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This review screened 296 articles on wearable sensors for home monitoring of people with Parkinson's Disease within the PubMed Database, from January 2017 to May 2023. A three-level maturity framework was applied for classifying the aims of 59 studies included: demonstrating technical efficacy, diagnostic sensitivity, or clinical utility. As secondary analysis, user experience (usability and patient adherence) was evaluated. The evidences provided by the studies were categorized and stratified according to the level of maturity. Our results indicate that approximately 75% of articles investigated diagnostic sensitivity, i.e. correlation of sensor-data with clinical parameters. Evidence of clinical utility, defined as improvement on health outcomes or clinical decisions after the use of the wearables, was found only in nine papers. A third of the articles included reported evidence of user experience. Future research should focus more on clinical utility, to facilitate the translation of research results within the management of Parkinson's Disease.
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BACKGROUND: Prolonged levodopa treatment in Parkinson's disease (PD) often leads to motor complications, including levodopa-induced dyskinesia (LID). Despite continuous levodopa treatment, some patients do not develop LID symptoms, even in later stages of the disease. OBJECTIVE: This study explores machine learning (ML) methods using baseline clinical characteristics to predict the development of LID in PD patients over four years, across multiple cohorts. METHODS: Using interpretable ML approaches, we analyzed clinical data from three independent longitudinal PD cohorts (LuxPARK, n = 356; PPMI, n = 484; ICEBERG, n = 113) to develop cross-cohort prognostic models and identify potential predictors for the development of LID. We examined cohort-specific and shared predictive factors, assessing model performance and stability through cross-validation analyses. RESULTS: Consistent cross-validation results for single and multiple cohort analyses highlighted the effectiveness of the ML models and identified baseline clinical characteristics with significant predictive value for the LID prognosis in PD. Predictors positively correlated with LID include axial symptoms, freezing of gait, and rigidity in the lower extremities. Conversely, the risk of developing LID was inversely associated with the occurrence of resting tremors, higher body weight, later onset of PD, and visuospatial abilities. CONCLUSIONS: This study presents interpretable ML models for dyskinesia prognosis with significant predictive power in cross-cohort analyses. The models may pave the way for proactive interventions against dyskinesia in PD by optimizing levodopa dosing regimens and adjunct treatments with dopamine agonists or MAO-B inhibitors, and by employing non-pharmacological interventions such as dietary adjustments affecting levodopa absorption for high-risk LID patients.
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Antiparkinsonianos , Discinesia Induzida por Medicamentos , Levodopa , Aprendizado de Máquina , Doença de Parkinson , Humanos , Levodopa/efeitos adversos , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Discinesia Induzida por Medicamentos/etiologia , Masculino , Feminino , Idoso , Antiparkinsonianos/efeitos adversos , Pessoa de Meia-Idade , Prognóstico , Estudos de Coortes , Estudos LongitudinaisRESUMO
The progression of Parkinson's disease (PD) is heterogeneous across patients, affecting counseling and inflating the number of patients needed to test potential neuroprotective treatments. Moreover, disease subtypes might require different therapies. This work uses a data-driven approach to investigate how observed heterogeneity in PD can be explained by the existence of distinct PD progression subtypes. To derive stable PD progression subtypes in an unbiased manner, we analyzed multimodal longitudinal data from three large PD cohorts and performed extensive cross-cohort validation. A latent time joint mixed-effects model (LTJMM) was used to align patients on a common disease timescale. Progression subtypes were identified by variational deep embedding with recurrence (VaDER). In each cohort, we identified a fast-progressing and a slow-progressing subtype, reflected by different patterns of motor and non-motor symptoms progression, survival rates, treatment response, features extracted from DaTSCAN imaging and digital gait assessments, education, and Alzheimer's disease pathology. Progression subtypes could be predicted with ROC-AUC up to 0.79 for individual patients when a one-year observation period was used for model training. Simulations demonstrated that enriching clinical trials with fast-progressing patients based on these predictions can reduce the required cohort size by 43%. Our results show that heterogeneity in PD can be explained by two distinct subtypes of PD progression that are stable across cohorts. These subtypes align with the brain-first vs. body-first concept, which potentially provides a biological explanation for subtype differences. Our predictive models will enable clinical trials with significantly lower sample sizes by enriching fast-progressing patients.
