different movement disorders, such as tremors, Parkinson's disease, or Huntington's disease. A wide range of motor and non-motor symptoms characterizes them. It is evident that in the modern era, the use of smart wrist devices, such as smartwatches, wristbands, and smart bracelets is spreading among all categories of people. This diffusion is justified by the limited costs, ease of use, and less invasiveness (and consequently greater acceptability) than other types of sensors used for health status monitoring. This systematic review aims to synthesize research studies using smart wrist devices for a specific class of movement disorders. Following PRISMA-S guidelines, 130 studies were selected and analyzed. For each selected study, information is provided relating to the smartwatch/wristband/bracelet model used (whether it is commercial or not), the number of end-users involved in the experimentation stage, and finally the characteristics of the benchmark dataset possibly used for testing. Moreover, some articles also reported the type of raw data extracted from the smart wrist device, the implemented designed algorithmic pipeline, and the data classification methodology. It turned out that most of the studies have been published in the last ten years, showing a growing interest in the scientific community. The selected articles mainly investigate the relationship between smart wrist devices and Parkinson's disease. Epilepsy and seizure detection are also research topics of interest, while there are few papers analyzing gait disorders, Huntington's Disease, ataxia, or Tourette Syndrome. However, the results of this review highlight the difficulties still present in the use of the smartwatch/wristband/bracelet for the identified categories of movement disorders, despite the advantages these technologies could bring in the dissemination of low-cost solutions usable directly within living environments and without the need for caregivers or medical personnel.

Exploring the Effect of Sampling Frequency on Real-World Mobility, Sedentary Behaviour, Physical Activity and Sleep Outcomes Measured with Wearable Devices in Rheumatoid Arthritis: Feasibility, Usability and Practical Considerations

Modern treat-to-target management of rheumatoid arthritis (RA) involves titration of drug therapy to achieve remission, requiring close monitoring of disease activity through frequent clinical assessments. Accelerometry offers a novel method for continuous remote monitoring of RA activity by capturing fluctuations in mobility, sedentary behaviours, physical activity and sleep patterns over prolonged periods without the expense, inconvenience and environmental impact of extra hospital visits. We aimed to (a) assess the feasibility, usability and acceptability of wearable devices in patients with active RA; (b) investigate the multivariate relationships within the dataset; and (c) explore the robustness of accelerometry outcomes to downsampling to facilitate future prolonged monitoring. Eleven people with active RA newly starting an arthritis drug completed clinical assessments at 4-week intervals for 12 weeks. Participants wore an Axivity AX6 wrist device (sampling frequency 100 Hz) for 7 days after each clinical assessment. Measures of macro gait (volume, pattern and variability), micro gait (pace, rhythm, variability, asymmetry and postural control of walking), sedentary behaviour (standing, sitting and lying) and physical activity (moderate to vigorous physical activity [MVPA], sustained inactive bouts [SIBs]) and sleep outcomes (sleep duration, wake up after sleep onset, number of awakenings) were recorded. Feasibility, usability and acceptability of wearable devices were assessed using Rabinovich's questionnaire, principal component (PC) analysis was used to investigate the multivariate relationships within the dataset, and Bland-Altman plots (bias and Limits of Agreement) and Intraclass Correlation Coefficient (ICC) were used to test the robustness of outcomes sampled at 100 Hz versus downsampled at 50 Hz and 25 Hz. Wearable devices obtained high feasibility, usability and acceptability scores among participants. Macro gait outcomes and MVPA (first PC) and micro gait outcomes and number of SIBs (second PC) exhibited the strongest loadings, with these first two PCs accounting for 40% of the variance of the dataset. Furthermore, these device metrics were robust to downsampling, showing good to excellent agreements (ICC ≥ 0.75). We identified two main domains of mobility, physical activity and sleep outcomes of people with RA: micro gait outcomes plus MVPA and micro gait outcomes plus number of SIBs. Combined with the high usability and acceptability of wearable devices and the robustness of outcomes to downsampling, our real-world data supports the feasibility of accelerometry for prolonged remote monitoring of RA disease activity.

Evaluation of motor fluctuations in Parkinson's disease: electronic vs. conventional paper diaries

Background

Paper symptom diaries are a common tool for assessing motor fluctuations in Parkinson's disease (PD) patients, but there are concerns about inaccuracies in the assessment of motor fluctuation due to recall bias and poor compliance. We, therefore, developed an electronic diary with reminder and real-time recording functions.

