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Validation of a home environment test battery for supporting assessments in advanced Parkinson’s disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
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2012 (English)In: Neurological Sciences, ISSN 1590-1874, E-ISSN 1590-3478, Vol. 33, no 4, 831-838 p.Article in journal (Refereed) Published
Abstract [en]

Test sequences in a test battery for Parkinson's disease patients, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting, during week-long test periods and results were summarized in an 'overall score'. 35 patients in stable and fluctuating conditions (15 age- and gender-matched pairs) used the test battery for 1 week, and were then assessed with UPDRS and PDQ-39. This procedure was repeated 1 week later, without treatment changes. Reliability was assessed by intraclass correlation coefficients and Cronbach's alpha. Convergent validity was assessed by Spearman rank correlations and known-groups' validity, by the Mann-Whitney test. According to anonymous usability questionnaires, the patients could easily complete the tasks. Median compliance (93%) and test-retest reliability (0.88) were good. The correlations between overall score and total UPDRS (-0.64) and PDQ-39 (-0.72) were adequate. Median overall score was 18% better in the stable compared to the fluctuating group (p = 0.0014).

Place, publisher, year, edition, pages
2012. Vol. 33, no 4, 831-838 p.
Keyword [en]
Parkinson’s disease, Motor fluctuations, Telemedicine, Self-assessment, Motor tests, Validity
National Category
Biomedical Laboratory Science/Technology Neurology
Research subject
Medical Informatics; Neurology
URN: urn:nbn:se:uu:diva-132632DOI: 10.1007/s10072-011-0844-5ISI: 000306551000015OAI: oai:DiVA.org:uu-132632DiVA: diva2:358653
Available from: 2010-10-23 Created: 2010-10-23 Last updated: 2012-08-20Bibliographically approved
In thesis
1. Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
Open this publication in new window or tab >>Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Beslutsstöd för behandling av patienter med avancerad Parkinsons sjukdom
Abstract [en]

The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms.

A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease.

Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 621
Parkinson’s disease, telemedicine, motor test, tapping, spiral, self-assessment, home-assessment, outcome measure, electronic diary, patient-reported outcome, remote patient monitoring, levodopa, infusion, pharmacokinetic, pharmacodynamic
National Category
Biomedical Laboratory Science/Technology
Research subject
Medical Informatics
urn:nbn:se:uu:diva-132635 (URN)978-91-554-7947-3 (ISBN)
Public defence
2010-12-18, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:00 (Swedish)
Available from: 2010-11-26 Created: 2010-10-23 Last updated: 2011-01-13Bibliographically approved

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