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INTRODUCTION: Gait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot study demonstrated a significant improvement of gait in patients with MSA of parkinsonian type (MSA-P) after physiotherapy and matching home-based exercise, as reflected by sensor-based gait parameters. In this study, we aim to investigate whether a gait-focused physiotherapy (GPT) and matching home-based exercise lead to a greater improvement of gait performance compared with a standard physiotherapy/home-based exercise programme (standard physiotherapy, SPT). METHODS AND ANALYSIS: This protocol was deployed to evaluate the effects of a GPT versus an active control undergoing SPT and matching home-based exercise with regard to laboratory gait parameters, physical activity measures and clinical scales in patients with Parkinson's disease (PD), MSA-P and PSP. The primary outcomes of the trial are sensor-based laboratory gait parameters, while the secondary outcome measures comprise real-world derived parameters, clinical rating scales and patient questionnaires. We aim to enrol 48 patients per disease group into this double-blind, randomised-controlled trial. The study starts with a 1 week wearable sensor-based monitoring of physical activity. After randomisation, patients undergo a 2 week daily inpatient physiotherapy, followed by 5 week matching unsupervised home-based training. A 1 week physical activity monitoring is repeated during the last week of intervention. ETHICS AND DISSEMINATION: This study, registered as 'Mobility in Atypical Parkinsonism: a Trial of Physiotherapy (Mobility_APP)' at clinicaltrials.gov (NCT04608604), received ethics approval by local committees of the involved centres. The patient's recruitment takes place at the Movement Disorders Units of Innsbruck (Austria), Erlangen (Germany), Lausanne (Switzerland), Luxembourg (Luxembourg) and Bolzano (Italy). The data resulting from this project will be submitted to peer-reviewed journals, presented at international congresses and made publicly available at the end of the trial. TRIAL REGISTRATION NUMBER: NCT04608604.
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Terapia por Exercício , Transtornos Parkinsonianos , Modalidades de Fisioterapia , Humanos , Terapia por Exercício/métodos , Transtornos Parkinsonianos/reabilitação , Transtornos Parkinsonianos/terapia , Método Duplo-Cego , Ensaios Clínicos Controlados Aleatórios como Assunto , Marcha , Doença de Parkinson/reabilitação , Doença de Parkinson/terapia , Atrofia de Múltiplos Sistemas/reabilitação , Atrofia de Múltiplos Sistemas/terapia , Paralisia Supranuclear Progressiva/terapia , Paralisia Supranuclear Progressiva/reabilitação , Serviços de Assistência Domiciliar , Idoso , Masculino , Feminino , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologiaRESUMO
BACKGROUND: The Comprehensive Geriatric Assessment (CGA) records geriatric syndromes in a standardized manner, allowing individualized treatment tailored to the patient's needs and resources. Its use has shown a beneficial effect on the functional outcome and survival of geriatric patients. A recently published German S1 guideline for level 2 CGA provides recommendations for the use of a broad variety of different assessment instruments for each geriatric syndrome. However, the actual use of assessment instruments in routine geriatric clinical practice and its consistency with the guideline and the current state of literature has not been investigated to date. METHODS: An online survey was developed by an expert group of geriatricians and sent to all licenced geriatricians (n = 569) within Germany. The survey included the following geriatric syndromes: motor function and self-help capability, cognition, depression, pain, dysphagia and nutrition, social status and comorbidity, pressure ulcers, language and speech, delirium, and frailty. Respondents were asked to report which geriatric assessment instruments are used to assess the respective syndromes. RESULTS: A total of 122 clinicians participated in the survey (response rate: 21%); after data cleaning, 76 data sets remained for analysis. All participants regularly used assessment instruments in the following categories: motor function, self-help capability, cognition, depression, and pain. The most frequently used instruments in these categories were the Timed Up and Go (TUG), the Barthel Index (BI), the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Visual Analogue Scale (VAS). Limited or heterogenous assessments are used in the following categories: delirium, frailty and social status. CONCLUSIONS: Our results show that the assessment of motor function, self-help capability, cognition, depression, pain, and dysphagia and nutrition is consistent with the recommendations of the S1 guideline for level 2 CGA. Instruments recommended for more frequent use include the Short Physical Performance Battery (SPPB), the Montreal Cognitive Assessment (MoCA), and the WHO-5 (depression). There is a particular need for standardized assessment of delirium, frailty and social status. The harmonization of assessment instruments throughout geriatric departments shall enable more effective treatment and prevention of age-related diseases and syndromes.
