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Monday, January 18, 2016

Clinical Trials Can Help with Social Isolation

In the February/March 2016 issue of Neurology Now, we talk to researchers about clinical trials designed to be conducted in the homes of participants. In this online exclusive, we explain why some trials are best conducted in labs or hospitals.




Clinical Trials in Labs Can Counter Social Isolation

Some clinical trials are still best conducted in the lab or in a group setting.


Not every test or trial can be conducted at home. If the study involves giving patients a magnetic resonance imaging (MRI) scan, for instance, “It doesn’t make sense to bring a $20,000 machine to someone’s house,” says Bruce H. Cohen, MD, FAAN, director of neurology at the Children’s Hospital Medical Center of Akron and a professor of pediatrics at Northeast Ohio Medical University.


Indeed, some assessments can be difficult to conduct over the phone or using a video chat program like Skype. For example, a standard test for Parkinson’s disease is to ask patients to tap their thumb and index finger as fast as they can, says E. Ray Dorsey, MD, MBA, a professor of neurology and co-director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center, who is leading the Connect.Parkinson study. But “if you’re on a Skype call and you’re having someone tap his or her thumb and index finger really fast, it’s hard to tell if the patient’s movement is breaking up or if it’s Skype that’s breaking up,” he says.


Some neurologic conditions can be very isolating, so it’s important to get people out of the house whenever possible. For example, “You don’t want to perpetuate social isolation in people with Alzheimer’s,” says Wolf E. Mehling, MD, a family and integrative medicine specialist at the University of California, San Francisco, Osher Center for Integrative Medicine.


Dr. Mehling is the lead investigator for the PairedPLIE (Paired Integrative Home Exercise for Seniors with Dementia and Their Caregivers) trial, which is testing an at-home exercise program for people with mild to moderate Alzheimer’s disease. The trial starts with four group classes to teach the exercises to the patient and caregiver. Once they’ve learned the basics of the program, they follow the routine at home for 16 weeks, guided by a 20-minute DVD. These initial group training sessions offer the added bonus of promoting social interaction, Dr. Mehling says. And since the ultimate goal of the program is to improve strength and mobility in these patients, the trial may make it easier for them to get out and about.


Doing a trial in a group setting is also important for caregivers, Dr. Mehling says. “They burn out when they’re always alone at home.” Participating in a group exercise class, for example, gives caregivers an opportunity to interact with others who can relate to their situation.