Objective: The aim of this randomized controlled study was to assess the effect of the electronic medication dispenser, Medido, on physical limitations in PD.

Background: Complex medication schedules in PD result in a lower therapy adherence. This contributes to suboptimal therapy and clinical deterioration. Medication reminder systems might improve therapy adherence and subsequently improve symptoms of PD.

Methods: PD patients with inclusion criteria age>40, a minimum of 4 moments of medication intake each day and experiencing on-off fluctuations, were randomized into the Medido group or the control group. The primary outcome ‘physical disability’ was measured by the AMC Linear Disability Scale (ALDS). Score ranges from 0 (worst) to 100 (best). Secondary outcomes were QoL (PDQ-39; 39 items, 0 best, 100 worst), experienced health status (EQ5D, VAS), non-motor symptoms (NMS-Quest), late motor symptoms (MDS-UPDRS-4) and QoL of the caregiver (PDQ-carer). Measurements were performed at baseline, 3 and 6 months follow-up.

Results: Seventy-eight patients were randomized. A non-significant improvement of 3.0 points (95% CI -5.6;11.6) was seen in ALDS after 6 months in the Medido group compared to the control group. In exploratory sub analyses, patients with H&Y classification >2.5 improved significantly with 14.7 points on ALDS compared to the control group (CI -28.5;-0.9, p=0.029). Numerically beter scores were seen in age >70 years (5.28 points, CI -20.7;10.1), disease duration >5 years (8.23 points, CI -21.7;5.2) and when not receiving help from a caregiver (7.82 points, CI -18.7;3.0). Overall, QoL in PDQ-39 deteriorated 1.0 (p=0.01), which was largely attributed to deterioration on stigma domain (12.5, p=0.125). This effect was particularly seen in H&Y<2.5 and patients <70 years. Patients >70 years improved in the domain cognition and significantly in emotional wellbeing (5.1 points, CI -4.9;15.09, p=0.016). The MDS-UPDRS-4 shows a tendency towards reduced frequency and a smaller amplitude of the on-off fluctuations when using the Medido. Overall, no effect was observed on VAS, EQ5D, NMS-quest and PDQ-carer scales.

Conclusions: Use of the Medido results in a clinical improvement of physical disability and seems particularly appropriate for the older and more severe patient. Stigmatisation offsets the clinical effects in the younger, uncomplicated patient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-and-feasibility-study-of-the-medido-eletronic-medication-dispenser-in-parkinsons-disease-a-multicentre-randomized-controlled-trial/