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Transtornos de Deglutição , Delírio , Fragilidade , Humanos , Idoso , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Avaliação Geriátrica/métodos , Dor , Inquéritos e QuestionáriosRESUMO
BACKGROUND: During the COVID-19 pandemic swift implementation of research cohorts was key. While many studies focused exclusively on infected individuals, population based cohorts are essential for the follow-up of SARS-CoV-2 impact on public health. Here we present the CON-VINCE cohort, estimate the point and period prevalence of the SARS-CoV-2 infection, reflect on the spread within the Luxembourgish population, examine immune responses to SARS-CoV-2 infection and vaccination, and ascertain the impact of the pandemic on population psychological wellbeing at a nationwide level. METHODS: A representative sample of the adult Luxembourgish population was enrolled. The cohort was followed-up for twelve months. SARS-CoV-2 RT-qPCR and serology were conducted at each sampling visit. The surveys included detailed epidemiological, clinical, socio-economic, and psychological data. RESULTS: One thousand eight hundred sixty-five individuals were followed over seven visits (April 2020-June 2021) with the final weighted period prevalence of SARS-CoV-2 infection of 15%. The participants had similar risks of being infected regardless of their gender, age, employment status and education level. Vaccination increased the chances of IgG-S positivity in infected individuals. Depression, anxiety, loneliness and stress levels increased at a point of study when there were strict containment measures, returning to baseline afterwards. CONCLUSION: The data collected in CON-VINCE study allowed obtaining insights into the infection spread in Luxembourg, immunity build-up and the impact of the pandemic on psychological wellbeing of the population. Moreover, the study holds great translational potential, as samples stored at the biobank, together with self-reported questionnaire information, can be exploited in further research. TRIAL REGISTRATION: Trial registration number: NCT04379297, 10 April 2020.
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COVID-19 , Adulto , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Pandemias , Luxemburgo/epidemiologia , Ansiedade/epidemiologiaRESUMO
BACKGROUND: With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. OBJECTIVE: The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. METHODS: In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. RESULTS: A total number of 450 participants (Mean ageâ=â69.5 years; SDâ=â10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. CONCLUSIONS: We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.
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Doença de Alzheimer , Disfunção Cognitiva , Humanos , Idoso , Luxemburgo/epidemiologia , Disfunção Cognitiva/terapia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Estilo de Vida , Seleção de PacientesRESUMO
Medication optimization is a common component of the treatment strategy in patients with Parkinson's disease. As the disease progresses, it is essential to compensate for the movement deterioration in patients. Conventionally, examining motor deterioration and prescribing medication requires the patient's onsite presence in hospitals or practices. Home-monitoring technologies can remotely deliver essential information to physicians and help them devise a treatment decision according to the patient's need. Additionally, they help to observe the patient's response to these changes. In this regard, we conducted a longitudinal study to collect gait data of patients with Parkinson's disease while they received medication changes. Using logistic regression classifier, we could detect the annotated motor deterioration during medication optimization with an accuracy of 92%. Moreover, an in-depth examination of the best features illustrated a decline in gait speed and swing phase duration in the deterioration phases due to suboptimal medication.Clinical relevance- Our proposed gait analysis method in this study provides objective, detailed, and punctual information to physicians. Revealing clinically relevant time points related to the patient's need for medical adaption alleviates therapy optimization for physicians and reduces the duration of suboptimal treatment for patients. As the home-monitoring system acts remotely, embedding it in the medical care pathways could improve patients' quality of life.
