title: Testing objective measures of motor impairment in early Parkinson's disease: Feasibility study of an at-home testing device.
abstract: We tested the feasibility of a computer based at-home testing device (AHTD) in early-stage, unmedicated Parkinson's disease (PD) patients over 6 months. We measured compliance, technical reliability, and patient satisfaction to weekly assessments of tremor, small and large muscle bradykinesia, speech, reaction/movement times, and complex motor control. relative to the UPDRS motor score. The AHTD is a 6.5'' x 10'' computerized assessment battery. Data are stored on a USB memory stick and sent by internet to a central data repository as encrypted data packets. Although not designed or powered to measure change, the study collected data to observe patterns relative to UPDRS motor scores. Fifty-two PD patients enrolled, and 50 completed the 6 month trial, 48 remaining without medication. Patients complied with 90.6% of weekly 30-minute assessments, and 98.5% of data packets were successfully transmitted and decrypted. On a 100-point scale, patient satisfaction with the program at study end was 87.2 (range: 80-100). UPDRS motor scores significantly worsened over 6 months, and trends for worsening over time occurred for alternating finger taps (P = 0.08), tremor (P = 0.06) and speech (P = 0.11). Change in tremor was a significant predictor of change in UPDRS (P = 0.047) and was detected in the first month of the study. This new computer-based technology offers a feasible format for assessing PD-related impairment from home. The high patient compliance and satisfaction suggest the feasibility of its incorporation into larger clinical trials, especially when travel is difficult and early changes or frequent data collection are considered important to document.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA. cgoetz@rush.edu
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Goetz
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Stebbins
authors.forename: David
authors.initials: D
authors.lastname: Wolff
authors.forename: William
authors.initials: W
authors.lastname: DeLeeuw
authors.forename: Helen
authors.initials: H
authors.lastname: Bronte-Stewart
authors.forename: Rodger
authors.initials: R
authors.lastname: Elble
authors.forename: Mark
authors.initials: M
authors.lastname: Hallett
authors.forename: John
authors.initials: J
authors.lastname: Nutt
authors.forename: Lorraine
authors.initials: L
authors.lastname: Ramig
authors.forename: Terence
authors.initials: T
authors.lastname: Sanger
authors.forename: Allan D
authors.initials: AD
authors.lastname: Wu
authors.forename: Peter H
authors.initials: PH
authors.lastname: Kraus
authors.forename: Lucia M
authors.initials: LM
authors.lastname: Blasucci
authors.forename: Ejaz A
authors.initials: EA
authors.lastname: Shamim
authors.forename: Kapil D
authors.initials: KD
authors.lastname: Sethi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Spielman
authors.forename: Ken
authors.initials: K
authors.lastname: Kubota
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Grove
authors.forename: Eric
authors.initials: E
authors.lastname: Dishman
authors.forename: C Barr
authors.initials: CB
authors.lastname: Taylor
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D017076:Computer-Aided Design; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018476:Hypokinesia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000209:etiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis* / Q000209:etiology