Abstract

Background:The emergence of new technologies measuring outcomes in Parkinson’s disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients’ own homes whilst they freely live and carry out normal day-to-day activities.Objective:This systematic review seeks to provide an overview of what technology is being used to test which outcomes in PD from free-living participant activity in the setting of the home environment. Additionally, this review seeks to form an impression of the nature of validation and clinimetric testing carried out on the technological device(s) being used.Methods:Five databases (Medline, Embase, PsycInfo, Cochrane and Web of Science) were systematically searched for papers dating from 2000. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants.Results:65 studies were selected for data extraction. There were wide varieties of participant sample sizes (<10 up to hundreds) and study durations (<2 weeks up to a year). The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living.Conclusions:Home-based free-living testing in PD is being conducted by multiple groups with diverse approaches, focussing mainly on motor symptoms and sleep.

Highlights

  • Parkinson’s disease (PD) is a chronic, progressive, disabling disorder of the central nervous system with a wide heterogeneity of clinical presentations and rates of progression

  • The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living

  • The MDS-UPDRS is predominantly used for clinical trials comparing therapeutic effects between groups on treatment versus placebo, to track longitudinal changes in PD cohorts over time or to guide clinical decision-making at the individual level in specific circumstances

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Summary

Introduction

Parkinson’s disease (PD) is a chronic, progressive, disabling disorder of the central nervous system with a wide heterogeneity of clinical presentations and rates of progression. The MDS-UPDRS (Movement Disorder SocietySponsored Revision of the Unified Parkinson’s Disease Rating Scale) [4] is the current gold-standard way of measuring disease severity in PD. The single or episodically repeated ‘snap-shot’ of the person’s symptoms and clinical signs is perhaps under-evaluating the symptomatology of some patients with PD, which can fluctuate from day to day and hour to hour It remains the gold standard against which all other measures are compared, including sensor-based assessments. The emergence of new technologies measuring outcomes in Parkinson’s disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients’ own homes whilst they freely live and carry out normal day-to-day activities. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants

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