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Doença de Parkinson , Humanos , Doença de Parkinson/tratamento farmacológico , Estudos Longitudinais , Qualidade de Vida , Monitorização Fisiológica , MovimentoRESUMO
BACKGROUND: Exercise therapy is considered effective for the treatment of motor impairment in patients with Parkinson's disease (PD). During the COVID-19 pandemic, training sessions were cancelled and the implementation of telerehabilitation concepts became a promising solution. The aim of this controlled interventional feasibility study was to evaluate the long-term acceptance and to explore initial effectiveness of a digital, home-based, high-frequency exercise program for PD patients. Training effects were assessed using patient-reported outcome measures combined with sensor-based and clinical scores. METHODS: 16 PD patients (smartphone group, SG) completed a home-based, individualized training program over 6-8 months using a smartphone app, remotely supervised by a therapist, and tailored to the patient's motor impairments and capacity. A control group (CG, n = 16) received medical treatment without participating in digital exercise training. The usability of the app was validated using System Usability Scale (SUS) and User Version of the Mobile Application Rating Scale (uMARS). Outcome measures included among others Unified Parkinson Disease Rating Scale, part III (UPDRS-III), sensor-based gait parameters derived from standardized gait tests, Parkinson's Disease Questionnaire (PDQ-39), and patient-defined motor activities of daily life (M-ADL). RESULTS: Exercise frequency of 74.5% demonstrated high adherence in this cohort. The application obtained 84% in SUS and more than 3.5/5 points in each subcategory of uMARS, indicating excellent usability. The individually assessed additional benefit showed at least 6 out of 10 points (Mean = 8.2 ± 1.3). From a clinical perspective, patient-defined M-ADL improved for 10 out of 16 patients by 15.5% after the training period. The results of the UPDRS-III remained stable in the SG while worsening in the CG by 3.1 points (24%). The PDQ-39 score worsened over 6-8 months by 83% (SG) and 59% (CG) but the subsection mobility showed a smaller decline in the SG (3%) compared to the CG (77%) without reaching significance level for all outcomes. Sensor-based gait parameters remained constant in both groups. CONCLUSIONS: Long-term training over 6-8 months with the app is considered feasible and acceptable, representing a cost-effective, individualized approach to complement dopaminergic treatment. This study indicates that personalized, digital, high-frequency training leads to benefits in motor sections of ADL and Quality of Life.
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Doença de Parkinson , Humanos , Doença de Parkinson/terapia , Qualidade de Vida , Smartphone , Estudos de Viabilidade , Pandemias , Resultado do Tratamento , Terapia por Exercício/métodos , Exercício FísicoRESUMO
The European Commission's draft for the European Health Data Space (EHDS) aims to empower citizens to access their personal health data and share it with physicians and other health-care providers. It further defines procedures for the secondary use of electronic health data for research and development. Although this planned legislation is undoubtedly a step in the right direction, implementation approaches could potentially result in centralised data silos that pose data privacy and security risks for individuals. To address this concern, we propose federated personal health data spaces, a novel architecture for storing, managing, and sharing personal electronic health records that puts citizens at the centre-both conceptually and technologically. The proposed architecture puts citizens in control by storing personal health data on a combination of personal devices rather than in centralised data silos. We describe how this federated architecture fits within the EHDS and can enable the same features as centralised systems while protecting the privacy of citizens. We further argue that increased privacy and control do not contradict the use of electronic health data for research and development. Instead, data sovereignty and transparency encourage active participation in studies and data sharing. This combination of privacy-by-design and transparent, privacy-preserving data sharing can enable health-care leaders to break the privacy-exploitation barrier, which currently limits the secondary use of health data in many cases.