Objectives and methods

To evaluate the effectiveness of the electronic diary, we compared compliance and motor fluctuation assessment with a paper diary. Nineteen PD patients were recruited and recorded paper diaries every 30 min from 8 am to 8 pm for 7 days, followed by 7 days of electronic diary recording using a smartphone and smartwatch. Prior to the recording period, the Parkinson's Disease Questionnaire (PDQ)-39 and the Movement Disorders Society-sponsored Unified Parkinson's Disease Rating Scale-Revised (MDS-UPDRS) 1, 2, 3, 4 were measured. Patients completed a patient questionnaire on the usability of the diaries after the recording period.

Results

Total reported time was significantly longer in paper diaries, but there was no significant difference in the number of entries (paper 115 [71-147] vs. electronic 109 [93-116], p = 0.77). There was a significant correlation between paper and electronic diaries with respect to motor status. ON time rate recorded in the electronic diary was significantly correlated with PDQ-39, MDS-UPDRS 1, 2, and 4, while MDS-UPDRS 1 was only correlated with ON time rate in the paper diary. The usability of our electronic diary was found to be satisfactory based on the results of patient questionnaire.

Conclusion

Electronic diaries are useful tools that more accurately reflect PD motor fluctuations.

Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis

BACKGROUND

Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear.

OBJECTIVE

This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery.

METHODS

A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes.

RESULTS

A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference -15.00, 95% CI -25.65 to -4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45%) in the likelihood of PPCs (risk ratio 0.45, 95% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference -1.53, 95% CI -2.95 to -0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference -1.42, 95% CI -3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates.

CONCLUSIONS

This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research.

TRIAL REGISTRATION

PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=430271.

Digital health and quality of care in Primary Health Care: an evaluation model

Introduction

The implementation of technologies in Primary Health Care with monitoring and evaluation of the quality of health care is fundamental to direct the access and quality of health care in the context of the Sustainable Development Goals. Our objective was to develop a model for evaluating digital health interventions in primary care, considering its impact on first contact, longitudinality, integrality and coordination in health.

Methodology

This is an exploratory methodological study of a qualitative nature. This study seeks to explore strategic actors' perceptions of an evaluation model, and was developed in a process between June 2021 and March 2024. The following stages were followed: Identification of previous models available in the literature, model development, model validation, model update. We performed a nominal group consensus technique online with seven experts. Stages taken to define the design of the model: sending the elaborated model, together with an electronic form with 18 subjective questions, such as brainstorming strategy, for recording impressions, judgment of agreement and suggestions; workshop for discussion by videoconference, at the time the objectives and the model diagram were presented, followed by debate with clarification of doubts and suggestions for clarification of the step-by-step design. After incorporating the suggestions, the model agreed upon in the workshop was subjected to another analysis by the same experts, sent in an online Google document, in which possible inconsistencies between the proposed model and the agreed one were verified, as well as the final agreement on the recommended proposal. At the end of this stage, with synchronous and asynchronous remote procedures, consensus was reached.

Results

The proposed evaluation model presents as primary categories, structure, process and result. The structure encompasses four indicators, namely, employees; financial resources; infrastructure resources; and regulatory and strategic resources. The process is organized into three dimensions, namely: technical dimension, organizational dimension and relational dimension. The results will be evaluated in products; intermediate results; and impacts (short, medium and long term). The results will be measured by the seven pillars of quality: efficacy, effectiveness, efficiency, optimization, acceptability, legitimacy, equity.

Conclusion

This study achieved the goal of developing a model to evaluate digital health interventions in Primary Health Care, helping to identify adequate and useful evaluation methods filling the gap of the lack of quality evaluation standards in the brazilian Digital Health Strategy. It presents an important difference in relation to models from different countries, as it considers the impacts on Primary Health Care quality attributes such as first contact care, longitudinality, integrality and coordination of care. The model will be used by managers and health professionals of Primary Health Care in a case study in Brazil to evaluate the quality of health care. It is expected that the proposed model may be used in other evaluation studies and countries through contextual adaptations.

Complexities and challenges of translating intervention success to real world gait in people with Parkinson's disease

Background

Unstable gait leading to falls negatively impacts the quality of life in many people with Parkinson's disease (PD). Systematic review evidence provides moderate to strong evidence of efficacy for a wide range of physiotherapy-based interventions to reduce gait impairment. However, outcomes have often focused on gait assessments conducted in controlled laboratory or clinical environments.

Objective

This perspective investigates the complexities and challenges of conducting real-world gait assessments in people with PD and the factors that may influence the translation from improved lab-assessed gait to improved real-world gait.

Methods

Through a thorough review of current literature, we present an in-depth analysis of current methodological approaches to real-world gait assessments and the challenges that may influence the translation of an intervention's success from lab-based outcomes to improved walking during daily life.

Results

We identified six key factors that may influence the translation of intervention success into real-world environments at different stages of the process. These factors comprise the gait intervention, parameters analyzed, sensor setup, assessment protocols, characteristics of walking bouts, and medication status. We provide recommendations for each factor based on our synthesis of current literature.

