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      Smartphone- and internet-assisted self-management and adherence tools to manage Parkinson’s disease (SMART-PD): study protocol for a randomised controlled trial (v7; 15 August 2014)

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          Abstract

          Background

          Nonadherence to treatment leads to suboptimal treatment outcomes and enormous costs to the economy. This is especially important in Parkinson’s disease (PD). The progressive nature of the degenerative process, the complex treatment regimens and the high rates of comorbid conditions make treatment adherence in PD a challenge. Clinicians have limited face-to-face consultation time with PD patients, making it difficult to comprehensively address non-adherence. The rapid growth of digital technologies provides an opportunity to improve adherence and the quality of decision-making during consultation. The aim of this randomised controlled trial (RCT) is to evaluate the impact of using a smartphone and web applications to promote patient self-management as a tool to increase treatment adherence and working with the data collected to enhance the quality of clinical consultation.

          Methods/Design

          A 4-month multicentre RCT with 222 patients will be conducted to compare use of a smartphone- and internet-enabled Parkinson’s tracker smartphone app with treatment as usual for patients with PD and/or their carers. The study investigators will compare the two groups immediately after intervention. Seven centres across England (6) and Scotland (1) will be involved. The primary objective of this trial is to assess whether patients with PD who use the app show improved medication adherence compared to those receiving treatment as usual alone. The secondary objectives are to investigate whether patients who receive the app and those who receive treatment as usual differ in terms of quality of life, quality of clinical consultation, overall disease state and activities of daily living. We also aim to investigate the experience of those receiving the intervention by conducting qualitative interviews with a sample of participants and clinicians, which will be administered by independent researchers.

          Trial registration

          ISRCTN45824264 (registered 5 November 2013)

          Electronic supplementary material

          The online version of this article (doi:10.1186/1745-6215-15-374) contains supplementary material, which is available to authorized users.

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          Most cited references27

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            • Article: not found

            Adherence to long-term therapies: evidence for action.

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              • Article: not found

              What contributes to quality of life in patients with Parkinson's disease?

              To identify the factors that determine quality of life (QoL) in patients with idiopathic Parkinson's disease in a population based sample. Quality of life (QoL) is increasingly recognised as a critical measure in health care as it incorporates the patients' own perspective of their health. All patients with Parkinson's disease seen in a population based study on the prevalence of parkinsonism were asked to complete a disease-specific QoL questionnaire (PDQ-39) and the Beck depression inventory. A structured questionnaire interview and a complete neurological examination, including the Hoehn and Yahr scale, the Schwab and England disability scale, the motor part of the unified Parkinson's disease rating scale (UPDRS part III), and the mini mental state examination were performed by a neurologist on the same day. The response rate was 78%. The factor most closely associated with QoL was the presence of depression, but disability, as measured by the Schwab and England scale, postural instability, and cognitive impairment additionally contributed to poor QoL. Although the UPDRS part III correlated significantly with QoL scores, it did not contribute substantially to predicting their variance once depression, disability, and postural instability had been taken into account. In addition, patients with akinetic rigid Parkinson's disease had worse QoL scores than those with tremor dominant disease, mainly due to impairment of axial features. Depression, disability, postural instability, and cognitive impairment have the greatest influence on QoL in Parkinson's disease. The improvement of these features should therefore become an important target in the treatment of the disease.
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                Author and article information

                Contributors
                rashmi@umotif.com
                Duolao.Wang@lstmed.ac.uk
                david.burn@newcastle.ac.uk
                ray.chaudhuri@nhs.net
                gac54@cam.ac.uk
                clare.galtrey@gmail.com
                bruce@umotif.com
                suvankar.pal@nhs.net
                jon.stamford@parkinsonsmovement.com
                malcolm.steiger@thewaltoncentre.nhs.uk
                adrian.williams@uhb.nhs
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                25 September 2014
                2014
                : 15
                : 1
                : 374
                Affiliations
                [ ]uMotif Ltd, London, UK
                [ ]Liverpool School of Tropical Medicine, Liverpool, UK
                [ ]Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
                [ ]Neurology/Movement Disorders, National Parkinson Foundation Centre of Excellence, King’s College Hospital, University Hospital Lewisham, Kings College and Institute of Psychiatry, London, UK
                [ ]John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                [ ]St George’s Healthcare NHS Foundation Trust, London, UK
                [ ]NHS Forth Valley, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
                [ ]The Cure Parkinson’s Trust, London, UK
                [ ]University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
                [ ]University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
                Article
                2341
                10.1186/1745-6215-15-374
                4283131
                25257518
                c60b9220-88a9-4e32-88a4-2f010d33dfbe
                © Lakshminarayana et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 May 2014
                : 18 August 2014
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2014

                Medicine
                long-term conditions,m-health,mobile application,parkinson’s disease,self-management
                Medicine
                long-term conditions, m-health, mobile application, parkinson’s disease, self-management

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