Pilot Study Shows Feasibility of Telemedicine for Parkinson's

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.