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.
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.
They also reported that televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) 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 be able to use telemedicine to 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 (range, 1-5) and a mean motor UPDRS of 34.7 (range, 1-108, with higher scores indicating greater disability).
The community participants were randomized to telemedicine care (six) or standard care (four). All four nursing home patients received telemedicine care. Those in the telemedicine group received three one-on-one visits over 6 months (month 1, 2, and 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.
The Web-based televideo assessments were conducted at the nursing home. They mirrored an inperson evaluation, during which patients 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 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 patients completed 94% of their telemedicine visits, showing trends toward improvement in care satisfaction, quality of life, and depressive symptoms.
The investigators also reported the motor UPDRS items were able to be completed at each visit. 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.
In focus group follow-up, both patients and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” Dr. Biglan said in an interview. “They were adamant that it was convenient and made communicating easy.” Nevertheless, “travel remained an issue for some, [and] others had mixed feelings about completing telemedicine visits at home without medical and technical support staff.”
Dr. Biglan said the study was limited by its focus on feasibility and a single disease. “While short-term feasibility was established, the long-tern feasibility and benefits of telemedicine [have yet] to be evaluated. The study's focus was PD, whose clinical evaluation is largely visual. The reliability and validity of telemedicine assessments for PD remains to be established, as does applicability to other conditions such as Alzheimer's disease, which are more common in nursing home populations.”
The researchers plan to expand the telemedicine initiatives to other sites and evaluate the use of remote assessments via telemedicine in clinical trials.
The study was funded by 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.