Objective: To establish a robust digital approach that encourages hospitalized Parkinson’s disease (PD) patients to self-report non-motor symptoms throughout inpatient care, and to determine whether reward-based engagement features improve diary adherence.

Background: During inpatient therapy optimization, PD patients are frequently asked to complete multiple non-motor questionnaires covering sleep, mood, pain, and quality of life [1]. These assessments are often paper-based, increasing staff workload and delaying feedback. Digital diaries may reduce administrative burden and enable patient-centered tracking. However, sustained adherence to repeated symptom reporting remains uncertain, particularly when questionnaires are extensive [2].

Method: We developed and evaluated three versions of a digital diary app to increase engagement: Cohort A (Questionnaires-only) with questionnaires and daily support check-ins; Cohort B (Streak), adding a streak feature awarding points for questionnaire completion against a daily goal; and Cohort C (Streak+Games), combining streaks with unlockable mini-games linked to streak progress. To address variable length of stay, primary analyses used events per inpatient day (total events divided by inpatient days). An adjusted regression model examined whether engagement cohort was associated with overall app activity after accounting for standardized age and disease duration, as well as sex.

Results: Seventy-five participants were included: Cohort A: n=26, Cohort: B n=25, and Cohort C: n=24. After normalizing for length of stay (events per inpatient day), overall app activity was higher in reward-feature cohorts (B/C) than in Cohort A (p<0.001) and remained significant after adjustment for age, sex, and disease duration (Cohort B vs A: p=0.003; Cohort C vs A: p<0.001).

Conclusion: Reward-based engagement features were associated with substantially higher daily diary use during inpatient PD care after normalizing for length of stay, independent of demographic and disease-related variables. A simple streak mechanism appeared sufficient to sustain reporting, supporting the feasibility of structured digital non-motor symptom monitoring during PD hospital care.

Higher normalized app activity in reward cohorts

Higher streak intensity in Cohort C than B

Reward features increased daily app activity

References: [1] Shurer J, Golden SLS, Mihas P, Browner N. More than medications: a patient-centered assessment of Parkinson’s disease care needs during hospitalization. Front Aging Neurosci. 2023;15. doi: 10.3389/fnagi.2023.1255428.
[2] Vizcarra JA, Sánchez-Ferro Á, Maetzler W, Marsili L, Zavala L, Lang AE, et al. The Parkinson’s disease e-diary: Developing a clinical and research tool for the digital age. Movement Disorders. 2019;34(5):676–81. doi: 10.1002/mds.27673.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/advancing-regular-non-motor-symptom-reporting-during-inpatient-parkinsons-disease-care-using-a-self-developed-digital-diary-a-three-cohort-engagement-evaluation/