Digital mobility assessment using wearable devices in people with Parkinson’s disease: a feasibility and implementation study in Ghana (TraPCAf) compared with a UK cohort

Abstract

Introduction Life expectancy is rising in Africa, increasing Parkinson’s disease (PD) prevalence. PD in Africa is often underdiagnosed/undertreated due to limited specialists, awareness and medication access. Gait impairments are among the earliest and most disabling PD symptoms, yet their presentation in African populations is poorly understood. This study aimed to (1) compare real-world mobility between PD and older controls in a population from Ghana (GHA-PD and GHA-CL), (2) examine associations between digital mobility outcomes (DMOs) and clinical/demographic factors between GHA-PD and a PD cohort from a high-income European country (UK-PD), and (3) assess the acceptability of the measurement method in GHA-PD and GHA-CL. Methods PD (n = 50) and controls (n = 30) in Ghana wore a wearable device (Axivity AX6) for seven days. Raw data were used to derive 24 DMOs using the Mobilise-D pipeline. An age-gender-matched PD and control cohort (UK-CL), based in United Kingdom, from another study was included for comparison. Differences were also analysed by controlling confounding factors. Results Sixteen of 24 DMOs differed significantly (p < 0.05) between GHA-PD and GHA-CL (steps per day: 2153 vs. 10001, daily walking time: 0.43 vs. 2.07 hours). Mobility impairment was more pronounced in GHA-PD than UK-PD, with differences remaining in 18 DMOs after adjustment for confounding factors. Feasibility and acceptability were high, although discomfort was commonly reported. Discussion Reduced mobility and gait quality in GHA-PD highlight risks of functional decline and loss of independence. Further research should investigate lifestyle, cultural, environmental and healthcare factors that might contribute to these disparities.