Pahwa Rajesh, Bergquist Filip, Horne Malcolm, Minshall Michael E
1University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA.
2University of Gothenburg, Box 431 40530 Gothenburg, Sweden.
J Clin Mov Disord. 2020 Apr 30;7:5. doi: 10.1186/s40734-020-00087-6. eCollection 2020.
The Personal KinetiGraph® (PKG®) Movement Recording System provides continuous, objective, ambulatory movement data during routine daily activities and provides information on medication compliance, motor fluctuations, immobility, and tremor for patients with Parkinson's disease (PD). Recent evidence has proposed targets for treatable symptoms. Indications for PKG vary by country and patient selection varies by physician.
The analyses were based upon 27,834 complete and de-identified PKGs from January 2012 to August 2018 used globally for routine clinical care. Median scores for bradykinesia (BKS) and dyskinesia (DKS) as well as percent time with tremor (PTT) and percent time immobile (PTI) were included as well as proportions of PKGs above published PKG summary score target values (BKS > 25, DKS > 9, PTT > 1%, PTI > 10%). Two sub-analyses included subjects who had 2+ PKG records and scores above proposed BKS and DKS targets, respectively, on their first PKG. Median BKS and DKS scores for subsequent PKGs (1st, 2nd, etc.) were summarized and limited to those with 100+ subsequent PKGs for each data point.
Significant differences between countries were found for all 4 PKG parameter median scores (all ). Overall, 54% of BKS scores were > 25 and ranged from 46 to 61% by country. 10% of all DKS scores were > 9 and ranged from 5 to 15% by country. Sub-analysis for BKS showed global median BKS and DKS scores across subsequent PKGs for subjects who had 2+ PKGs and had BKS > 25 on their first PKG. There were significant changes in BKS from 1st to 2nd-6th PKGs Sub-analysis for DKS showed global median BKS & DKS scores across subsequent PKGs for subjects who had 2+ PKGs and had DKS > 9 on their first PKG. There were significant changes in DKS from 1st to 2nd and 3rd PKGs .
This analysis shows that in every country evaluated a meaningful proportion of patients have sub-optimal PD motor symptoms and substantial variations exist across countries. Continuous objective measurement (COM) in routine care of PD enables identification and quantification of PD motor symptoms, which can be used to enhance clinical decision making, track symptoms over time and improve PD symptom scores. Thus, clinicians can use these PKG scores during routine clinical management to identify PD symptoms and work to move patients into a target range or a more controlled symptom state.
个人运动记录仪（PKG®）运动记录系统可在日常活动期间提供连续、客观的动态运动数据，并为帕金森病（PD）患者提供有关药物依从性、运动波动、运动不能和震颤的信息。最近的证据提出了可治疗症状的目标。PKG的适应症因国家而异，患者选择也因医生而异。
分析基于2012年1月至2018年8月在全球用于常规临床护理的27834份完整且匿名的PKG数据。纳入了运动迟缓（BKS）和异动症（DKS）的中位数评分，以及震颤时间百分比（PTT）和静止时间百分比（PTI），以及高于已发表的PKG综合评分目标值（BKS>25、DKS>9、PTT>1%、PTI>10%）的PKG比例。两项亚分析分别纳入了在首次PKG时有2份及以上PKG记录且评分高于提议的BKS和DKS目标的受试者。汇总了后续PKG（第1次、第2次等）的BKS和DKS中位数评分，并将每个数据点限制为有100份及以上后续PKG的受试者。
在所有4个PKG参数中位数评分方面，各国之间均存在显著差异（均）。总体而言，54%的BKS评分>25，各国范围为46%至61%。所有DKS评分的10%>9，各国范围为5%至15%。对BKS的亚分析显示，对于有2份及以上PKG且首次PKG时BKS>25的受试者，后续PKG的全球BKS和DKS中位数评分。从第1次到第2次至第6次PKG，BKS有显著变化。对DKS的亚分析显示，对于有2份及以上PKG且首次PKG时DKS>9的受试者，后续PKG的全球BKS和DKS中位数评分。从第1次到第2次和第3次PKG，DKS有显著变化。
该分析表明，在每个评估的国家中，都有相当比例的患者存在次优的PD运动症状，且各国之间存在很大差异。在PD常规护理中进行连续客观测量（COM）能够识别和量化PD运动症状，可用于加强临床决策、随时间跟踪症状并改善PD症状评分。因此，临床医生在常规临床管理期间可使用这些PKG评分来识别PD症状，并努力使患者进入目标范围或症状更可控的状态。
