Tracker app supports self-management in Parkinson’s disease
A smartphone-based Parkinson’s tracker app (PTA) may prove to be a novel and effective strategy for improving short-term self-reported medication adherence and quality of clinical consultation, according to a study.
“Th[e] finding suggests that PTA is useful in improving care for a significant period of time between clinic consultations,” researchers said.
PTA includes several features that facilitate self-management support, including the following: (1) an interface to track several self-monitoring measures (sleep, movement and suppleness, among others), (2) a medication reminder system, (3) an option to generate report of patient data to aid follow-up appointment with physician, and (4) games to track physical responsiveness and cognition.
The app also provides information about PD obtained from Parkinson’s UK and the Cure Parkinson’s Trust.
“Self-management support refers to increasing patient participation, collaborative goal setting, treatment planning and assisting patients to gain control over their lives,” researchers said. “It can teach PD patients how to better utilize healthcare resources and how to form more effective partnerships with their care providers.”
In a trial evaluating the impact of PTA on patient self-management, treatment adherence and quality of clinical consultation, PD patients using the app showed a significant increase in the primary outcome measure of self-reported adherence to treatment (as assessed by Morisky Medication Adherence Scale) compared with patients who received treatment as usual (TAU; mean difference [MD], 0.39; 95 percent CI, 0.04 to 0.74; p=0.0304). [NPJ Parkinson's Disease 2017;doi:10.1038/s41531-016-0003-z]
Additionally, results for patients’ perception of quality of consultation (MD, 0.15; 0.03 to 0.27; p=0.0110) and nonmotor symptoms (MD, −0.82; −1.75 to 0.10; p=0.0822) were more favourable with PTA than with TAU.
“The complexity of treatment along with PD affecting cognitive processes such as sorting or planning tasks might explain why the PTA helped in improving adherence as medication reminders and symptom tracking were core features,” researchers explained.
A total of 201 patients (mean age 60.31 years; 60.7 percent male) participated in the study and were randomized to either PTA (n= 94) or TAU (n=107). However, only 72 percent completed the 16-week trial period (n=68 in the PTA group; n=90 in the TAU group).
User retention in the current study is similar to that observed during a previous pilot study of the PTA. Researchers said the higher level of user retention might be attributed to factors including the user interface design and simplicity in the user experience. [Int J Integr Care 2014;URN:NBN:NL:UI:10-1-116512]
“The app is perceived as given by participant’s clinical team and thereby acting as an extension of [the patient’s] recommended care and [having] the direct benefit of understanding their health better as reported by PTA users,” they pointed out.
“[On the other hand] the higher study drop-out rate in the PTA group is likely due to the participants needing to perform an additional trial task of using the PTA compared to the TAU group. Additionally, the PTA may not have met all participants’ needs (for example, some of the self-monitoring measures chosen by the trial team may not be applicable to some participants), which could have contributed to the dropouts,” they added.
The researchers also acknowledged the challenge of investigating adherence using a pragmatic design. Data on recruitment rates for randomized controlled trials underscore the difficulty of recruiting patients and of retaining recruited patients “despite implementing various retention strategies along with letters.”
Additional studies with longer duration are needed to determine the effect of the PTA on health services use, as well as how much self-reported adherence is clinically meaningful in PD.