These trade-offs indicate that virtual exams may offer the greatest promise when implemented alongside in-clinic visits and passive monitoring strategies.Ī robust evidence base for clinical utility is needed for regulatory approval and commercial uptake.
Still, the completion rate of PD-VMEs was imperfect, declining from 80% in week 1 to 40% in week 52. Virtual exams only require interaction twice a week. It does require consistent use, which appears achievable given the average daily wear time of 22.1 hours in the PPP study. On the other hand, passive monitoring enables higher temporal resolution 6 and may impose fewer burdens on patients. On the one hand, virtual exams are better able to assess intent to move when evaluating symptoms like bradykinesia. Virtual exams may also synergize well with passive monitoring. Regardless, in-clinic exams may complement virtual exams by providing access to medical staff to confirm disease diagnoses, identify major protocol deviations, and order further testing. This suggests that clinical observation may not faithfully capture the real-world experiences of PD patients, but could also indicate increased protocol deviations at home. Notably, PD-VMEs conducted in the clinic were not always concordant with PD-VMEs conducted at home using the same protocol. Relative to in-clinic exams, virtual exams offer more frequent and convenient monitoring in natural living environments. Other investigated measures included arm-twisting amplitude for measuring upper extremity bradykinesia and arm swing acceleration for measuring gait impairment. Exam measures, such as lateral tremor acceleration for assessing resting tremor, exhibited moderate-to-strong correlation with consensus disease severity ratings (MDS-UPDRS III), test-retest reliability consistent with that of MDS-UPDRS III 5, and small-to-medium effect sizes for fast-acting PD medications. In total, 370 participants logged 22,668 virtual exams over 70 weeks. Each task corresponds to elements of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III exam 4, currently the “gold-standard” for motor evaluation of PD.ĭigital instructions guided participants through the motor exam: once under clinical observation and then twice weekly at home. Using accelerometer data from the Study Watch, the authors developed a PD virtual motor exam (PD-VME) consisting of eight self-guided tasks. Participants are monitored at 4-month intervals via on-site clinical assessments and continuously via the Verily Study Watch. Remaining challenges include integration of data streams across complementary monitoring techniques and alignment of digital measurements with outcomes most meaningful to patients.Ĭo-sponsored by Verily, the Personalized Parkinson’s Project (PPP) is a prospective single-center study of patients with early-stage PD in the Netherlands 3.
A virtual motor exam could complement in-clinic visits and passive monitoring strategies to unlock more precise insights for PD treatment. A team from Verily (formerly Google Life Sciences) developed and validated a smartwatch-based motor exam for PD that is concordant with standard disease severity ratings, responsive to medication effects, and reliable across repeat measurements 2. In particular, digital biomarkers and clinical outcome assessments (COAs) may improve on qualitative evaluations for conditions like Parkinson’s disease (PD). Smartwatches now have nearly half a billion active users 1, enabling longitudinal and multimodal health monitoring at unprecedented scale. After transforming information exchange and the global economy, consumer technology has come for healthcare.
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