Objective measurement in routine care of people with Parkinson’s disease improves outcomes

It is common in medicine to titrate therapy according to target ranges of
objectively measured parameters. Objective measurement of motor
function is available for Parkinson’s Disease (PD), making it possible to
optimise therapy and clinical outcomes. In this study, an
accelerometry-based measurement and predefined target ranges were used to
assess motor function in a Northern Tasmania PD cohort managed by a
Movement Disorder clinic. Approximately 40% (n=103) of the total
PD population participated in this study and motor scores were within
target in 22%. In the 78% above target, changes in oral therapy
were recommended in 74%, Advanced Therapy in 12% and treatment was
contraindicated in 9%. Following changes in oral therapy, there
was a further objective measurement and clinical consultation to establish
whether scores had reached target range: if so subjects left the study,
otherwise further changes of therapy were recommended (unless
contraindications were present). Seventy-seven cases completed
the study, with 48% achieving target (including 22% at outset), Advanced
Therapy recommended in 19% and contraindications preventing any change in
therapy in 17%.  In the 43% of cases in whom oral therapy was
changed, total UPDRS improved significantly (effect size =8) as did the
PDQ39 in cases reaching target. NMS Quest and MOCA scores also
improved significantly. This study shows that many people in a
representative cohort of PD would benefit from objective assessment and
treatment of their PD features against a target.