Evaluation of Clinical Utility of the Personal KinetiGraph<sup>®</sup> in the Management of Parkinson Disease

Abstract

INTRODUCTION: Parkinson's disease (PD) is a disorder characterized by complex motor and non-motor symptoms that can be difficult for patients to accurately communicate. Wearable technologies portend improvements in assessment and monitoring of these symptoms, with their clinical utility currently being evaluated in routine clinical care. OBJECTIVE: To evaluate the clinical utility of the Personal KinetiGraph® (PKG®) Movement Recording System in the routine clinical care of persons with PD (PWP). METHODS: Clinically stable, non-demented PWP presented for two routine clinic visits that included: medication review, symptom review, neurological examination including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III/IV, and completion of a clinical management plan by a movement disorder specialist prior to review of the PKG report. After reviewing the PKG report, the clinician completed a modified clinical management plan taking into consideration the findings of the PKG. This was repeated at a second visit to evaluate various outcome measures following PKG-enhanced management. RESULTS: The PKG improved the assessment of PD symptoms and the response to treatment, while increasing patient activity levels and compliance. Clinical management plans enhanced by PKG led to different recommendations in 29.4% of cases compared with standard of care due to higher rates of bradykinesia, dyskinesia, tremor, and fluctuations identified by PKG. Using the PKG in the clinical management plan led to a change in medications in 75% (21/28) of patients and both a statistically significant difference and a clinically meaningful reduction in MDS-UPDRS III score of 4.8 (p = 0.028). Additionally, positive changes in both the clinician (17/28; 61%) and patient-reported (13/24; 54%) Global Impression of Improvement were reported. CONCLUSION: The PKG is a valuable tool in augmenting clinical management when utilized along with a clinical assessment.

Comparing Objective and Subjective Measures of Parkinson's Disease Using the Parkinson's KinetiGraph

“…However, this metric could prove to be a useful baseline in determining the medication response time of individual patients. Several recent studies have shown that motor symptom data from wearable devices can help clinicians to better assess motor symptoms as well as to potentially alter medication schedule for better treatment and management of the disease ( 4 , 15 – 17 ). Patients wearing a PKG or other similar wearable sensor could provide their motor symptom data to clinicians, who would be able to use sensor data in conjunction with this response time finding to determine the magnitude of the response to medication as well as the individual's expected response time.…”

“…Parkinsonian patients may experience difficulty in recognizing and reporting their symptoms, and subjective recordings, such as surveys and diaries, can be prone to bias and inaccuracies (3). Thus, wearable sensors can provide objective symptom data that can help clinicians modify medications to more effectively manage symptoms of Parkinson's disease (4,5).…”

“…Parkinsonian patients may experience difficulty in recognizing and reporting their symptoms, and subjective recordings, such as surveys and diaries, can be prone to bias and inaccuracies ( 3 ). Thus, wearable sensors can provide objective symptom data that can help clinicians modify medications to more effectively manage symptoms of Parkinson's disease ( 4 , 5 ). While studies involving these sensors often compare device results to clinical assessments, to our knowledge, no study so far has analyzed device results in conjunction with patients' subjective experiences regarding their motor symptoms ( 6 – 8 ).…”

Predicting Parkinson’s Disease Medication Regimen Using Sensor Technology

“…Characteristics of the patient cohort and selection process are described in the study by Nahab et al 16 , which explored the clinical utility of the PKG in routine care of Parkinson's patients. All patients were selected from the UCSD Movement Disorder Center from June 2016 to March 2017.…”

“…All patients were selected from the UCSD Movement Disorder Center from June 2016 to March 2017. The study's inclusion criteria included: an age range of 46-83, being on levodopa, and a H&Y range 1-3 16 . The participants underwent two clinical assessment visits.…”