PDF(Pubmed)
Abstract：
Utilizing technology to precisely quantify Parkinson\'s disease motor symptoms has evolved over the past 50 years from single point in time assessments using traditional biomechanical approaches to continuous monitoring of performance with wearables. Despite advances in the precision, usability, availability and affordability of technology, the \"gold standard\" for assessing Parkinson\'s motor symptoms continues to be a subjective clinical assessment as none of these technologies have been fully integrated into routine clinical care of Parkinson\'s disease patients. To facilitate the integration of technology into routine clinical care, the Develop with Clinical Intent (DCI) model was created. The DCI model takes a unique approach to the development and integration of technology into clinical practice by focusing on the clinical problem to be solved by technology rather than focusing on the technology and then contemplating how it could be integrated into clinical care. The DCI model was successfully used to develop the Parkinson\'s disease Waiting Room of the Future (WROTF) within the Center for Neurological Restoration at the Cleveland Clinic. Within the WROTF, Parkinson\'s disease patients complete the self-directed PD-Optimize application on an iPad. The PD-Optimize platform contains cognitive and motor assessments to quantify PD symptoms that are difficult and time-consuming to evaluate clinically. PD-Optimize is completed by the patient prior to their medical appointment and the results are immediately integrated into the electronic health record for discussion with the movement disorder neurologist. Insights from the clinical use of PD-Optimize has spurred the development of a virtual reality technology to evaluate instrumental activities of daily living in PD patients. This new technology will undergo rigorous assessment and validation as dictated by the DCI model. The DCI model is intended to serve as a health enablement roadmap to formalize and accelerate the process of bringing the advantages of cutting-edge technology to those who could benefit the most: the patient.
摘要：
在过去的50年里，利用技术精确量化帕金森病的运动症状已经从使用传统生物力学方法的单点评估发展到对可穿戴设备性能的连续监测。尽管精度有了进步，可用性，技术的可用性和可负担性，评估帕金森运动症状的“金标准”仍然是主观的临床评估，因为这些技术都没有完全融入帕金森病患者的常规临床护理中。为了促进技术融入常规临床护理，建立了临床意图开发(DCI)模型。DCI模型采用独特的方法来开发技术并将其整合到临床实践中，方法是专注于技术要解决的临床问题，而不是专注于技术，然后考虑如何将其整合到临床护理中。DCI模型已成功用于克利夫兰诊所神经恢复中心的未来帕金森病候诊室（WROTF）。在WROTF中,帕金森病患者在iPad上完成自我指导的PD-Optimize应用程序。PD-Optimize平台包含认知和运动评估，以量化临床评估困难且耗时的PD症状。PD-优化由患者在他们的医疗预约之前完成,并且结果立即被整合到电子健康记录中以与运动障碍神经科医生讨论。PD-Optimize临床使用的见解刺激了虚拟现实技术的发展，以评估PD患者日常生活的仪器活动。这项新技术将按照DCI模型的要求进行严格的评估和验证。DCI模型旨在作为健康支持路线图，以正式化和加速将尖端技术的优势带给最可能受益的人的过程：患者。
