Objective: To objectively assess mobility and gait parameters in the ON and OFF state in patients with advanced Parkinson’s disease (PD) under everyday conditions using a recording device.

Background: Assessing motor fluctuations in advanced PD patients in the outpatient setting can be time-consuming and challenging. Usually, clinicians must rely on historical information provided by the patient and caregivers, and diaries when assessing motor fluctuations and their impact on the patients’ mobility. This information is often subject to several biases, yet it is the basis for deciding if the current therapy is sufficient for controlling motor fluctuations or whether an invasive therapy might be indicated. An objective assessment would be very desirable in order to overcome the limitations of historical data and diaries.

Method: 147 PD patients with motor fluctuations were recorded over a period of at least 7 days using a Class IIa wearable medical device over the left hip bone analysing inertial signals with a set of validated machine learning algorithms running in real time. Data of interest were ON time, OFF time, dyskinesia, paces per hour in OFF and ON stage, cadence, and stride length. Each patient was on their individually optimised medication, which was not modified during this period.

Results: The recording revealed considerable motor fluctuations with an average ON of 40.7% (SD 14.1), dyskinesia of 16.5% (SD 14.9), and OFF of 10.5% (SD 6.7). For data of different Hoehn & Yahr (H&Y) stages see table 1. The number of paces per hour in ON was twice as high as in OFF (726.2 (SD 424.1) versus 315.7 (SD 320.5); significant differences were found only in the H&Y 2, 2.5, and 3 stages. Stride length and cadence did not vary within the H&Y groups.

Conclusion: The use of a wearable medical device analysing mobility patterns and gait parameters may provide objective information on the extent of motor fluctuations in the home environment and may facilitate the identification of individual patients who may benefit from invasive therapies.

Table 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/device-aided-recording-of-gait-parameters-and-motor-fluctuations-in-patients-with-advanced-parkinsons-disease-in-the-home-environment/