Evaluation of motor fluctuations in Parkinson's disease: electronic vs. conventional paper diaries

Kanako Asai; Sayo Kawahara; Emi Shirahata; Kimihiro Iwasaki; Hikoichiro Nakai; Yuta Kajiyama; Seira Taniguchi; Lindun Ge; Keita Kakuda; Yasuyoshi Kimura; Tadashi Miyahara; Hiroki R Ueda; Kensuke Ikenaka; Hideki Mochizuki

doi:10.3389/fneur.2024.1476708

Evaluation of motor fluctuations in Parkinson's disease: electronic vs. conventional paper diaries

Front Neurol. 2024 Nov 22:15:1476708. doi: 10.3389/fneur.2024.1476708. eCollection 2024.

Authors

Affiliations

¹ Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
² ACCELStars, Bunkyo-ku, Tokyo, Japan.
³ Department of Neurology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
⁴ Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁵ Laboratory for Synthetic Biology, RIKEN Center for Biosystems Dynamics Research (BDR), Suita, Osaka, Japan.
⁶ Department of Systems Biology, Institute of Life Science, Kurume University, Kurume, Fukuoka, Japan.

Abstract

Background: Paper symptom diaries are a common tool for assessing motor fluctuations in Parkinson's disease (PD) patients, but there are concerns about inaccuracies in the assessment of motor fluctuation due to recall bias and poor compliance. We, therefore, developed an electronic diary with reminder and real-time recording functions.

Objectives and methods: To evaluate the effectiveness of the electronic diary, we compared compliance and motor fluctuation assessment with a paper diary. Nineteen PD patients were recruited and recorded paper diaries every 30 min from 8 am to 8 pm for 7 days, followed by 7 days of electronic diary recording using a smartphone and smartwatch. Prior to the recording period, the Parkinson's Disease Questionnaire (PDQ)-39 and the Movement Disorders Society-sponsored Unified Parkinson's Disease Rating Scale-Revised (MDS-UPDRS) 1, 2, 3, 4 were measured. Patients completed a patient questionnaire on the usability of the diaries after the recording period.

Results: Total reported time was significantly longer in paper diaries, but there was no significant difference in the number of entries (paper 115 [71-147] vs. electronic 109 [93-116], p = 0.77). There was a significant correlation between paper and electronic diaries with respect to motor status. ON time rate recorded in the electronic diary was significantly correlated with PDQ-39, MDS-UPDRS 1, 2, and 4, while MDS-UPDRS 1 was only correlated with ON time rate in the paper diary. The usability of our electronic diary was found to be satisfactory based on the results of patient questionnaire.

Conclusion: Electronic diaries are useful tools that more accurately reflect PD motor fluctuations.

Keywords: Parkinson’s disease; electric device; motor fluctuations; motor symptom diary; patient reported outcome measures.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This study received funding from ACCELStars. The funder had the following involvement in the study: Providing equipment (Apple Watch and iPhone) and designing and developing the application. The funder was not involved in the patient recruitment, data analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.