Better living thanks to telemedicine – "TelePark"- project targets patients with Parkinson’s disease

Parkinson's disease is a progressive nervous system disorder that primarily affects movement of patients and makes their everyday lives very challenging. It also makes regular doctor appointments and treatment sessions necessary. "TelePark" - a project that collects different movement-related parameters using sensors and apps is designed to improve the quality of life for Parkinson’s patients.

In this MEDICA-tradefair.com interview, Dr. Loewenbrück talks about the guiding idea of the TelePark Project, describes how it works and explains why the TelePark concept also offers great benefits when applied to other chronic diseases.

Which guiding idea prompted the "TelePark" Project?

Dr. Kai Loewenbrück: The guiding idea is that Parkinson's patients require specialist care services at a certain stage of the disease. As physicians, our core responsibility is to make equity in health a priority and safeguard it in the future in light of an increasing number of patients. Not only is this our conviction but it is also demanded by the Movement Disorder Society as our professional organization. This can only work if we consistently implement telemedicine programs and processes.

How is the telemedicine-based care concept and doctor-patient interaction meant to work?

Loewenbrück: It predominantly requires multimodal interaction. We plan to use different approaches to telemedicine. On the one hand, we plan to conduct medical consultations with patients through video conferences, and on the other hand, we propose to monitor patients thanks to sensors they wear every day without the need for them to do anything beyond that. What’s more, our app can ask patients to run specific tests or simply to provide information about any symptoms.

Which symptoms are being captured in this setting?

Loewenbrück: There are many different symptoms associated with Parkinson's disease. This includes symptoms of mobility problems, such as slowing of movement or gait impairments. But there are also a variety of non-motor symptoms of this disease. These must also be detected. They range from impulsive-compulsive disorders, such as gambling or shopping addiction, which can be easily monitored thanks to changes in smartphone usage, to the appearance of hallucinations, psychosis, delusions and depression. All of them are important aspects that affect the treatment plan.

How do you recognize symptoms that are undetectable by sensors?

Loewenbrück: They are detected by analyzing routine smartphone use for example. The idea here is not to track any websites patients visit but whether there are temporal fluctuations in smartphone usage. All patients undergo longitudinal monitoring where we compare the data of the individual patients. It’s easy to imagine that an impulse control disorder can cause the patient to use his/her phone non-stop. However, the number of phone calls is likely to decrease if the patient is depressed and he/she may stop using messenger services altogether. The project objective is to find methods that collect relevant information but are manageable and realistic for patients at the same time. An alternative would be to send all patients a questionnaire each day, asking questions like "Do you have problems controlling your behavior?" However, patients would likely not want to participate. If we use questionnaires to monitor the disease, patients may be willing to respond only once a month. Incidentally, we will also go this route because there are many validated and tried and tested survey tools available in this area. Patients are asked to regularly complete them via an app. This is ultimately about striking the right balance between high data quality and patient acceptance and the best approach to achieve it.

How do patients know when they should wear the motion sensors? Are there any guidelines?

Loewenbrück: There are reference points of preceding similarly designed projects with which we work in close collaboration. Needless to say, it always depends on what you want to identify. For some parameters, you may have to average data over a longer period of time to obtain clean data. This always depends on the power of the technology, such as battery life and type of sensors for example. The goal is to automatically prompt patients via an app to routinely use specific modules of our telemedicine approach, either by wearing different sensors, completing questionnaires or by performing active tests using a smartphone or tablet.

The sensor-collected parameters are automatically transmitted to physicians. On average, how long does it take from parameter transmission to the analysis/documentation of the results?

Loewenbrück: You have established gait parameters, for example, which can be extracted from the raw data that has been collected by the sensors. Ultimately, the length of time depends on how long you have to collect the data to be able to extract the parameters. For example, if data averaging requires several hours or even days, we will obtain a result after this time. This is always dependent on the examined parameters. The idea is that the parameter data is continuously and as quickly available as possible. Patients exhibiting the highest intra-individual standard deviations should be automatically prioritized and signaled to doctors.

How do patients benefit from participating in the project?

Loewenbrück: This is planned as a randomized controlled trial – patients are randomly assigned to the telemedicine arm, while other patients are randomly assigned to a control arm. We postulate that the regularity of care provided by telemedicine including video consultations can improve the quality of life. This is due to better symptom management thanks to a frequent and patient-centered personalized approach to treatment.

What would be the next steps if the project proves successful?

Loewenbrück: If the project is a great success, it should provide a long-term basis for telemedicine-based communication with Parkinson's patients in our region. We will also try to coordinate our project with similar projects as much as possible. Our goal here is to collaborate because we do not want to create a point solution.

Aside from connecting Parkinson’s patients with specialists, can the "TelePark" Project also be applied to other diseases?

Loewenbrück: Definitely. Parkinson's disease is a model to help develop telemedicine-based approaches because it involves a lot of information that enables us to directly offer a patient benefit. This also applies to all other chronic diseases where physicians depend on in-depth knowledge of their patients to provide the best care. There is also a high level of motivation to develop effective concepts for other chronic diseases.