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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Accurately monitoring motor and non-motor symptoms as well as complications in people with Parkinson\u2019s disease (PD) is a major challenge, both during clinical management and when conducting clinical trials investigating new treatments. A variety of strategies have been relied upon including questionnaires, motor diaries, and the serial administration of structured clinical exams like part III of the MDS-UPDRS. To evaluate the potential use of mobile and wearable technologies in clinical trials of new pharmacotherapies targeting PD symptoms, we carried out a project (project BlueSky) encompassing four clinical studies, in which 60 healthy volunteers (aged 23\u201369; 33 females) and 95 people with PD (aged 42\u201380; 37 females; years since diagnosis 1\u201324 years; Hoehn and Yahr 1\u20133) participated and were monitored in either a laboratory environment, a simulated apartment, or at home and in the community. In this paper, we investigated (i) the utility and reliability of self-reports for describing motor fluctuations; (ii) the agreement between participants and clinical raters on the presence of motor complications; (iii) the ability of video raters to accurately assess motor symptoms, and (iv) the dynamics of tremor, dyskinesia, and bradykinesia as they evolve over the medication cycle. Future papers will explore methods for estimating symptom severity based on sensor data. We found that 38% of participants who were asked to complete an electronic motor diary at home missed ~25% of total possible entries and otherwise made entries with an average delay of &gt;4\u2009h. During clinical evaluations by PD specialists, self-reports of dyskinesia were marked by ~35% false negatives and 15% false positives. Compared with live evaluation, the video evaluation of part III of the MDS-UPDRS significantly underestimated the subtle features of tremor and extremity bradykinesia, suggesting that these aspects of the disease may be underappreciated during remote assessments. On the other hand, live and video raters agreed on aspects of postural instability and gait. Our results highlight the significant opportunity for objective, high-resolution, continuous monitoring afforded by wearable technology to improve upon the monitoring of PD symptoms.<\/jats:p>","DOI":"10.1038\/s41746-019-0214-x","type":"journal-article","created":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T11:03:13Z","timestamp":1579258993000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":100,"title":["mHealth and wearable technology should replace motor diaries to track motor fluctuations in Parkinson\u2019s disease"],"prefix":"10.1038","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6011-5702","authenticated-orcid":false,"given":"M. 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J.F.D is currently a shareholder of NeuroMotrix and Medapplets. P.B. has received grant support from the American Heart Association, the Department of Defense, the Michael J Fox Foundation, the National Institutes of Health (NIH), the National Science Foundation (NSF), and the Peabody Foundation including sub-awards on NIH and NSF SBIR grants from Barrett Technology (Newton, MA), BioSensics (Watertown, MA) and Veristride (Salt Lake City, UT). He has also received grant support from Emerge Diagnostics (Carlsbad, CA), MC10 (Lexington MA), Mitsui Chemicals (Tokyo, Japan), Pfizer (New York City, NY), Shimmer Research (Dublin Ireland), and SynPhNe (Singapore). He serves in an advisory role the Michael J Fox Foundation, the NIH-funded Center for Translation of Rehabilitation Engineering Advances and Technology, and the NIH-funded New England Pediatric Device Consortium. He also serves on the Scientific Advisory Boards of Hocoma AG (Zurich, Switzerland), Trexo (Toronto Canada), and ABLE Human Motion (Barcelona, Spain) in an uncompensated role. All other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}