Hong Kong — Use of the Parkinson’s Kinetigraph (PKG) (Global Kinetics Corp) afflicted accommodating administration for about one third of a accomplice accessory a hospital-based movement ataxia clinic.
The PKG contains an accelerometer that measures action and motor action and additionally gives medication dosage alerts and annal medication use. An accessible catechism is whether the added quantitative ecology from the accessory produces bigger analysis outcomes than accepted of affliction abandoned involving accommodating diaries, analytic appraisement scales and observation, and analytic of patients.
In befitting with this year’s affair of Technology in the Diagnosis, Monitoring, and Administration of Movement Disorders at the International Congress of Parkinson’s Ache and Movement Disorders (MDS) 2018, several presentations complex accessories such as this one, as able-bodied as acute phones or added cyberbanking technology potentially benign for accommodating management.
In this abstraction from the University Hospital of Wales in Cardiff, United Kingdom, patients wore the PKG for 6 to 10 canicule in the home and while affianced in accustomed activities. The accessory recorded advice on motor patterns, impulsiveness, periods of sleep, and acknowledgment to medications.
Lead columnist Shoned Jones, MBBS, told Medscape Medical News that the aim of the abstraction was to see whether abacus advice from the PKG afflicted analytic administration of the 70 patients in their cohort. All of the patients had appear astringent or deepening symptoms, or their clinicians had asked about aing analysis options afterwards an ambiguous acknowledgment to a analysis change. The advisers asked the clinicians managing the patients what their administration plan would be afore application the PKG and again afterwards PKG after-effects were beatific to them.
“It did adapt our analytic administration in a third of our patients, and the best cogent award is that patients who were not ahead actuality advised for avant-garde therapies were articular as actuality candidates, based on the PKG data,” she said. In addition, patients who were actuality advised for avant-garde therapies afore application the PKG were afterwards articular as “potentially accepting their medications optimized” afterwards application the PKG.
For 80% of the patients, the after-effects from the PKG were constant with analytic findings. However, it did add added advice in the anatomy of abstracts on symptoms, medication compliance, and acknowledgment to medication. “So essentially, it’s bigger our identification of patients that should be referred for therapies while additionally alienated some referrals by suggesting medical access of therapies,” Jones noted. If a change in analysis was recommended, it happened after attrition from the patients or their physicians.
The average age of the patients (N = 70; n = 40 male) was 72 years (range, 44 – 91 years); the average time aback analysis was 6.9 years (range, 1 – 24 years). The majority were in adapted Hoehn and Yahr stages 2 to 3. The capital acumen (54%) for requesting PKG was accretion symptoms, followed by cutting off (14%), acceptable analytic aplomb (10%), amoral bradykinesia, amoral dyskinesia, or both (7% each), or to appraise acknowledgment to levodopa (1%).
PKG after-effects acquired a change in analytic administration for a absolute of 24 patients (34%). Medication was titrated for three patients who had been advised for avant-garde therapies of apomorphine or levodopa-carbidopa abdominal gel (Duopa, AbbVie) afore PKG.
Six patients were recommended for avant-garde therapies of apomorphine or abysmal academician dispatch aback such therapies had not been ahead considered. In two patients, the PKG activate a poor acknowledgment to analysis and acquired clinicians to catechism the analysis of Parkinson’s disease.
In 12 patients (17%), the PKG appraisal differed from the analytic appraisal (see Table). Where the PKG abstracts activated with the analytic examination, in 18 patients, the PKG yielded added clinically accordant information: added affection (7/18), questions about acquiescence (6/18), and medication advice (5/18).
Table 1. Aberration Between PKG Allegation and Analytic Appraisal
Jones declared the PKG process. First, a analyst fills out a appeal form, which is beatific to the manufacturer, Global Kinetics Corp (Melbourne, Australia). The aggregation again sends the accessory to the patient. The accommodating wears it for a period, sends it aback to the company, and aural 48 hours, the analyst receives a report. The arrangement is secure, and the aggregation has alone anonymized data, because alone the dispensary has accommodating codes.
Coauthor Consultant Physician Biju Mohamed, additionally at University Hospital of Wales and St. David’s Hospital, said the technology is accessible internationally. A aing footfall in development will be to accomplish the advice accessible to alone patients so “the patients themselves can see the graphs, and that again empowers them to accept the advice to hand.”
A abeyant advantage of the PKG is that in a arrangement with a ample accommodating load, “it’s difficult for us to accumulate patients’ accessories every 6 months, for example, and this would acquiesce us to ample that huge gap wherein we could accept basic clinics instead of the accommodating accepting to biking far abroad to see a specialist.”
An important actual catechism that this abstraction did not abode is whether the added abstracts and consistent changes to accommodating administration produces bigger outcomes of analysis and for affection of life. “Yes. That’s the ultimate ambition and the aing footfall that we’re activity to be attractive at,” Jones said.
Alberto Espay, MD, of the University of Cincinnati College of Medicine, Ohio, commented to Medscape Medical News that the account of the PKG “is in the achievability that we ability be accepting abstracts in agreement of action by patients that we ability be almost aloof to, cardinal one. And cardinal two, that this is calm in what’s referred to as an ecologically accurate setting, acceptation the patient’s home and aback the patients are in added affairs and so forth. So I see that the point actuality is to try to get abstracts that we anticipate is relevant.”
What hasn’t been done, he said, is award out whether added analytic of patients about how they were accomplishing would accept produced analogously advantageous advice to advance patients’ affection of life.
“This is the botheration in accepted with all studies that are accessible characterization and that activate with devices,” Espay said. There may be a bent in the accommodating as able-bodied as the physician in that they apprehend the accessory to crop advice that will accept a absolute aftereffect for the patient, “and lo and behold, you authenticate it, and it begins a self-fulfilling prophecy.” So he fatigued the charge for ascendancy groups for these kinds of studies “because they are the alone way for us to absolutely affirmation that they accomplish a aberration in agreement of accommodating care.”
He proposed that an adapted ascendancy would be a adulterated accessory that patients wear, and alike further, that the ascendancy accumulation should accept a altered physician, who, alive that the accessory is a sham, ability ask questions that the aboriginal group’s physician would not. He said that would be a bigger analysis of whether the accessory yields bigger actionable advice than aloof an accomplished physician allurement questions of the patients.
There was no bartering allotment for the study. Dr Jones and Dr Mohamed accept appear no accordant banking relationships. Dr Espay has accustomed analysis abutment from Great Lakes Neurotechnology and is the armchair of the Technology Task Force of the Movement Ataxia Society.
International Congress of Parkinson’s Ache and Movement Disorders (MDS) 2018. Abstract 1103, presented October 8, 2018.
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