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Using A Smartphone Based Self-Management Platform To Support Medication Adherence And Clinical Consultation In Parkinson’s Disease Results From The Smart-PD Randomised Controlled Trial

2016; Elsevier BV; Volume: 19; Issue: 7 Linguagem: Inglês

10.1016/j.jval.2016.09.2027

1524-4733

R Lakshminarayana, D Wang, David J. Burn, К. Ray Chaudhuri, Bruce Hellman, I SMART-PD Investigators,

Parkinson's Disease Mechanisms and Treatments

The progressive nature of Parkinson’s disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with PD patients. A multi-centre (7 centres) RCT was conducted in England and Scotland to assess the impact of using a smartphone based Parkinson’s Tracker App (PTA) to promote patient self-management, enhance treatment adherence and quality of clinical consultation. Eligible patients were randomised using a 1:1 ratio on computer-generated random sequence, stratified by centre and using blocks of variable size, to intervention (PTA) or control (Treatment as Usual, TAU). Primary outcome was score of adherence to treatment (Morisky Medication Adherence Scale -8) at 16 weeks. Secondary outcomes were Quality of Life (QoL) (Parkinson’s Disease Questionnaire -39), quality of consultation for patients (Patient-Centered Questionnaire for PD), impact on non-motor symptoms (Non-Motor Symptoms Questionnaire – NMS Quest), depression and anxiety (Hospital Anxiety and Depression Scale) and beliefs about medication (Beliefs about Medication Questionnaire) at 16 weeks. Primary and secondary endpoints were analysed using a generalised linear model with treatment as the fixed effect and baseline measurement as the covariate. 156 patients completed the study (PTA=68 and TAU=88). At 16 weeks PTA significantly improved adherence, compared to TAU (mean difference: 0.39, 95%CI 0.04 to 0.74; p=0.0304) with no confounding effects of gender, number of comorbidities and age. Among secondary outcomes PTA significantly improved patients’ perception of quality of consultation (0.15, 95%CI 0.03 to 0.27; p=0.0110). There was a borderline significant change in the non-motor symptoms (-0.82, 95%CI-1.75 to 0.10; p=0.0822). 79% of participants in the PTA group continued to use and engage with the application throughout the 16-week trial period. The PTA can be an effective and novel way of enhancing medication adherence and quality of clinical consultation by supporting self-management in PD.