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Kehagia AA, Chowienczyk S, Helena van Velthoven M, King E, North T, Shenton D, Abraham J, Langley J, Partridge R, Ankeny U, Gorst T, Edwards E, Whipps S, Batup M, Rideout J, Swabey M, Inches J, Bentley S, Gilbert G, Carroll C. Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative. J Parkinsons Dis 2024; 14:197-208. [PMID: 38250784 PMCID: PMC10836560 DOI: 10.3233/jpd-230205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed. OBJECTIVE To evaluate feasibility, acceptability and safety of Home Based Care. METHODS We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews. RESULTS Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment. CONCLUSIONS We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.
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Affiliation(s)
- Angie A. Kehagia
- School of Biomedical Engineering and Imaging Sciences, King’s Technology Evaluation Centre, King’s College London, UK
- University of Plymouth, Plymouth, UK
| | | | | | - Emma King
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | | | | | | | | | - Terry Gorst
- South West Academic Health Science Network, Exeter, UK
| | | | | | | | | | - Mat Swabey
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jemma Inches
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sue Bentley
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Camille Carroll
- University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
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Russell J, Inches J, Carroll CB, Bergmann JHM. A modular, deep learning-based holistic intent sensing system tested with Parkinson's disease patients and controls. Front Neurol 2023; 14:1260445. [PMID: 38020624 PMCID: PMC10646321 DOI: 10.3389/fneur.2023.1260445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
People living with mobility-limiting conditions such as Parkinson's disease can struggle to physically complete intended tasks. Intent-sensing technology can measure and even predict these intended tasks, such that assistive technology could help a user to safely complete them. In prior research, algorithmic systems have been proposed, developed and tested for measuring user intent through a Probabilistic Sensor Network, allowing multiple sensors to be dynamically combined in a modular fashion. A time-segmented deep-learning system has also been presented to predict intent continuously. This study combines these principles, and so proposes, develops and tests a novel algorithm for multi-modal intent sensing, combining measurements from IMU sensors with those from a microphone and interpreting the outputs using time-segmented deep learning. It is tested on a new data set consisting of a mix of non-disabled control volunteers and participants with Parkinson's disease, and used to classify three activities of daily living as quickly and accurately as possible. Results showed intent could be determined with an accuracy of 97.4% within 0.5 s of inception of the idea to act, which subsequently improved monotonically to a maximum of 99.9918% over the course of the activity. This evidence supports the conclusion that intent sensing is viable as a potential input for assistive medical devices.
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Affiliation(s)
- Joseph Russell
- Natural Interaction Lab, Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Jemma Inches
- University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
| | - Camille B. Carroll
- University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
- Newcastle University Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle-upon-Tyne, United Kingdom
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jeroen H. M. Bergmann
- Natural Interaction Lab, Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Sorrell L, Leta V, Barnett A, Stevens K, King A, Inches J, Kobylecki C, Walker R, Chaudhuri KR, Martin H, Rideout J, Sneyd JR, Campbell S, Carroll C. Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: A multicentre UK-based study. PLoS One 2023; 18:e0285349. [PMID: 37523365 PMCID: PMC10389727 DOI: 10.1371/journal.pone.0285349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Parkinson's disease has been identified as a risk factor for severe Coronavirus disease 2019 (COVID-19) outcomes. However, whether the significant high risk of death from COVID-19 in people with Parkinson's disease is specific to the disease itself or driven by other concomitant and known risk factors such as comorbidities, age, and frailty remains unclear. OBJECTIVE To investigate clinical profiles and outcomes of people with Parkinson's disease and atypical parkinsonian syndromes who tested positive for COVID-19 in the hospital setting in a multicentre UK-based study. METHODS A retrospective cohort study of Parkinson's disease patients with a positive SARS-CoV-2 test admitted to hospital between February 2020 and July 2021. An online survey was used to collect data from clinical care records, recording patient, Parkinson's disease and COVID-19 characteristics. Associations with time-to-mortality and severe outcomes were analysed using either the Cox proportional hazards model or logistic regression models, as appropriate. RESULTS Data from 552 admissions were collected: 365 (66%) male; median (inter-quartile range) age 80 (74-85) years. The 34-day all-cause mortality rate was 38.4%; male sex, increased age and frailty, Parkinson's dementia syndrome, requirement for respiratory support and no vaccination were associated with increased mortality risk. Community-acquired COVID-19 and co-morbid chronic neurological disorder were associated with increased odds of requiring respiratory support. Hospital-acquired COVID-19 and delirium were associated with requiring an increase in care level post-discharge. CONCLUSIONS This first, multicentre, UK-based study on people with Parkinson's disease or atypical parkinsonian syndromes, hospitalised with COVID-19, adds and expands previous findings on clinical profiles and outcomes in this population.
