Can wearable technology improve clinic visits or clinical trials?
The world of smart devices and wearable technology has exploded over the past decade. From a watch that can take phone calls to a refrigerator that can order groceries to Siri, Alexa, and Google Assistant, our interactions with technology occur around the clock. There are many apps and devices that millions of people already use to track daily behaviors, from sleep to steps to calories eaten. Could these devices be harnessed to improve clinical care and research in Parkinson’s disease?
Traditional clinic visits are very subjective. Current diagnosis and staging rests highly on qualitative descriptions of symptoms by patients and scale-based ratings of movements and other behaviors by clinicians. If someone’s memory isn’t clear or if internal ratings are off from one clinician to another, this can lead to different treatment recommendations or even a missed diagnosis. If someone can’t recreate a troublesome behavior in the clinic, if they get nervous about being in medical situations (sometimes called white coat syndrome), or if they’re just having an off day, an aspect of care may get too little or too much attention. The clinic is an artificial environment, and clinicians and researchers may be able to learn more about individual patients and Parkinson’s disease as a whole with access to large datasets with continuous, rater-independent, and objective data. Subtle clinical signs could be noticed earlier, progression of the disease could be better monitored with fewer clinic visits, and reactions to different medication regimens or rehabilitation treatments could be measured more sensitively. Wearable technologies can also make data collection in clinical trials more streamlined and better able to detect small but significant changes in symptoms or behavior.
Wearable sensors are now able to measure behaviors such as tremor, bradykinesia, gait, falls, sleep, heart rate, dyskinesia, and motor fluctuations. Smartphone and smartwatch apps can measure tremor, voice, finger-tapping, balance, gait, and cognition. There are even remote sensors that can be placed in the home and involve no direct interactions with the technology. Information can be collected through active participation in clinic or research tasks while in the home environment or through passive monitoring while someone is going about their normal daily activities.
Ideally, a wearable technology for healthcare and medical research should:
Be reliable (if you do the same task in the same way, the devices should give you the same data)
Be valid (the device should measure what it claims to measure)
Be comfortable
Be compact
Be simple to attach to the body and difficult to dislodge
Be easy to operate and troubleshoot
Not impact normal daily behavior
Provide useful information
Improve upon current clinical procedures
Give results that will make sense to clinicians and regulatory agencies
Protect your privacy!
Not surprisingly, these new technologies aren’t without their drawbacks. As technology complexity increases, so does the possibility that it could malfunction or break down entirely. Battery life has improved greatly in the past decade, but devices still need to be charged. Clinicians and research teams need to be able to understand how to handle missing data when someone is charging their device. People tend to be excited about using these devices initially, but the novelty can wear off – some research studies report up to 50% of people stop using the devices in a trial! Wearable technologies can improve on, but won’t solve all of the troubles of clinical trials (see the WPC Blog post Why Does It Take So Long?). Device companies are subject to business pressures and can go out of business, potentially leaving users, clinicians, and researchers out on a limb. Finally, researchers and clinicians need to understand what the data from these technologies mean, how to analyze and understand big datasets with thousands of data points, and what kind of change in the data represents a clinically meaningful change.
Are wearable technologies going away anytime soon? Certainly not. Am I going to be able to give my smartwatch data to my doctor at my next visit? Probably not at this time. Although technology continues to advance, there is still much more work to be done and many more questions to be answered before Parkinson’s clinical care as we know it will be dramatically altered by wearable technologies. How do you feel about wearable technologies?
Corinne Jones, PhD, CCC-SLP presented at the 5th World Parkinson Congress in Kyoto, Japan. She is currently an Assistant Professor in the Department of Neurology at The University of Texas at Austin and a speech language pathologist with UT Health Austin.
Ideas and opinions expressed in this post reflect that of the authors solely. They do not reflect the opinions or positions of the World Parkinson Coalition®