Digital health technology, which spans phone apps to telemedicine, is advancing Parkinson’s disease research and clinical care, according to different review studies.
“Digital health technology is an important and promising field that is beginning to make a real tangible impact on persons with [Parkinson’s disease],” Anat Mirelman, PhD, a neurology specialist at Tel Aviv University in Israel, said in a press release.
Several reviews on the state of digital health in Parkinson’s disease were the focus of a special issue of the Journal of Parkinson’s Disease, and highlighted in the editorial article, “Using Technology to Reshape Clinical Care and Research in Parkinson’s Disease.”
Parkinson’s is characterized by the progressive loss of coordination and movement, which has a sizable impact on the lives of people with the disorder, as well as their families and caregivers.
Digital technology is now part of many aspects of society, including medical care and research, and its role in current clinical practice and Parkinson’s research is expanding. Digital health technology refers to a wide range of applications, such as wearable and non-contact sensors, smartphone applications, and telemedicine for remote interactions.
Mirelman, collaborating with investigators in the U.S. and the Netherlands, reviewed the practice of using digital health technologies to advance the care and treatment of people with Parkinson’s disease.
“This special supplement includes a series of succinct reviews that cover many practical and relevant aspects, such as digital monitoring, telemedicine, digital therapeutics, virtual clinical trials and digital progression biomarkers for clinical trials,” Mirelman said. “All reviews offer both a view of the current state-of-the-art and informed perspectives on future directions.”
In recent years, researchers have examined the use of technology-based objective measures with mixed results. There are differences in measure mobility in a home environment, in which movement is self-initiated and goal-directed, compared to a more controlled clinical setting. But the use of digital technology in clinical practice is still limited.
“Despite the accumulating body of evidence to support the feasibility, utility, and benefits of various digital technology approaches, the use of digital technology in clinical practice has long remained scarce,” said Bastiaan Bloem, MD, PhD, a study author at Radboud University Nijmegen Medical Center in the Netherlands.
With the limitations imposed by the ongoing coronavirus pandemic (COVID-19), digital health technology has increased, which is rapidly transforming neurological care and research.
“It has taken a contagion to make patients, physicians, and insurers pay better attention,” Bloem said. “Specifically, the limits on our ability to travel imposed by the ongoing coronavirus pandemic has led to a dramatic increase in the use of digital platforms in a matter of a few months.”
This “unprecedented” change “has been identified as one of the few silver linings of the pandemic,” he added.
With patients wearing sensors while at home, clinicians can monitor their motor symptoms in real-time, and better understand behavioral changes and the impact of social distancing on non-motor symptoms.
For example, assessing sleep problems, a common Parkinson’s non-motor symptom, is typically done in a sleep lab, which is an artificial setting. Monitoring sleep can now be regularly done at home, in a more passive setting, the study noted, which may also inform about sleep disorders in the early stages of the disease.
Digital tools may also expose disease features that are largely hidden, including social difficulties and voice impairments, and allow for the real-time measuring of tremors, uncontrolled movements, and falls, as well as objectively evaluating the effects of therapies. This may lead to a better understanding of variable disease processes over time, and provide more accurate outcomes that can be measured in a real-world setting.
As more assessments are conducted in the home with mobile devices, clinical trials can also be more decentralized. Furthermore, digital measurement can support the expansion of digital therapies such as deep brain stimulation, and new treatment approaches like music for gait impairment, cognitive behavioral therapy for anxiety, and speech therapy given at the home rather than the clinic.
Still, “there remain significant challenges,” Mirelman noted. “These include the digital divide, the issue of privacy and security, and reimbursement, which requires health insurance companies and other payers to be persuaded by the merits of technology.”
The pandemic also exposed the limitations of telemedicine and disease monitoring practices. In particular, a need remains for in-person clinic visits, especially for new patients, which can help build relationships with healthcare providers.
“The COVID-19 pandemic has emphasized some of the shortcomings of telemedicine or monitoring approaches, such as the undiminished need for in-person visits, especially for new patients,” Bloem said. “These shortcomings raise yet another question as to what extent digital health technologies will survive when our lives get back to a new normal after this pandemic has resolved.”
One certainty, however, is that “the digital revolution has definitely started. We can almost be equally certain that this is only the beginning,” he added. “The future of digital medicine will likely benefit both patients and healthcare in ways that are currently difficult to predict.”
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