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Affiliation(s)
- Lexy Sorrell
- University of Plymouth, Plymouth, United Kingdom
| | - Valentina Leta
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Kara Stevens
- Exploristics Ltd, Belfast, Northern Ireland, United Kingdom
| | - Angela King
- University of Plymouth, Plymouth, United Kingdom
| | - Jemma Inches
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Christopher Kobylecki
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Richard Walker
- Department of Medicine, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
- Population Health Science Institute, Newcastle University, Newcastle, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Hannah Martin
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | | | | | - Camille Carroll
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
- Newcastle University, Newcastle, United Kingdom
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Stevens KN, Creanor S, Jeffery A, Whone A, Zajicek J, Foggo A, Jones B, Chapman R, Cocking L, Wilks J, Webb D, Carroll C, Inches J, Underwood D, Frost J, James A, Schofield C, James R, O’Reilly C, Sheridan R, Statton S, Goff A, Russell T, Whitcher A, Craw S, Lewis A, Sophia R, Amar K, Hernandez R, Pitcher A, Carvey S, Hamlin R, Lyell V, Aubry L, Carey G, Coebergh J, Mojela I, Molloy S, Berceruelo Bergaz Y, Camera B, Campbell P, Morris H, Samakomva T, Schrag A, Fuller S, Misbahuddin A, Parker L, Visentin E, Gallehawk S, Rudd J, Singh S, Wilson S, Creven J, Croucher Y, Tluk S, Watts P, Hargreaves S, Johnson D, Worboys L, Worth P, Brooke J, Kobylecki C, Parker V, Johnson L, Joseph R, Melville J, Raw J, Birt J, Hare M, Shaik S, Alty J, Cosgrove J, Burn D, Green A, McNichol A, Pavese N, Pilkington H, Price M, Walker K, Chaudhuri R, Podlewska A, Reddy P, Trivedi D, Bandmann O, Clegg R, Cole G, Emery A, Dostal V, Graham J, Keshet-Price J, Mamutse G, Miller-Fik A, Wiltshire A, Wright C, Dixon K, Abdelhafiz A, Rose J. Evaluation of Simvastatin as a Disease-Modifying Treatment for Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2022; 79:1232-1241. [PMID: 36315128 PMCID: PMC9623477 DOI: 10.1001/jamaneurol.2022.3718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Importance Current treatments manage symptoms of Parkinson disease (PD), but no known treatment slows disease progression. Preclinical and epidemiological studies support the potential use of statins as disease-modifying therapy. Objective To determine whether simvastatin has potential as a disease-modifying treatment for patients with moderate PD. Design, Setting, and Participants This randomized clinical trial, a double-blind, parallel-group, placebo-controlled futility trial, was conducted between March 2016 and May 2020 within 23 National Health Service Trusts in England. Participants aged 40 to 90 years with a diagnosis of idiopathic PD, with a modified Hoehn and Yahr stage of 3.0 or less while taking medication, and taking dopaminergic medication with wearing-off phenomenon were included. Data were analyzed from May 2020 to September 2020, with additional analysis in February 2021. Interventions Participants were allocated 1:1 to simvastatin or matched placebo via a computer-generated random sequence, stratified by site and Hoehn and Yahr stage. In the simvastatin arm, participants entered a 1-month phase of simvastatin, 40 mg daily, followed by 23 months of simvastatin, 80 mg daily, before a 2-month washout period. Main Outcomes and Measures The prespecified primary outcome was 24-month change in Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III score measured while not taking medication (high scores indicate worse outcome). The primary futility analysis included participants who commenced the 80-mg phase and had valid primary outcome data. The safety analysis included all participants who commenced trial treatment and is reported by dose at time of event. Results Of 332 patients assessed for eligibility, 32 declined and 65 were ineligible. Of 235 recruited participants, 97 (41%) were female, 233 (99%) were White, and the mean (SD) age was 65.4 (9.4) years. A total of 216 patients progressed to the 80-mg dose. Primary outcome analysis (n = 178) indicated the simvastatin group had an additional deterioration in MDS-UPDRS III score while not taking medication at 24 months compared with the placebo group (1.52 points; 2-sided 80% CI, -0.77 to 3.80; 1-sided futility test P = .006). A total of 37 serious adverse events (AEs), including 3 deaths, and 171 AEs were reported for participants receiving 0-mg simvastatin; 37 serious AEs and 150 AEs were reported for participants taking 40 mg or 80 mg of simvastatin. Four participants withdrew from the trial because of an AE. Conclusions and Relevance In this randomized clinical trial, simvastatin was futile as a disease-modifying therapy in patients with PD of moderate severity, providing no evidence to support proceeding to a phase 3 trial. Trial Registration ISRCTN Identifier: 16108482.
