Assessing Eligibility for Apomorphine Therapy in Parkinson's Disease: The Telemonitoring Potential.

Abstract

Background: Although there are established guidelines for the selection of suitable candidates, objective and timely referral for the use of apomorphine remains challenging.

Objectives: This research examined how telemonitoring may facilitate referrals for continuous subcutaneous apomorphine infusion in Parkinson's disease (PD).

Methods: A Blind Rater and a multi-disciplinary team (MDT) including an expert PD nurse, neurologist, and geriatrician determined apomorphine pump treatment eligibility for 20 patients with PD. The MDT considered telemonitoring data and physical examination to determine eligibility. The Blind Rater used only telemonitoring data (PDMonitor®) to evaluate eligibility.

Results: The results show that using wearable sensors to determine appropriateness of apomorphine pump treatment is similar to a complete method that combines objective motor symptom monitoring with clinical evaluation. The MDT and blind rater had a 0.89 Cohen's kappa coefficient, which suggests high rate of agreement. The best-performing objective metric for differentiating patients who were recommended (APO) from those non-recommended (non-APO) for apomorphine pump therapy, was the device-reported percentage of time in the "ON" state, which takes into consideration the "OFF" and dyskinesia time. The APO group had lower values in this metric and could be differentiated from the non-APO group accurately (85%).

Conclusions: Using telemonitoring to determine eligibility for apomorphine therapy might improve evaluation and treatment in patients with PD and, therefore help improve their quality of life.