Objective: This pragmatic randomized open trial evaluated if the information from a Parkinson Kinetigraph (PKG) recording changed the management of PD patients at a visit to the physician within 4 months and if PKG information had any impact on objective or self-assessed outcome three months later.

Background: The PKG provides objective information about Parkinson related movement patterns. Open studies indicate that the use of PKG at movement disorder centres can improve outcome and quality of life [1,2]. The WestPORTS study is a population representative cohort study where patients with PD in West Sweden are regularly assessed with PKG and self-ratings.

Method: Patients in the WestPORTS study were recruited to this substudy if they had not previously used the PKG. Patients were randomly assigned to one of two groups, the intervention group where the managing physician received the PKG report and a short interpretation before next visit (within 16W), and the control group where the managing physician instead received the results of the patients’ PDQ8 and NMSQ self rating. At the visit the physician filled out a short questionnaire about the perceived treatment effect and whether management should be changed or not. Patients were re-evaluated with PKG and self ratings 3 months after the visit. Changes in medication between visit and follow up were identified based on medical records and reported use. The study is registered at ClinicalTrials.gov: NCT03152721.

Results: Out of the 150 patients randomized (75 per group), 121 had an appointment in time (59 control, 61 intervention). Over 2/3 of patients in each group could be classified as “uncontrolled” based on the PKG. There was no difference in the frequency (primary outcome, X2 = 0.8945, p=0.3443) or type of management change between the two groups. The changes in PKG scores and self-ratings were not different between the groups 3 months after the visit. An explorative analysis of patients with ≥6 years disease duration provided similar  results.

Conclusion: This randomized trial demonstrated no difference in management when the physician was provided with a PKG recording instead of information from PDQ8 and NMSQ at a regular visit. Physicians in this study were neurologists or geriatricians, but most were not movement disorder specialists. The results could tentatively reflect limited strategies for acting on information about poorly controlled symptoms.

References: 1. Farzanehfar P, Woodrow H, Braybrook M, McGregor S, Evans A, Nicklason F, et al. Objective measurement in routine care of people with Parkinson’s disease improves outcomes. NPJ Parkinson’s Disease. 2018. doi:10.1038/s41531-018-0046-4 2. Johansson D, Ericsson A, Johansson A, Medvedev A, Nyholm D, Ohlsson F, et al. Individualization of levodopa treatment using a microtablet dispenser and ambulatory accelerometry. CNS Neurosci Ther. 2018;24: 439–447.

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