Development of a remote therapeutic monitoring platform: applications for movement disorders

Digital health tools are emerging as a promising solution for optimizing Deep Brain Stimulation (DBS) therapy for neurodegenerative diseases such as Parkinson's Disease (PD), addressing challenges of therapy maintenance, care access, and discrete assessments. Wearable technology and mobile health platforms can offer remote monitoring capabilities, allowing for real-time virtual programming with optimization of patients' therapy, use of digital biomarkers that can help identify the onset, symptoms, medication-related fluctuations and side-effects, and response to DBS treatment. Through an investigational remote monitoring application (RM app) integrating patient-reported outcomes (PROs) and objective data using wearables, we aimed to develop an accessible, data-driven digital tool to monitor patient symptoms and deliver low-burden and easy-to-access DBS therapy. The platform is designed to be compatible with several consumer-grade wearables and ensures patient data privacy and security. We conducted a feasibility study to test the tool's effectiveness in a large-scale DBS study, where subjects received a home-monitoring kit consisting of an iPhone and Apple Watch, pre-configured with the RM app to enable remote data collection. Compliance in this paper is defined as adherence to the RM app and Apple watch usage. Analysis of 67 subjects from the study demonstrated an average compliance rate of 63.3% for daily check-ins, 85.5% for monthly surveys and 61.9% for passive data with an average of 55 days of post-implant data. The study highlights the feasibility of frequent monitoring in the early post-implant period that could lead to optimal outcomes for patients. The platform developed can further optimize study execution and be extended to other chronic conditions treated with neuromodulation implants such as depression and pain.