Digital Inclusion in Parkinson's Disease: A Case-Control Study

Abstract

Background: People with Parkinson's disease (pwPD) are a candidate population to regularly use telemedicine services. However, their implementation into clinical practice can be limited by the so-called "digital exclusion" of the target population.

Objective: We aimed to (1) explore the level of digital inclusion in a cohort of pwPD as compared to sex- and age-matched healthy controls (HC), and (2) to determine the possible influence of both socio-demographic factors and disease features on the level of digital exclusion.

Methods: Four hundred and ninety pwPD and 140 HC completed the Digital Inclusion Questionnaire (DIQUEST), which measures two barriers related to digital access and skills; demographic data (age, sex, education and economic status) and clinical characteristics (Hoeh & Yahr stage, MDS-UPDRSIII, presence of depression/apathy, and/or mild cognitive decline) were also collected. Nonparametric tests were used for comparative analyses; multivariate linear regression models were performed to establish the predictive value of demographics and disease-related variables on the DIQUEST scores.

Results: pwPD had a higher level of digital exclusion than HC especially due to poorer digital skills. Both depression/apathy and mild cognitive decline were associated with a more pronounced digital exclusion. Beyond demographic variables, the presence of PD as well as its severity independently predicted the level of digital exclusion.

Conclusions: PwPD suffer from a significant digital exclusion. Our results further highlight the paradox whereby subjects with more advanced PD are more prone to be digitally excluded, despite being the population that would most need telemedicine services.

Keywords: digital divide; digital technology; remote monitoring; telehealth; telemedicine.