Conclusion

This perspective emphasizes the importance of measuring intervention success outside of the laboratory environment using real-world gait assessments. Our findings support the need for future studies to bridge the gap between proven efficacy for gait as assessed in controlled laboratory environments and real-world impact for people with PD.

A scoping review assessing the usability of digital health technologies targeting people with multiple sclerosis

Digital health technologies (DHTs) have become progressively more integrated into the healthcare of people with multiple sclerosis (MS). To ensure that DHTs meet end-users' needs, it is essential to assess their usability. The objective of this study was to determine how DHTs targeting people with MS incorporate usability characteristics into their design and/or evaluation. We conducted a scoping review of DHT studies in MS published from 2010 to the present using PubMed, Web of Science, OVID Medline, CINAHL, Embase, and medRxiv. Covidence was used to facilitate the review. We included articles that focused on people with MS and/or their caregivers, studied DHTs (including mhealth, telehealth, and wearables), and employed quantitative, qualitative, or mixed methods designs. Thirty-two studies that assessed usability were included, which represents a minority of studies (26%) that assessed DHTs in MS. The most common DHT was mobile applications (n = 23, 70%). Overall, studies were highly heterogeneous with respect to what usability principles were considered and how usability was assessed. These findings suggest that there is a major gap in the application of standardized usability assessments to DHTs in MS. Improvements in the standardization of usability assessments will have implications for the future of digital health care for people with MS.

Advancements in Wearable Digital Health Technology: A Review of Epilepsy Management

This review explores recent advancements in wearable digital health technology specifically designed to manage epilepsy. Epilepsy presents unique challenges in monitoring and management due to the unpredictable nature of seizures. Wearable devices offer continuous monitoring and real-time data collection, providing insights into seizure patterns and trends. Wearable technology is important in epilepsy management because it enables early detection, prediction, and personalized intervention, empowering patients and healthcare providers. Key findings highlight the potential of wearable devices to improve seizure detection accuracy, enhance patient empowerment through real-time monitoring, and facilitate data-driven decision-making in clinical practice. However, further research is needed to validate the accuracy and reliability of these devices across diverse patient populations and clinical settings. Collaborative efforts between researchers, clinicians, technology developers, and patients are essential to drive innovation and advancements in wearable digital health technology for epilepsy management, ultimately improving outcomes and quality of life for individuals with this neurological condition.

Digital Mobility Measures: A Window into Real-World Severity and Progression of Parkinson's Disease

BACKGROUND

Real-world monitoring using wearable sensors has enormous potential for assessing disease severity and symptoms among persons with Parkinson's disease (PD). Many distinct features can be extracted, reflecting multiple mobility domains. However, it is unclear which digital measures are related to PD severity and are sensitive to disease progression.

OBJECTIVES

The aim was to identify real-world mobility measures that reflect PD severity and show discriminant ability and sensitivity to disease progression, compared to the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scale.

METHODS

Multicenter real-world continuous (24/7) digital mobility data from 587 persons with PD and 68 matched healthy controls were collected using an accelerometer adhered to the lower back. Machine learning feature selection and regression algorithms evaluated associations of the digital measures using the MDS-UPDRS (I-III). Binary logistic regression assessed discriminatory value using controls, and longitudinal observational data from a subgroup (n = 33) evaluated sensitivity to change over time.

RESULTS

Digital measures were only moderately correlated with the MDS-UPDRS (part II-r = 0.60 and parts I and III-r = 0.50). Most associated measures reflected activity quantity and distribution patterns. A model with 14 digital measures accurately distinguished recently diagnosed persons with PD from healthy controls (81.1%, area under the curve: 0.87); digital measures showed larger effect sizes (Cohen's d: [0.19-0.66]), for change over time than any of the MDS-UPDRS parts (Cohen's d: [0.04-0.12]).

CONCLUSIONS

Real-world mobility measures are moderately associated with clinical assessments, suggesting that they capture different aspects of motor capacity and function. Digital mobility measures are sensitive to early-stage disease and to disease progression, to a larger degree than conventional clinical assessments, demonstrating their utility, primarily for clinical trials but ultimately also for clinical care. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

The Importance of Digital Health Literacy in an Evolving Parkinson's Disease Care System

Digital health technologies are growing at a rapid pace and changing the healthcare landscape. Our current understanding of digital health literacy in Parkinson's disease (PD) is limited. In this review, we discuss the potential challenges of low digital health literacy in PD with particular attention to telehealth, deep brain stimulation, wearable sensors, and smartphone applications. We also highlight inequities in access to digital health technologies. Future research is needed to better understand digital health literacy among individuals with PD and to develop effective solutions. We must invest resources to evaluate, understand, and enhance digital health literacy for individuals with PD.