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Registros Eletrônicos de Saúde , Médicos , Humanos , Segurança Computacional , Privacidade , Atenção à SaúdeRESUMO
Artificial intelligence (AI) and machine learning (ML) methods are currently widely employed in medicine and healthcare. A PubMed search returns more than 100,000 articles on these topics published between 2018 and 2022 alone. Notwithstanding several recent reviews in various subfields of AI and ML in medicine, we have yet to see a comprehensive review around the methods' use in longitudinal analysis and prediction of an individual patient's health status within a personalized disease pathway. This review seeks to fill that gap. After an overview of the AI and ML methods employed in this field and of specific medical applications of models of this type, the review discusses the strengths and limitations of current studies and looks ahead to future strands of research in this field. We aim to enable interested readers to gain a detailed impression of the research currently available and accordingly plan future work around predictive models for deterioration in health status.
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Inteligência Artificial , Medicina de Precisão , Humanos , Aprendizado de MáquinaRESUMO
Falls are an eminent risk for older adults and especially patients with neurodegenerative disorders, such as Parkinson's disease (PD). Recent advancements in wearable sensor technology and machine learning may provide a possibility for an individualized prediction of fall risk based on gait recordings from standardized gait tests or from unconstrained real-world scenarios. However, the most effective aggregation of continuous real-world data as well as the potential of unsupervised gait tests recorded over multiple days for fall risk prediction still need to be investigated. Therefore, we present a data set containing real-world gait and unsupervised 4x10-Meter-Walking-Tests of 40 PD patients, continuously recorded with foot-worn inertial sensors over a period of two weeks. In this prospective study, falls were self-reported during a three-month follow-up phase, serving as ground truth for fall risk prediction. The purpose of this study was to compare different data aggregation approaches and machine learning models for the prospective prediction of fall risk using gait parameters derived either from continuous real-world recordings or from unsupervised gait tests. The highest balanced accuracy of 74.0% (sensitivity: 60.0%, specificity: 88.0%) was achieved with a Random Forest Classifier applied to the real-world gait data when aggregating all walking bouts and days of each participant. Our findings suggest that fall risk can be predicted best by merging the entire two-week real-world gait data of a patient, outperforming the prediction using unsupervised gait tests (68.0% balanced accuracy) and contribute to an improved understanding of fall risk prediction.
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Doença de Parkinson , Dispositivos Eletrônicos Vestíveis , Humanos , Idoso , Estudos Prospectivos , Marcha , CaminhadaRESUMO
Background: Deep phenotyping of Parkinson's disease (PD) is essential to investigate this fastest-growing neurodegenerative disorder. Since 2015, over 800 individuals with PD and atypical parkinsonism along with more than 800 control subjects have been recruited in the frame of the observational, monocentric, nation-wide, longitudinal-prospective Luxembourg Parkinson's study. Objective: To profile the baseline dataset and to explore risk factors, comorbidities and clinical profiles associated with PD, atypical parkinsonism and controls. Methods: Epidemiological and clinical characteristics of all 1,648 participants divided in disease and control groups were investigated. Then, a cross-sectional group comparison was performed between the three largest groups: PD, progressive supranuclear palsy (PSP) and controls. Subsequently, multiple linear and logistic regression models were fitted adjusting for confounders. Results: The mean (SD) age at onset (AAO) of PD was 62.3 (11.8) years with 15% early onset (AAO < 50 years), mean disease duration 4.90 (5.16) years, male sex 66.5% and mean MDS-UPDRS III 35.2 (16.3). For PSP, the respective values were: 67.6 (8.2) years, all PSP with AAO > 50 years, 2.80 (2.62) years, 62.7% and 53.3 (19.5). The highest frequency of hyposmia was detected in PD followed by PSP and controls (72.9%; 53.2%; 14.7%), challenging the use of hyposmia as discriminating feature in PD vs. PSP. Alcohol abstinence was significantly higher in PD than controls (17.6 vs. 12.9%, p = 0.003). Conclusion: Luxembourg Parkinson's study constitutes a valuable resource to strengthen the understanding of complex traits in the aforementioned neurodegenerative disorders. It corroborated several previously observed clinical profiles, and provided insight on frequency of hyposmia in PSP and dietary habits, such as alcohol abstinence in PD.Clinical trial registration: clinicaltrials.gov, NCT05266872.
