The state of telemedicine for persons with Parkinson's disease

Abstract

Purpose of review The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders. Recent findings Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment. Summary The availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.

Impact of COVID-19 Pandemic on (Health) Care Situation of People with Parkinson’s Disease in Germany (Care4PD)

“…However, our data indicate that although technical options were accessible in most PwP (even those with p-LTC, who additionally might not only need technical options but also care staff support to use the technology), acceptance and use of this technique was rather low in both groups. Although telemedicine approaches have been shown to be effective [ 60 , 61 ] and are widely recommended for PwP [ 16 , 32 , 62 ], even by the International Parkinson and Movement Disorder Society [ 1 ], our findings are congruent with previous studies documenting that even high levels of satisfaction with telemedicine did not translate into a sustained interest or use of this health care approach [ 2 , 12 ]. Extensive promotion of remote or virtual care modes that have been found to be as effective as in-person communication [ 63 ] or alternative offerings (e.g., conducting more house calls by medical and/or therapeutical staff, cross-sectoral approaches with PD nurse specialists as in other countries that are only rarely deployed in Germany so far [ 64 ]) should be focused on in the future.…”

Rapid Dynamic Naturalistic Monitoring of Bradykinesia in Parkinson’s Disease Using a Wrist-Worn Accelerometer

“…Previous systems have been validated over the course of days. However, other suggested clinical state tracking applications would require short time scale feedback [ 22 ], including fine-grained cycle-by-cycle medication adjustments and conventional [ 48 , 49 ] or adaptive [ 50 , 51 , 52 , 53 ] deep brain stimulation programming. Moreover, the significant predictive performance in patients with and without both tremor and dyskinesia (AIMS) fluctuations underlines the potential of dynamic naturalistic monitoring for a wide spectrum of PD patients ( Figure S4A,B ).…”

Caregiver Burden in Partners of Parkinsonian Patients with Deep Brain Stimulation

“…Telemedicine has already proven to reduce CB due to more flexible patient treatment and reduction of transportation issues to outpatient clinics [ 67 ]. Telemedicine comprises teleconsultation, telemonitoring and teletreatment [ 68 ]. Telehealth with teleprogramming of DBS has become particularly important during the COVID-19 pandemic with overall satisfactory patient experience [ 69 , 70 ].…”