JMIR Publications

ABSTRACT

Background:

Digital Health Technologies (DHTs) enable remote, objective and frequent assessments of motor signs in people living with Parkinson’s (PwP). It remains unclear whether participant satisfaction with daily DHT interactions relates to long-term adherence and clinical outcomes.

Objective:

To quantify PwP’s satisfaction with daily remote DHT monitoring and its relationships with DHT adherence, motor disease severity, and anxiety and depression.

Methods:

Data from 710 participants living with early-stage Parkinson’s were analyzed from the PASADENA Phase IIa (NCT03100149; n=293) and PADOVA Phase IIb (NCT04777331; n=417) studies. At baseline, PASADENA participants (H&Y 1–2) were treatment-naive or on stable MAO-Bi, PADOVA participants (H&Y 1–2) were on stable L-DOPA or MAO-Bi. Remote monitoring with the Roche PD Mobile Application included active tests (AT), surveys, and passive monitoring (PM) via a study watch and phone, over 2 years (PASADENA) or 76–172 weeks (PADOVA). Towards the end of both studies (follow-up), participants completed questionnaires on DHT acceptance (Likert-scale: 1=very negative, 5=very positive) and open feedback. “Global satisfaction” with the DHT was defined as the mean Likert score from 4 comparable questions in the PASADENA and PADOVA questionnaires. Open feedback was analyzed qualitatively. Spearman’s correlations related global satisfaction levels with overall DHT adherence, self-reported motor experiences of daily living (MDS-UPDRS Part II), clinician-rated motor sign severity (MDS-UPDRS Part III) and, for PASADENA, anxiety and depression (HADS).

Results:

Global satisfaction was 4.2/5 (SD=0.7) in PASADENA and 3.9/5 (SD=0.7) in PADOVA, reflecting overall positive sentiments. Most participants rated all DHT aspects positively, including study devices and app (PASADENA: 3.6±1.0; PADOVA: 3.4±1.0) and daily active testing (PASADENA: 3.9±1.3; PADOVA: 3.9±1.2). Respondents highlighted areas for improvement in open feedback, including technical issues (PASADENA: 20%; PADOVA: 29%), repetitive ATs/surveys (PASADENA and PADOVA:13%) and device usability (PASADENA: 10%; PADOVA:12%). Higher global satisfaction ratings were weakly-to-moderately associated with higher adherence levels in PASADENA (AT: ρ=0.40; PM smartphone [PMsp]: ρ=0.29; PM smartwatch [PMsw]: ρ=0.23; all P<.001) and PADOVA (AT: ρ=0.24; PMsp: ρ=0.18; PMsw: ρ=0.17; all P<.001). Global satisfaction showed negligible-to-weak and inconsistent associations (-.11≤ρ≤.14) with MDS-UPDRS Parts II and III across studies. In PASADENA, lower global satisfaction ratings were weakly associated with higher levels of anxiety (ρ=−.15, P=.02) and depression (ρ=−0.11, P=.06).

Conclusions:

Participants living with early-stage Parkinson’s were generally satisfied with daily DHT testing in clinical trials over ~1.5–3 years. Satisfaction was positively associated with adherence but not robustly with motor disease severity, anxiety and depression. Improving device design, battery life and test variety may boost satisfaction and adherence, strengthening DHT-based monitoring. Clinical Trial: ClinicalTrials.gov NCT03100149 (PASADENA), NCT04777331 (PADOVA)