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, 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

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.

Conflict of interest statement

GV was employed at Philips Research at the time of study preparation, data collection, data analysis, and drafting of the manuscript. BB currently serves as co-editor-in-chief for the Journal of Parkinson's Disease, serves on the editorial board of Practical Neurology and Digital Biomarkers, has received honoraria from serving on the scientific advisory board for Abbvie, Biogen, and UCB, has received fees for speaking at conferences from AbbVie, Zambon, Roche, GE Healthcare, and Bial, and has received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, UCB, Not Impossible, the Hersenstichting Nederland, the Parkinson's Foundation, Verily Life Sciences, Horizon 2020, and the Parkinson Vereniging (all paid to the institute). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 van den Bergh, Evers, de Vries, Silva de Lima, Bloem, Valenti and Meinders.

Figures

Figure 1
Figure 1
The Philips lifeline GoSafe necklace.
Figure 2
Figure 2
The Vital@Home application for persons with PD in pilot 1 (A-D) and pilot 2 (E, F), including the homepage of the app displaying progress toward physical activity goals (A), the manual entry of activities (B), a part of the fall questionnaire (C), the medication registration (D), and the reworked activity (E) and step count (F) homepage for pilot 2. *Translation of 2d: Add medications (top); Which medication? How many did you take? At what time? (questions in the middle); Confirm medication intake (bottom).
Figure 3
Figure 3
Overview of study procedures and measured outcomes. The procedures were completed twice. PT, physiotherapist. PwPD, persons with Parkinson's disease. NFOG-Q, New Freezing of Gait Questionnaire, self-reported amount of FOG moments in the past month. FTSTS, Five Times Sit To Stand, measures balance during transfers. Mini-BESTest, Mini Balance Evaluation Systems Test, measures static and dynamic balance. TUG, Timed Up & Go, measures functional mobility. SMW, Six Meter Walk, measures comfortable walking speed, for pragmatic reasons shortened version of 10 Meter Walk. SUS, System Usability Scale, measures perceived usability of the system.
Figure 4
Figure 4
Frequency distribution of the number of compliant days for all persons with Parkinson's disease (PwPDs) wearing the GoSafe necklace in pilot 1 (A) and pilot 2 (B).

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