Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease

Robin van den Bergh; Luc J W Evers; Nienke M de Vries; Ana L Silva de Lima; Bastiaan R Bloem; Giulio Valenti; Marjan J Meinders

doi:10.3389/fneur.2023.1251395

Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease

Front Neurol. 2023 Oct 12:14:1251395. doi: 10.3389/fneur.2023.1251395. eCollection 2023.

Authors

Robin van den Bergh¹, Luc J W Evers^{1

2}, Nienke M de Vries¹, Ana L Silva de Lima¹, Bastiaan R Bloem¹, Giulio Valenti³, Marjan J Meinders^{1

4}

Affiliations

¹ Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands.
² Radboud University, Institute for Computing and Information Sciences, Department of Data Science, Nijmegen, Netherlands.
³ Philips Research, Department of Connected Care and Remote Patient Management, Eindhoven, Netherlands.
⁴ Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, Netherlands.

Abstract

Background: Physiotherapy for persons with Parkinson's disease (PwPD) could benefit from objective and continuous tracking of physical activity and falls in daily life.

Objectives: We designed a remote monitoring system for this purpose and describe the experiences of PwPD and physiotherapists who used the system in daily clinical practice.

Methods: Twenty-one PwPD (15 men) wore a sensor necklace to passively record physical activity and falls for 6 weeks. They also used a smartphone app to self-report daily activities, (near-)falls and medication intake. They discussed those data with their PD-specialized physiotherapist (n = 9) during three regular treatment sessions. User experiences and aspects to be improved were gathered through interviews with PwPD and physiotherapists, resulting in system updates. The system was evaluated in a second pilot with 25 new PwPD (17 men) and eight physiotherapists.

Results: We applied thematic analysis to the interview data resulting in two main themes: usability and utility. First, the usability of the system was rated positively, with the necklace being easy to use. However, some PwPD with limited digital literacy or cognitive impairments found the app unclear. Second, the perceived utility of the system varied among PwPD. While many PwPD were motivated to increase their activity level, others were not additionally motivated because they perceived their activity level as high. Physiotherapists appreciated the objective recording of physical activity at home and used the monitoring of falls to enlarge awareness of the importance of falls for PwPD. Based on the interview data of all participants, we drafted three user profiles for PwPD regarding the benefits of remote monitoring for physiotherapy: for profile 1, a monitoring system could act as a flagging dashboard to signal the need for renewed treatment; for profile 2, a monitoring system could be a motivational tool to maintain physical activity; for profile 3, a monitoring system could passively track physical activity and falls at home. Finally, for a subgroup of PwPD the burdens of monitoring will outweigh the benefits.

Conclusions: Overall, both PwPD and physiotherapists underline the potential of a remote monitoring system to support physiotherapy by targeting physical activity and (near-)falls. Our findings emphasize the importance of personalization in remote monitoring technology, as illustrated by our user profiles.

Keywords: Parkinson's disease; falls; personalized care; physical activity; physiotherapy; remote monitoring; telemedicine; wearable electronic devices.

Grants and funding

The Radboudumc Center of Expertise for Parkinson & Movement Disorders is supported by the Center of Excellence grant from the Parkinson's Foundation. RB and MM were supported by the Gatsby Foundation [GAT3676] as well as by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. This activity has received funding from the European Institute of Innovation and Technology (EIT). This body of the European Union receives support from the European Union's Horizon 2020 research and innovation program. The Vital@Home project was part of EIT Digital, grant numbers 17158 and 18146.