Self-Management Systems for Patients and Clinicians in Parkinson's Disease Care: A Scoping Review

Background

Digital self-management tools including mobile apps and wearables can enhance personalized care in Parkinson's disease, and incorporating patient and clinician feedback into their evaluation can empower users and nurture patient-clinician relationships, necessitating a review to assess the state of the art and refine their use.

Objective

This review aimed to summarize the state of the art of self-management systems used in Parkinson's disease management, detailing the application of self-management techniques and the integration of clinicians. It also aimed to provide a concise synthesis on the acceptance and usability of these systems from the clinicians' standpoint, reflecting both patient engagement and clinician experience.

Methods

The review was organized following the PRISMA extension for Scoping Reviews and PICOS frameworks. Studies were retrieved from PubMed, CINAHL, Scopus, ACM Digital Library, and IEEE Xplore. Data was collected using a predefined form and then analyzed descriptively.

Results

Of the 15,231 studies retrieved, 33 were included. Five technology types were identified, with systems combining technologies being the most evaluated. Common self-management strategies included educational material and symptom journals. Only 11 studies gathered data from clinicians or reported evidence of clinician integration; out of those, six studies point out the importance of raw data availability, data visualization, and integrated data summaries.

Conclusions

While self-management systems for Parkinson's disease are well-received by patients, the studies underscore the urgency for more research into their usability for clinicians and integration into daily medical workflows to enhance overall care quality.

Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson's Disease

Motor and nonmotor symptoms occur in early Parkinson's disease (PD), or even in the prodromal stage. Many of these symptoms can be addressed by allied health therapies, including physical therapy, occupational therapy, speech therapy, and psychological therapies. However, referrals to these services early in the disease are low. We provide a review summarizing the efficacy of proactive allied health interventions on motor and nonmotor symptoms and daily function in prodromal and early disease. We also highlight areas for additional research and provide recommendations to improve care for individuals with early PD within each discipline. We recognize the overlapping roles of the allied health disciplines and support integrated or transdisciplinary care beginning soon after diagnosis to help stem the tide in the progression of PD symptoms and disability.

Barriers and facilitators for healthcare providers to implement family-centered care in Parkinson's disease: a scoping review

Aims

This study aimed to identify and synthesize the barriers and facilitators to the implementation of family-centered care in Parkinson's disease (PD) and to provide a reference for evidence-based Parkinson's disease nursing practice.

Methods

This scoping review follows the methodology framework proposed by Arksey and O'Malley. Four databases including PubMed, Web of Science, Embase, and Cochrane Library were searched. Barriers and facilitators were summarized based on the ecological family-centered model.

Results

Through a comprehensive literature search, 35 studies were found for this scoping review. Barriers and facilitators to implementing family-centered care in PD included physiological factors, environmental factors, culturally based conflicts, living arrangements, education or skills training, group experiences, and individual and family consultations.

Conclusion

Implementing family-centered care in Parkinson's disease is essential to providing comprehensive care that improves outcomes for both PD patients and their family members.

A smartphone-based tapping task as a marker of medication response in Parkinson's disease: a proof of concept study

Tapping tasks have the potential to distinguish between ON-OFF fluctuations in Parkinson's disease (PD) possibly aiding assessment of medication status in e-diaries and research. This proof of concept study aims to assess the feasibility and accuracy of a smartphone-based tapping task (developed as part of the cloudUPDRS-project) to discriminate between ON-OFF used in the home setting without supervision. 32 PD patients performed the task before their first medication intake, followed by two test sessions after 1 and 3 h. Testing was repeated for 7 days. Index finger tapping between two targets was performed as fast as possible with each hand. Self-reported ON-OFF status was also indicated. Reminders were sent for testing and medication intake. We studied task compliance, objective performance (frequency and inter-tap distance), classification accuracy and repeatability of tapping. Average compliance was 97.0% (± 3.3%), but 16 patients (50%) needed remote assistance. Self-reported ON-OFF scores and objective tapping were worse pre versus post medication intake (p < 0.0005). Repeated tests showed good to excellent test-retest reliability in ON (0.707 ≤ ICC ≤ 0.975). Although 7 days learning effects were apparent, ON-OFF differences remained. Discriminative accuracy for ON-OFF was particularly good for right-hand tapping (0.72 ≤ AUC ≤ 0.80). Medication dose was associated with ON-OFF tapping changes. Unsupervised tapping tests performed on a smartphone have the potential to classify ON-OFF fluctuations in the home setting, despite some learning and time effects. Replication of these results are needed in a wider sample of patients.