Objective measurement in routine care of people with Parkinson's disease improves outcomes

Abstract

It is common in medicine to titrate therapy according to target ranges of objectively measured parameters. Objective measurement of motor function is available for Parkinson's Disease (PD), making it possible to optimise therapy and clinical outcomes. In this study, an accelerometry based measurement and predefined target ranges were used to assess motor function in a Northern Tasmania PD cohort managed by a Movement Disorder clinic. Approximately 40% (n = 103) of the total PD population participated in this study and motor scores were within target in 22%. In the 78% above target, changes in oral therapy were recommended in 74%, Advanced Therapy in 12% and treatment was contraindicated in 9%. Following changes in oral therapy, there was a further objective measurement and clinical consultation to establish whether scores had reached target range: if so subjects left the study, otherwise further changes of therapy were recommended (unless contraindications were present). Seventy-seven cases completed the study, with 48% achieving target (including 22% at outset), Advanced Therapy recommended in 19% and contraindications preventing any change in therapy in 17%. In the 43% of cases in whom oral therapy was changed, total UPDRS improved significantly (effect size = 8) as did the PDQ39 in cases reaching target. NMS Quest and MOCA scores also improved significantly. This study shows that many people in a representative cohort of PD would benefit from objective assessment and treatment of their PD features against a target.

Fig. 1

Flow diagram of the study. At the outset of the study, there were 103 participants. The relative proportion of people within target and outside of target are shown in yellow boxes. All proportions in yellow boxes relate to the 103 subjects entering the study. Twenty-two (23%) were controlled and 80 (78%) had uncontrolled motor function, in whom adjustment of oral therapy was attempted in 33 (32%), 12 (12%) were immediately referred for AT, no treatment attempt was made in 9 (9%) cases and 26 (25%) were protocol violations. The 77 PwP participated to the end of the study (i.e., after those classes as protocol violators were removed) have been surrounded by an orange box. The outcomes at the end of the study are shown in orange filled boxes at the bottom of the flow-chart as percentages of the 77 subjects who completed the study. There were 48% who were controlled (c.f. 30% at the outset: 23/77), 15% who were improved but still outside of target, 19% referred for AT and 17% in whom further treatment of motor function was contraindicated