Abstract
The progressive nature of Parkinson’s disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson’s disease patients, making it difficult to comprehensively address non-adherence. Here we share the results from a multi-centre (seven centres) randomised controlled trial conducted in England and Scotland to assess the impact of using a smartphone-based Parkinson’s tracker app to promote patient self-management, enhance treatment adherence and quality of clinical consultation. Eligible Parkinson’s disease patients were randomised using a 1:1 ratio according to a computer-generated random sequence, stratified by centre and using blocks of variable size, to intervention Parkinson’s Tracker App or control (Treatment as Usual). Primary outcome was the self-reported score of adherence to treatment (Morisky medication adherence scale −8) at 16 weeks. Secondary outcomes were Quality of Life (Parkinson’s disease questionnaire −39), quality of consultation for Parkinson’s disease patients (Patient-centred questionnaire for Parkinson’s disease), impact on non-motor symptoms (Non-motor symptoms questionnaire), depression and anxiety (Hospital anxiety and depression scale) and beliefs about medication (Beliefs about Medication Questionnaire) at 16 weeks. Primary and secondary endpoints were analysed using a generalised linear model with treatment as the fixed effect and baseline measurement as the covariate. 158 patients completed the study (Parkinson’s tracker app = 68 and TAU = 90). At 16 weeks Parkinson’s tracker app significantly improved adherence, compared to treatment as usual (mean difference: 0.39, 95%CI 0.04–0.74; p = 0.0304) with no confounding effects of gender, number of comorbidities and age. Among secondary outcomes, Parkinson’s tracker app significantly improved patients’ perception of quality of consultation (0.15, 95% CI 0.03 to 0.27; p = 0.0110). The change in non-motor symptoms was −0.82 (95% CI −1.75 to 0.10; p = 0.0822). 72% of participants in the Parkinson’s tracker app group continued to use and engage with the application throughout the 16-week trial period. The Parkinson’s tracker app can be an effective and novel way of enhancing self-reported medication adherence and quality of clinical consultation by supporting self-management in Parkinson’s disease in patients owning smartphones. Further work is recommended to determine whether the benefits of the intervention are maintained beyond the 16 week study period.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, after Alzheimer’s disease[1] and affects 6.3 million people worldwide.[2]
Non-motor symptoms such as depression, anxiety, fatigue and sleep disturbance are frequently overlooked by clinicians[4] and contribute to significant burden on people with PD and their carers.[5]
Of the 522 (70.8%) who Nonadherence is linked to poor Quality of Life (QoL), increased hospitalisation admissions and premature mortality.[17,18] responded, 277 (53%) did not meet the inclusion criteria, 65 (12.4%) declined to participate and 180 (34.5%) could not take part due to Delivering self-management support digitally, including support other reasons including not having devices with iPhone/iPad or for understanding and managing treatment has shown improve- Android operating systems or being unable to make it to the Outments health outcomes and processes of care in other chronic Patient appointment
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, after Alzheimer’s disease[1] and affects 6.3 million people worldwide.[2]. Managing motor and non-motor symptoms and the risk of side effects from medications leads to complex treatment regimes.[7]
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