Feasibility of an App-Assisted and Home-Based Video Version of the Timed up and Go Test for Patients with Parkinson Disease: vTUG
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Background
Parkinson Disease (PD) is a progressive neurological disorder. Current therapeutic trials investigate treatments that can potentially modify the disease course. Testing their efficiency requires frequent and precise clinical outcome assessments (COA) of symptoms that remain problematic under symptomatic treatments, such as gait and balance. Home-based examinations may enhance patient compliance and, in addition, produce more reliable results by assessing patients more regularly in their familiar surroundings.
Objective
The objective of this study was to assess the feasibility of a digitized COA designed to video record the Timed up and Go (vTUG) test at home via a study-specific smartphone app for patients with PD.
Method
In this study, 28 patients were recruited and asked to perform at home each week a set of three consecutive vTUG tests over a period of 12 weeks using an app. The videos were subjected to a manual review to ascertain the durations of the individual vTUG phases, as well as to identify any errors or deviations in the setup that might have influenced the result. To evaluate the usability and user-friendliness of the vTUG and app, the System Usability Scale (SUS) and User Experience Questionnaire (UEQ) were administered to patients at the study end.
Results
Overall, 19 patients completed the 12-week study, 17 of which recorded 10 videos or more. A total of 706 vTUGs with complete timings were recorded. Random Forest Regression yielded “time to walk up” as the most important segment of the vTUG for predicting the total time. Variance of vTUG total time was significantly higher between weeks than it was between the three consecutive vTUGs at one time point [F(254,23) = 6.50, p < 0.001]. The correlation between vTUG total time and UPDRS III total score was weak (r = 0.24). Yet, correlation between vTUG and a derived gait subscore (UPDRS III items 9-13) was strong (r = .59). A linear mixed-effects model revealed a significant effect of patient-reported motion status on vTUG total time. Including additional variables such as UPDRS III gait subscore, different footwear, and chairs used, further improved the model fit.
Conclusion
Assessment of gait and balance by home-based vTUG is feasible. Factors influencing the read-out were identified and could be controlled for future use and longitudinal trials.