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BACKGROUND: Bradykinesia and rigidity are prototypical motor impairments of Parkinson disease (PD) highly influencing everyday life. Exercise training is an effective treatment alternative for motor symptoms, complementing dopaminergic medication. High frequency training is necessary to yield clinically relevant improvements. Exercise programs need to be tailored to individual symptoms and integrated in patients' everyday life. Due to the COVID-19 pandemic, exercise groups in outpatient setting were largely reduced. Developing remotely supervised solutions is therefore of significant importance. OBJECTIVE: This pilot study aimed to evaluate the feasibility of a digital, home-based, high-frequency exercise program for patients with PD. METHODS: In this pilot interventional study, patients diagnosed with PD received 4 weeks of personalized exercise at home using a smartphone app, remotely supervised by specialized therapists. Exercises were chosen based on the patient-defined motor impairment and depending on the patients' individual capacity (therapists defined 3-5 short training sequences for each participant). In a first education session, the tailored exercise program was explained and demonstrated to each participant and they were thoroughly introduced to the smartphone app. Intervention effects were evaluated using the Unified Parkinson Disease Rating Scale, part III; standardized sensor-based gait analysis; Timed Up and Go Test; 2-minute walk test; quality of life assessed by the Parkinson Disease Questionnaire; and patient-defined motor tasks of daily living. Usability of the smartphone app was assessed by the System Usability Scale. All participants gave written informed consent before initiation of the study. RESULTS: In total, 15 individuals with PD completed the intervention phase without any withdrawals or dropouts. The System Usability Scale reached an average score of 72.2 (SD 6.5) indicating good usability of the smartphone app. Patient-defined motor tasks of daily living significantly improved by 40% on average in 87% (13/15) of the patients. There was no significant impact on the quality of life as assessed by the Parkinson Disease Questionnaire (but the subsections regarding mobility and social support improved by 14% from 25 to 21 and 19% from 15 to 13, respectively). Motor symptoms rated by Unified Parkinson Disease Rating Scale, part III, did not improve significantly but a descriptive improvement of 14% from 18 to 16 could be observed. Clinically relevant changes in Timed Up and Go test, 2-minute walk test, and sensor-based gait parameters or functional gait tests were not observed. CONCLUSIONS: This pilot interventional study presented that a tailored, digital, home-based, and high-frequency exercise program over 4 weeks was feasible and improved patient-defined motor activities of daily life based on a self-developed patient-defined impairment score indicating that digital exercise concepts may have the potential to beneficially impact motor symptoms of daily living. Future studies should investigate sustainability effects in controlled study designs conducted over a longer period.
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BACKGROUND: The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN: The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. DISCUSSION: The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. TRIAL REGISTRATION: ISRCTN12051706.
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Fragilidade , Doença de Parkinson , Doença Pulmonar Obstrutiva Crônica , Humanos , Monitorização Fisiológica , Estudos Observacionais como Assunto , Modalidades de FisioterapiaRESUMO
Falls are among the leading causes of injuries or death for the elderly, and the prevalence is especially high for patients suffering from neurological diseases like Parkinson's disease (PD). Today, inertial measurement units (IMUs) can be integrated unobtrusively into patients' everyday lives to monitor various mobility and gait parameters, which are related to common risk factors like reduced balance or reduced lower-limb muscle strength. Although stair ambulation is a fundamental part of everyday life and is known for its unique challenges for the gait and balance system, long-term gait analysis studies have not investigated real-world stair ambulation parameters yet. Therefore, we applied a recently published gait analysis pipeline on foot-worn IMU data of 40 PD patients over a recording period of two weeks to extract objective gait parameters from level walking but also from stair ascending and descending. In combination with prospective fall records, we investigated group differences in gait parameters of future fallers compared to non-fallers for each individual gait activity. We found significant differences in stair ascending and descending parameters. Stance time was increased by up to 20 % and gait speed reduced by up to 16 % for fallers compared to non-fallers during stair walking. These differences were not present in level walking parameters. This suggests that real-world stair ambulation provides sensitive parameters for mobility and fall risk due to the challenges stairs add to the balance and control system. Our work complements existing gait analysis studies by adding new insights into mobility and gait performance during real-world gait.
