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Using Wearable Technology to Measure the Effectiveness of Osteopathic Manipulative Treatment on Parkinson Disease Motor Symptoms
Poon, J. [2]
Docherty, J. [10]
Mancini, J. [25]
DiFrancisco-Donoghue, J. [9]
Cheriyan, G. [6]
Leder, A. [15]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e150-e151. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

motor symptoms [1]
OMT [2951]
osteopathic manipulative treatment [2973]
randomized controlled trial [710]
tremor [5]

Abstract:

Introduction: Parkinson disease (PD) is a chronic, progressive disorder characterized by tremor, bradykinesia, rigidity, dyskinesia, and postural instability. The tremor that presents in PD is typically a rest tremor, meaning it is most apparent when the affected body part is not being engaged in purposeful activity. Tremor affects multiple domains of quality of life, from physical to psychosocial, in a large proportion of patients. Bradykinesia is a global slowing of movements. Dyskinesia consists of abnormal, involuntary movements. The recent development of the Parkinson's KinetiGraph (PKG, Global Kinetics) system, a device to be worn on the wrist, makes objective monitoring of such motor symptoms possible via accelerometric measurements. Long term monitoring of these symptoms is advantageous to account for daily variability commonly experienced in PD. Current treatment options for PD include pharmacologic, nonpharmacologic, and surgical modalities. There is limited data on the effect of osteopathic manipulative treatment (OMT) on tremors and movement in PD subjects. Hypothesis: We hypothesize that biweekly OMT sessions over a 6-week period will reduce motor symptoms in patients with PD, namely tremor, bradykinesia, and dyskinesia. Statement of Significance: Directly treating muscular and ligamentous restrictions with OMT may provide motor symptom relief in the PD population and potentially improve quality of life. Methods: This study was approved by the NYIT institutional review board. Four PD subjects with balance and motor deficits were randomly assigned into the treatment arm or control arm, with 2 subjects per group. The treatment group received a biweekly OMT protocol for 6 weeks. OMT protocol focused on reducing somatic dysfunctions in the head, spine, and extremities and used primarily muscle energy and articulatory techniques. The control group received biweekly counseling sessions for 6 weeks to account for physician face-to-face time in the treatment arm. Presence of baseline motor symptoms was assessed using the PKG system, a device worn on the wrist for 6 days before the first treatment (week 1). Following the final treatment (week 6), subjects again wore the PKG device on the wrist for 6 days. Severity of bradykinesia (BK) and dyskinesia (DK) was measured and scored by Global Kinetics. Tremor was measured as the percent of total time with tremor (PTT). Median scores for BK and DK, and PTT from before and after treatment were analyzed using a 2×3 mixed ANOVA approach. Data Analysis and Results: BK values before and after OMT were 37.8 (SE=2.7) and 38.05 (SE=3.15), respectively. BK values before and after counseling intervention were 28.8 (SE=2.3) and 30.2 (SE=0.9). Higher scores represented worse BK. No significant differences were found (P=.489). Pre- and post-OMT DK values were 0.55 (SE=0.15) and 0.3 (SE=0). Pre- and postcounseling DK values were 0.85 (SE=0.15) and 0.45 (SE=0.15). Lower scores represented worse DK. No significant differences were found (P=.698). Pre- and post-OMT PTT values were 13.3% (SE = 0.7) and 7.5% (SE = 0.6). Pre- and postcounseling PTT values were 11.5% (SE=10.8) and 13.05% (SE=12.05). Comparison of the groups showed improvement in the OMT group over the control group; although that finding was not statistically significant, it may be clinically significant (P=.055). Conclusion: Results from this study suggest that OMT may decrease tremor severity in PD patients. Limitations of this study include a small sample size and analysis of raw PKG data by a third party (Global Kinetics). The project demonstrates the feasibility of using wearable devices to obtain objective measurements in movement disorders such as PD. Further research is warranted with larger sample sizes to determine whether OMT can produce clinically significant changes.

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