Long-term ambulatory assessment of motor symptoms in movement disorders: a best-evidence review

Abstract Introduction Aassessing movement disorders in daily life can provide information that might not be available during a short clinical visit. This review provides an overview of the currently available ambulatory registration methods to assess motor symptoms. Methods A systematic review was performed of ambulatory registration methods, registering motor symptoms for at least 24 h. The following characteristics were studied: study goal, study population, data acquisition, outcome measures, and data interpretation. Results For the classical subjective approach, a patient-kept diary, two types are widely applied: the ON/OFF diary to assess the medication response status in patients with Parkinson’s Disease (PD), and the fall diary to assess fall frequency. Both diaries are established methods for clinical decision-making. However, both diaries have disadvantages, especially since self-report might not always agree with clinicians’ ratings. An often-used alternative objective approach that employs accelerometry can assess activity levels and gait, monitor disease progression and distinguish between healthy controls and patients. However, accelerometry cannot reliably assess medication status in PD nor distinguish between different diseases. Also due to the heterogeneity in body locations for the accelerometer and outcome measures, there are no gold standards to rely on. Accelerometry to assess tremor can be used to obtain clinically valid measures. The combination of objective and subjective measurements is, at this point, mainly useful for scientific research. Conclusion Subjective measurements of ON/OFF status and fall frequency remain the most widely adopted long-term registration methods. Most other methods first need more validation in a clinical setting before they can be applied in patient care.