Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson’s disease

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.

The BRadykinesia Akinesia INcoordination (BRAIN) Tap Test: Capturing the Sequence Effect

“…In the third experiment, a smart device version of the test (“TapPD” developed by uMotif Limited for Apple [Cupertino, CA] iPhone and iPad devices) was used in addition to the keyboard test . The same device was used for all participants.…”

The Use of Data Collected From mHealth Apps to Inform Evidence‐Based Quality Improvement: An Integrative Review

“…Studies varied greatly in their aims, methodologies, and sample sizes. A variety of study designs were selected for analysis, including four systematic reviews (Holmen et al., ; Kitsiou, Pare, Jaana, & Gerber, ; Lee et al., ; Peiris, Praveen, Johnson, & Mogulluru, ), four randomized controlled trials (Armstrong, Coyte, Brown, Beber, & Semple, ; Cingi et al., ; Lakshminarayana et al., ; Wolf et al., ), one nonrandomized controlled trial (Sundberg et al., ), three retrospective cohort studies (Dickson, Sumathipala, & Reeves, ; Khanna, Sambandam, Gul, & Mounasamy, ; Twichell et al., ), six pilot studies (Foo et al., ; Gunter et al., ; Jakel et al., ; Macpherson et al., ; Patel, Siegler, Stromberg, Ravitz, & Hanson, ; Semple, Sharpe, Murnaghan, Theodoropoulos, & Metcalfe, ), and one case report (Gernart et al., ).…”

“…Data collected through apps were used both in real time to deliver health care, inform healthcare decision‐making, and create self‐awareness (Armstrong et al., ; Cingi et al., ; Dickson et al., ; Foo et al., ; Gunter et al., ; Jakel et al., ; Khanna et al., ; Macpherson et al., ; Semple et al., ; Sundberg et al., ; Twichell et al., ), and retrospectively to inform healthcare management (Gernart et al., ; Lakshminarayana et al., ; Semple et al., ; Wolf et al., ), communication strategies (Khanna et al., ; Patel et al., ), and healthcare delivery changes (Foo et al., ).…”

“…While not the main focus of the apps, a number of quality improvements and outcomes were reported in the studies reviewed. These included improvements to clinical outcomes (Cingi et al., ), disease control and management (Kitsiou et al., ; Lakshminarayana et al., ), quality of life (Cingi et al., ; Sundberg et al., ), time to treatment (Dickson et al., ; Twichell et al., ), communication (Foo et al., ; Khanna et al., ; Macpherson et al., ), awareness of patient information (Khanna et al., ; Lee et al., ), symptom burden (Sundberg et al., ), emotional functioning (Sundberg et al., ), medication adherence (Lakshminarayana et al., ), time efficiency (Foo et al., ; Khanna et al., ; Lee et al., ; Patel et al., ; Semple et al., ), disease management (Holmen et al., ), follow‐up time (Armstrong et al., ; Semple et al., ), and patient management (Foo et al., ; Lakshminarayana et al., ). Of the 19 studies reviewed, only one article (Foo et al., ) made explicit links outlining that data collected from the app were used to inform quality improvement.…”

The BRadykinesia Akinesia INcoordination (BRAIN) tap test: capturing the sequence effect

“…In the third experiment, a smart device version of the test ("TapPD" developed by uMotif Limited for Apple iPhone and iPad devices) was used alongside the keyboard test [17][18]. Participants used their index finger to alternately tap two target areas on the screen as fast and as accurately as possible for a period of 30 seconds.…”