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Affiliation(s)
- Kara N. Stevens
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom,Exploristics Ltd, Belfast, United Kingdom
| | - Siobhan Creanor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Alison Jeffery
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - John Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, United Kingdom
| | - Andy Foggo
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Plymouth, United Kingdom
| | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rebecca Chapman
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Cocking
- NIHR BioResource, University of Cambridge, Cambridge, United Kingdom
| | - Jonny Wilks
- MAC Clinical Research, Blackpool, United Kingdom
| | - Doug Webb
- Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Sorrell L, King A, Inches J, Rideout J, Sneyd R, Kobylecki C, Chaudhuri R, Walker R, Martin H, Carroll C. 110 Outcome and mortality of hospital admission with COVID-19 for individuals with parkinsonian syndromes. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate features of Parkinson’s disease (PD) and atypical Parkinson’s syndromes (APS) associated with poor outcome and mortality in people with COVID-19 in a hospital setting.BackgroundPrevious studies have demonstrated increased mortality of COVID-19 in people with PD. However, it is not known whether this is associated with disease-related factors (eg autonomic dysfunc- tion, dysphagia).MethodsAn online survey tool captured anonymised patient data from hospital admission records of people with PD and APS who tested positive for COVID-19 between February 2020 and July 2021. We will use Cox proportional hazards and linear regression models to evaluate which characteristics are associ- ated with mortality, increased care requirement and more severe COVID-19 infection. Models will be adjusted for known associations with poor outcome, such as co-morbidities, age and sex.ResultsData were collected from 556 admissions from 21 UK sites: 66.2% male; median (IQR) age 80 (11) years; median disease duration 5 (7) years. 19.2% were asymptomatic, 28.8% had mild symptoms and 52.5% required respiratory support. 38.3% died within 4 weeks of a positive COVID-19 test. Preliminary Kaplan-Meier curves suggest that co-existing dementia, marked motor fluctuations and more advanced Hoehn and Yahr stage may be associated with 28-day mortality. Full statistical analysis is in progress.ConclusionsIdentification of Parkinson’s features associated with poor in-hospital COVID-19 outcome will allow a more informed discussion relating to individual COVID-19 risk.
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King E, Inches J, Edwards E, Rideout J, Whipps S, Holley M, Gorst T, Carroll C. 023 Evaluating a home-based care pathway for people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCurrent care pathways for people with Parkinson’s (PwP) are not tailored to need. In line with the NHS Long Term Plan, together with PwP, we have co-developed, piloted and evaluated an innovative care pathway, ‘Home Based Care (HBC)’, based on supported self-management, triggered contacts and digitally-enabled remote monitoring.MethodEvaluation was performed at baseline and 6-monthly of motor (UPDRS II and accelerometer) and non-motor (NMSQ, PDSS2, HADS) symptoms, acceptability and self-management efficacy. Care was audited using Parkinson’s UK national audit standards. Process measures captured feasibility.ResultsData are available for 93 patients at baseline and 38 at 6m. Compared with baseline, after 6m on HBC, fewer PwP had uncontrolled bradykinesia (55.3% vs 63.4%), severe non-motor symptom burden (32.4% vs 50.6%), depression (2.9% vs 15.9%) and anxiety (17.1% vs 23.2%); median UPDRS II improved from 12.0 to 9.0; PwP felt more involved in care (70% vs 42%), listened to (72% vs 48%) and treated as an individual (81% vs 58%), as well as having increased PD understanding (57% vs 38%) and ability to self- manage (45% vs 34%). HBC met 93% of national audit criteria.ConclusionsWe have demonstrated acceptability, feasibility and effectiveness of our novel Parkinson’s care pathway.e.king6@nhs.net|NIHR Bursary
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