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Doença de Parkinson , Idoso , Marcha/fisiologia , Humanos , Equilíbrio Postural/fisiologia , Estudos Prospectivos , Caminhada/fisiologiaRESUMO
BACKGROUND AND OBJECTIVES: Hereditary spastic paraplegia (HSP) causes progressive spasticity and weakness of the lower limbs. As neurological examination and the clinical Spastic Paraplegia Rating Scale (SPRS) are subject to potential patient- and clinician-dependent bias, instrumented gait analysis bears the potential to objectively quantify impaired gait. The aim of the present study was to investigate gait cyclicity parameters by application of a mobile gait analysis system in a cross sectional cohort of HSP patients and a longitudinal fast progressing subcohort. METHODS: Using wearable sensors attached to the shoes, HSP patients and controls performed a 4x10 meters walking test during regular visits in three outpatient centers. Patients were also rated according to the SPRS and in a subset, questionnaires on quality of life and fear of falling were obtained. An unsupervised segmentation algorithm was employed to extract stride parameters and respective coefficients of variation. RESULTS: Mobile gait analysis was performed in a total of 112 ambulatory HSP patients and 112 age and gender matched controls. While swing time was unchanged compared to controls, there were significant increases in the duration of the total stride phase and the duration of the stance phase, both regarding absolute values and coefficients of variation values. While stride parameters did not correlate to age, weight or height of the patients, there were significant associations of absolute stride parameters to single SPRS items reflecting impaired mobility (|r| > 0.50), to patients' quality of life (|r| > 0.44), and notably to disease duration (|r| > 0.27). Sensor-derived coefficients of variation, on the other hand, were associated with patient-reported fear of falling (|r| > 0.41) and cognitive impairment (|r| > 0.40). In a small 1-year follow-up analysis of patients with complicated HSP and fast progression, absolute values of mobile gait parameters had significantly worsened compared to baseline. DISCUSSION: The presented wearable sensor system provides parameters of stride characteristics which appear clinically valid to reflect gait impairment in HSP. Due to the feasibility with regard to time, space and costs, the present study forms the basis for larger scale longitudinal and interventional studies in HSP.
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The clinical presentation of Parkinson's disease (PD) is both complex and heterogeneous, and its precise classification often requires an intensive work-up. The differential diagnosis, assessment of disease progression, evaluation of therapeutic responses, or identification of PD subtypes frequently remains uncertain from a clinical point of view. Various tissue- and fluid-based biomarkers are currently being investigated to improve the description of PD. From a clinician's perspective, signatures from blood that are relatively easy to obtain would have great potential for use in clinical practice if they fulfill the necessary requirements as PD biomarker. In this review article, we summarize the knowledge on blood-based PD biomarkers and present both a researcher's and a clinician's perspective on recent developments and potential future applications.
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Doença de Parkinson , Biomarcadores , Diagnóstico Diferencial , Progressão da Doença , Humanos , Doença de Parkinson/diagnóstico , alfa-SinucleínaRESUMO
PURPOSE: We assess feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system. METHODS: Gait parameters of 83 patients (83.34 ± 5.88 years, 58/25 female/male) were recorded at admission and/or discharge to/from two geriatric inpatient wards. Gait parameters were tested for statistically significant differences between admission and discharge. Walking distance measured by a wearable gait analysis system was correlated with distance assessed by physiotherapists. Examiners rated usability using the system usability scale. Patients reported acceptability on a five-point Likert-scale. RESULTS: The total distance measures highly correlate (r = 0.89). System Usability Scale is above the median threshold of 68, indicating good usability. Majority of patients does not have objections regarding the use of the system. Among other gait parameters, mean heel strike angle changes significantly between admission and discharge. CONCLUSION: Wearable gait analysis system is objectively and subjectively usable in a clinical setting and accepted by patients. It offers a reasonably valid assessment of gait parameters and is a feasible way for instrumented gait analysis.