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    Devices for remote monitoring of Parkinson's disease

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    1 Recommendations

    1.1 Kinesia 360, KinesiaU, PDMonitor, Personal KinetiGraph (PKG), and STAT-ON are conditionally recommended as options for remote monitoring of Parkinson's disease only if:

    • further evidence is generated on:

      • the impact on resources associated with using the technologies (for people with Parkinson's disease and their carers; see section 4.1)

      • the size of impact of using the technologies on symptoms or health-related quality of life (for people with Parkinson's disease and their carers) and how long this lasts for (see section 4.2)

      • how frequently the devices are used, and under what circumstances, in the NHS (see section 4.3).

    • cost impact is managed (see recommendation 1.2).

    1.2 Commissioners should consider the available payment options for the technologies when deciding which to use (for example, pay per use, a subscription model or outright purchase). They should take into account the fact that the technologies may not be needed any more if further data shows they are not cost effective.

    1.3 Clinicians should consider features of the devices and how they are used when identifying which may be most suitable for a person, particularly for people with restricted movement, missing limbs, people who are frail or have cognitive impairment. Clinicians should also support people to set up and operate the remote monitoring devices if needed.

    Why the committee made these recommendations

    Monitoring symptoms of Parkinson's disease is important to help clinicians make decisions about a person's care. But this can be difficult in current practice because symptoms can come and go and may be difficult to recall or describe. Review appointments may also be infrequent. Sometimes people with Parkinson's disease may struggle to accurately assess their symptoms and how severe they thought they were may differ from those of their carer (care-partner). There is therefore an unmet need for more objective monitoring of symptoms. Using these devices could help clinicians to better determine when changes to treatment are needed. This could help better manage symptoms of Parkinson's disease which could improve quality of life for people with Parkinson's disease and their carers.

    There is a lack of evidence about how much of an impact using the devices in the NHS would have on quality of life for both the person with Parkinson's disease and their carers. The devices could help save NHS resources, but it is unclear by how much, and which resources. The largest amount of evidence is for PKG, but its generalisability to the NHS is not certain because in the main trial more check ups were done, both for people who did and did not have the device, than they would in the NHS. The device was also used more frequently than would be expected in NHS care.

    Having early conditional access to these technologies could improve management of symptoms and quality of life for people with Parkinson's disease and their carers. Data should be collected so that a full assessment of the clinical and cost effectiveness of the technologies can be done. Therefore, the devices are conditionally recommended for use as an option to help monitor people with Parkinson's disease. Clinicians should take into account whether people need help to use the devices and if one device is more suited to a person than others. It can only be used if the cost impact is managed by considering the different payment options for the technologies.