Objective: To assess whether information obtained from Parkinson’s Kinetigraph (PKG) influences clinical decision-making.

Background: PKG is a relatively new technology: the device is worn continuously for 6-10 days in the home environment and records data on motor function, offers dose alerts and can register medication use. Graphical representation of motor patterns (bradykinesias and dyskinesias) is produced and information can be gained about immobility, somnolence, propensity to impulsiveness and responsiveness to medication.

Methods: A descriptive study of 70 patients attending a hospital-based movement disorder clinic between December 2015 and February 2017, all of whom had PKG data requested by the examining physician as part of routine care. All patients had a diagnosis of PD with either self-reported severe or worsening symptomatology, or an uncertain response to a treatment change and a clinical query over the next best management course. Clinicians were asked to record their proposed management before and after PKG data was available to them.

Results: Data from 70 patients were analysed. The median age was 65 years and 40 (53%) of patients were male. 68 (94%) patients were living in own home. 51 (74%) of the patients had Hoehn and Yahr rating between 2 and 3. Median time from diagnosis was 6.9 years. Increasing symptoms and wearing-off were the commonest reasons for undertaking PKG. Kinetigraph analysis was consistent with clinical impression in 53 patients (76%). It gave additional clinically-relevant information in 18 (25%) patients (unidentified brady- or dyskinesia). Clinical decision changed in 24 (34%) patients based on the results of PKG. 4 (6%) patients clinically considered to require an advanced treatment had current medication titrated instead. 5 (7%) patients in whom advanced treatments were not being considered pre-PKG, were deemed to require them and were subsequently referred. In 2 patients the PKG demonstrated a poor response to medication which led to revision of the diagnosis.

Conclusions: Patient management has actively changed based on PKG information for a significant number of patients in this clinic cohort. The PKG may allow better identification of individuals needing more complex therapies, as well as facilitating medication changes that may delay the need for such treatments. Such outcomes may improve quality of life for the individuals as well as improving cost-efficiency in the service.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-the-parkinsons-kinetigraph-change-clinical-practice/