Lakshminarayana Rashmi, Wang Duolao, Burn David, Chaudhuri K Ray, Galtrey Clare, Guzman Natalie Valle, Hellman Bruce, Pal Suvankar, Stamford Jon, Steiger Malcolm, Stott R W, Teo James, Barker Roger A, Wang Emma, Bloem Bastiaan R, van der Eijk Martijn, Rochester Lynn, Williams Adrian
uMotif Ltd, London, UK.
Liverpool School of Tropical Medicine, Liverpool, UK.
NPJ Parkinsons Dis. 2017 Jan 9;3:2. doi: 10.1038/s41531-016-0003-z. eCollection 2017.
The progressive nature of Parkinson's disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson's disease patients, making it difficult to comprehensively address non-adherence. Here we share the results from a multi-centre (seven centres) randomised controlled trial conducted in England and Scotland to assess the impact of using a smartphone-based Parkinson's tracker app to promote patient self-management, enhance treatment adherence and quality of clinical consultation. Eligible Parkinson's disease patients were randomised using a 1:1 ratio according to a computer-generated random sequence, stratified by centre and using blocks of variable size, to intervention Parkinson's Tracker App or control (Treatment as Usual). Primary outcome was the self-reported score of adherence to treatment (Morisky medication adherence scale -8) at 16 weeks. Secondary outcomes were Quality of Life (Parkinson's disease questionnaire -39), quality of consultation for Parkinson's disease patients (), impact on non-motor symptoms (Non-motor symptoms questionnaire), depression and anxiety (Hospital anxiety and depression scale) and beliefs about medication (Beliefs about Medication Questionnaire) at 16 weeks. Primary and secondary endpoints were analysed using a generalised linear model with treatment as the fixed effect and baseline measurement as the covariate. 158 patients completed the study (Parkinson's tracker app = 68 and TAU = 90). At 16 weeks Parkinson's tracker app significantly improved adherence, compared to treatment as usual (mean difference: 0.39, 95%CI 0.04-0.74; = 0.0304) with no confounding effects of gender, number of comorbidities and age. Among secondary outcomes, Parkinson's tracker app significantly improved patients' perception of quality of consultation (0.15, 95% CI 0.03 to 0.27; = 0.0110). The change in non-motor symptoms was -0.82 (95% CI -1.75 to 0.10; = 0.0822). 72% of participants in the Parkinson's tracker app group continued to use and engage with the application throughout the 16-week trial period. The Parkinson's tracker app can be an effective and novel way of enhancing self-reported medication adherence and quality of clinical consultation by supporting self-management in Parkinson's disease in patients owning smartphones. Further work is recommended to determine whether the benefits of the intervention are maintained beyond the 16 week study period.
帕金森病的渐进性、复杂的治疗方案以及高共病率使得自我管理和治疗依从性成为一项挑战。临床医生与帕金森病患者面对面咨询的时间有限，难以全面解决治疗不依从问题。在此，我们分享一项在英格兰和苏格兰进行的多中心（七个中心）随机对照试验的结果，以评估使用基于智能手机的帕金森病追踪应用程序对促进患者自我管理、提高治疗依从性和临床咨询质量的影响。符合条件的帕金森病患者根据计算机生成的随机序列按1:1比例随机分组，按中心分层并使用不同大小的区组，分为干预组（帕金森病追踪应用程序）或对照组（常规治疗）。主要结局是16周时自我报告的治疗依从性评分（莫里西药物依从性量表 -8）。次要结局包括16周时的生活质量（帕金森病问卷 -39）、帕金森病患者的咨询质量、对非运动症状的影响（非运动症状问卷）、抑郁和焦虑（医院焦虑抑郁量表）以及对药物的信念（药物信念问卷）。使用以治疗为固定效应、基线测量为协变量的广义线性模型分析主要和次要终点。158名患者完成了研究（帕金森病追踪应用程序组 = 68人，常规治疗组 = 90人）。在16周时，与常规治疗相比，帕金森病追踪应用程序显著提高了依从性（平均差异：0.39，95%置信区间0.04 - 0.74；P = 0.0304），且不存在性别、共病数量和年龄的混杂效应。在次要结局中，帕金森病追踪应用程序显著改善了患者对咨询质量的感知（0.15，95%置信区间0.03至0.27；P = 0.0110）。非运动症状的变化为 -0.82（95%置信区间 -1.75至0.10；P = 0.0822）。在16周的试验期内，帕金森病追踪应用程序组72%的参与者继续使用并参与该应用程序。对于拥有智能手机的帕金森病患者，帕金森病追踪应用程序通过支持自我管理，可以成为提高自我报告的药物依从性和临床咨询质量的一种有效且新颖的方式。建议进一步开展工作，以确定干预的益处是否能在16周研究期之后持续存在。
