Investigator/Author: Joohi Jimenez-Shahed, MD; Benjamin Kummer, MD, Chloe Sweetnam, MSc
1. Measure the acceptability, adoption, appropriateness and feasibility of remote preoperative assessments of patients who are candidates for deep brain stimulation.
2. Determine the feasibility of assessing MDS-UPDRS III examination elements by patients at home.
3. Create an optimized protocol for the remote pre-operative assessment of DBS candidates.
Background: Remote pre-operative DBS evaluations are now possible via telehealth, but challenges exist in ensuring consistent, high quality assessments over an internet connection. Video analysis software has been developed to objectively examine PD motor symptoms using video recordings of a patient’s examination. Combined use of such platforms with human video review can allow pseudo-synchronous assessments of PD symptoms (i.e., measuring symptoms recorded during a video visit with a clinician) or asynchronous assessments (i.e. video made/uploaded elsewhere to a secure server and automatically rated by software or manually by a clinician). There is a need to develop protocols that are easy for both patients and clinicians to accurately and remotely assess PD motor symptoms. For patients, these assessments can save time, expense and discomfort while improving access to DBS expertise for those who live remote from performing centers. For providers, asynchronous assessments may obviate the need for face-to-face encounters in otherwise overloaded clinical settings, thereby helping throughput in ambulatory practices.
Methods/Design: Patients with PD who are DBS candidates will be asked to participate in this pilot study, using their preferred clinical scenario, and with a goal of recruiting a minimum of 15 subjects. Patients in Group 1 will receive instructions on how to create and upload PD symptom rating videos at home to be used in conjunction with a subsequent telemedicine visit. In Group 2, videos of PD examinations will be conducted and recorded by the clinician during a telemedicine visit using the video platform for the visit. In Group 3 (the control group), clinicians will conduct and videotape PD examinations during an in-person clinic visit. All examinations will be rated by clinicians and using the video analysis program. Clinician and computer ratings will be compared, and clinicians and patients will be queried about the ease of use, feasibility, challenges and barriers to adoption, and impact on resource utilization.
Relevance to Diagnosis/Treatment of Parkinson’s Disease: DBS is the surgical standard of care for patients who have been experiencing motor complications or refractory tremor yet many patients are unable to access this therapy in a timely manner due to their geographic location, referral practices, or physician knowledgeability. This pilot project will yield valuable insights into the best methods for implementation of a remote DBS evaluation clinic, which will in turn enable larger numbers of patients to both learn about and gain access to this highly effective therapy.