Combat PD-Innovative delivery of a home-based gamified therapeutic exercise programme for Parkinson's disease

Year Submitted: 2024
Published Date: 31 December 2024

Tags: Care Process ＆ Redesign, Technology, Workflow Redesign, Productivity, Cost Saving

About this Content

Aims

1. To determine the feasibility of Combat PD in terms of (i) facilitating adherence to prescribed therapeutic exercise, measured by exercise frequency, duration and intensity, and (ii) usability. 2. To estimate the clinical efficacy of Combat PD in improving motor and non-motor function in PD, compared to usual standard of care physiotherapy in a control arm. 3. To examine the safety of Combat PD in terms of adverse events.

Background

Combat PD is a digital solution to overcome the constraints of time and space in delivering holistic care, in particular therapeutic exercises, to patients with Parkinson’s disease (PwP). This novel mobile application-based disease companion aims to promote regular aerobic exercise in PwP early in the disease course by engaging them through appropriately challenging, goal-oriented physical activities with real-time heart rate monitoring, gamified components, sustaining habit change through continued and consistent contact with healthcare providers via remote monitoring, and increasing self-efficacy and ownership of disease management through the use of patient in-app self-assessment tools.

Methods

Eligible patients were randomized to either the aerobic exercise group using Combat PD or the control group. 30-minutes of moderate intensity exergaming sessions were performed using the Combat PD mobile application at patients’ homes, 2 times a week for 3 months while the control group was instructed to perform stretching exercises twice a week with a control mobile application for 3 months. In addition to the app-based training, participants in both groups were instructed to perform 1 session of brisk walking per week for 3 months. The primary endpoint is adherence to the exercise programme, measured by actual exercise frequency, duration, and intensity (period of exercise performed within prescribed heart rate zone), compared to prescribed exercise targets. Usability was assessed through a semi-structured user questionnaire with items on a Likert scale and a validated user version of the Mobile Application Rating Scale (uMARS).

Results

1. Mobile application that supports the self-monitoring of mobility function was developed and a reliability and validity testing. 2. Full version of Combat PD exergames with 20 game modules was developed. 3. Development of 2 supported mobile applications - one for exercise log, one for control group. 4. Development of a web-based portal. Our first patient was recruited in March 2023. 12 patients have completed the study – 5 patients in control group, 7 in the intervention. 40 patients were screened – 8 excluded (did not meet inclusion criteria or had exclusion criteria), 9 rejected and 10 were not contactable. In the intervention group, patients averaged 2.5 exercise sessions weekly and exercised for a mean of 45 minutes per session. An average of 34% of time during exercise hit the prescribed heart rate target. The intervention was well-tolerated and there were no associated adverse events. Compliance to Combat PD app is good and with Combat PD, patients were able to adhere to the prescribed exercise intensity. This has reduced the need for in-person supervised physiotherapy sessions, manpower saving and cost saving to patients. The better adherence to evidence-based exercise training could potentially prevent functional delay and mobility disability.

Conclusion

Combat PD is a safe and effective platform to deliver a home-based exercise therapy to patients with Parkinson’s.

Lessons Learnt

The design of exergames took longer than expected time to complete due to unforeseen technical challenges such as to detect motions with minimal motion sensors and titrating sensitivity of movement sensors to adapt to movement deficits experienced in patients with PD. These technical challenges were eventually overcome by numerous rounds of testing and constant feedback given to our technical collaborator. The finetuning of the prototype was also delayed by remote communication and working with a tech team that resides outside Singapore. Support from research coordinator is instrumental for research administrative tasks, preparation, organization and coordination of study schedules and sessions, as well as study recruitment and data management. Insufficient RA FTE was budgeted.

Additional Information

1. Poster and abstract submitted for SHBC congress 2021 and won Best Poster Award (Allied health Category) – Silver: Smartphone-based mobility assessment in Parkinson’s disease: A validity study. This project has also been shared to the CHI CHILD project. 2. Abstract for Movement Disorders Conference 2021: Innovative delivery of a home-based gamified therapeutic exercise programme for Parkinson’s disease. A usability study of a technology-assisted healthcare approach. 3. Abstract for Movement Disorders Conference 2021: Smartphone-based mobility assessment in Parkinson’s disease: A validity study. 4. Movement Disorders Conference 2023 A qualitative study exploring the feasibility of exergames among people with Parkinson's disease.

Keywords

Parkinson’s, digital solution, mobile application, aerobic exercise, healthcare providers

Innovators' Details

Connect with this contributor!

Chloe Chung Lau Ha - Chloe_lh_chung@ttsh.com.sg

Project Attachment

805_TTSH_NTFHIP 2024_Combat PD - Innovative deli.pdf