Malmö University Publications
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Design, Development and Validation of Smartphone- and Wearable-Based Digital Biomarkers for Parkinson's Disease
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).ORCID iD: 0000-0002-7102-083X
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Parkinson’s disease (PD) is a progressive neurodegenerative brain disorder that significantly impacts quality of life for those who are affected. It is a rapidly growing condition affecting millions of people worldwide. Its treatments focus on managing symptoms and slowing the degenerative process, as there are no validated treatments that can stop its progression or prevent it. Effective management of the disease relies on accurate and timely assessment of symptoms based on clinical ratings, traditionally performed through clinical examinations using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). However, in-clinic assessments are infrequent and may not capture the full spectrum of symptom fluctuations in daily life. Modern consumer technologies, such as smartphones and wearable devices allow one to measure common symptoms thanks to the sensors embedded in these devices. Existing literature has clearly shown that these technologies can be used to diagnose PD; however, the current understanding falls short in terms of objectively quantifying its symptoms in daily living conditions.

Following a design science research methodology, this thesis addresses this research gap by exploring the feasibility of using smartphones and wearable technology to quantify PD symptoms in a real-world, at-home setting. The research presents a cross-platform mobile application developed for data collection from PD patients with the aim to identify promising system components and data types for capturing PD symptoms. Using data mining, statistical, and machine learning techniques, the research investigates whether it is feasible to estimate the MDS-UPDRS scale from objective measurements collected via smartphone data and wrist-worn actigraphy. Additionally, it investigates the usability of the proposed mobile application for PD patients and explores how data are interpreted by both patients and clinicians. The results show that smartphone-derived features can correlate strongly with reference wrist-worn actigraphy features (up to 0.91) for tremor-related assessments, while regression models estimate MDS-UPDRS Part III scores with mean absolute errors of approximately 6 points. The system also captures medication-related symptom fluctuations. Usability and user-centered evaluations further indicate that the proposed system is feasible for at-home use by patients, while also providing insights into how patients and clinicians may co-interpret symptom-tracking data and what they need from meaningful data representations. These contributions are presented through the associated peer-reviewed papers and supported by an open-source application that makes PD symptom assessment more accessible, objective, and patient-centric.

Place, publisher, year, edition, pages
Malmö: Malmö University Press , 2026. , p. 74
Series
Studies in Computer Science
National Category
Computer Sciences
Identifiers
URN: urn:nbn:se:mau:diva-83990DOI: 10.24834/isbn.9789178777846ISBN: 978-91-7877-783-9 (print)ISBN: 978-91-7877-784-6 (electronic)OAI: oai:DiVA.org:mau-83990DiVA, id: diva2:2057427
Public defence
2026-06-09, NI: B0E07, Nordenskiöldsgatan 1, Malmö, 13:15 (English)
Opponent
Supervisors
Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-05-19Bibliographically approved
List of papers
1. Linking data collected from mobile phones with symptoms level in Parkinson's Disease: data exploration of the mPower study
Open this publication in new window or tab >>Linking data collected from mobile phones with symptoms level in Parkinson's Disease: data exploration of the mPower study
2022 (English)In: Pervasive Computing Technologies for Healthcare: 16th EAI International Conference, PervasiveHealth 2022, Thessaloniki, Greece, December 12-14, 2022, Proceedings / [ed] Tsanas, Athanasios; Triantafyllidis, Andreas, Cham: Springer, 2022Conference paper, Published paper (Refereed)
Abstract [en]

Advancements in technology, such as smartphones and wearabledevices, can be used for collecting movement data through embeddedsensors. This paper focuses on linking Parkinson’s Disease severitywith data collected from mobile phones in the mPower study. As referencefor symptoms’ severity, we use the answers provided to part 2 ofthe standard MDS-UPDRS scale. As input variables, we use the featurescomputed within mPower from the raw data collected during 4 phonebasedactivities: walking, rest, voice and finger tapping. The features arefiltered in order to remove unreliable datapoints and associated to referencevalues. After pre-processing, 5 Machine Learning algorithms areapplied for predictive analysis. We show that, notwithstanding the noisedue to the data being collected in an uncontrolled manner, the regressedsymptom levels are moderately to strongly correlated with the actualvalues (highest Pearson’s correlation = 0.6). However, the high differencebetween the values also implies that the regressed values can not beconsidered as a substitute for a conventional clinical assessment (lowestmean absolute error = 5.4).

Place, publisher, year, edition, pages
Cham: Springer, 2022
Series
Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, ISSN 1867-8211
Keywords
mobile health, Parkinson’s disease, mPower data
National Category
Computer Sciences
Identifiers
urn:nbn:se:mau:diva-58646 (URN)10.1007/978-3-031-34586-9_29 (DOI)001436746400029 ()2-s2.0-85164108273 (Scopus ID)978-3-031-34585-2 (ISBN)978-3-031-34586-9 (ISBN)
Conference
16th EAI International Conference, Pervasive Health 2022, Thessaloniki, Greece, December 12-14, 2022
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2026-05-05Bibliographically approved
2. Mobistudy: Mobile-based, platform-independent, multi-dimensional data collection for clinical studies
Open this publication in new window or tab >>Mobistudy: Mobile-based, platform-independent, multi-dimensional data collection for clinical studies
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2022 (English)In: IoT 2021: Conference Proceedings, ACM Digital Library, 2022, p. 219-222Conference paper, Published paper (Refereed)
Abstract [en]

Internet of Things (IoT) can work as a useful tool for clinical research. We developed a software platform that allows researchers to publish clinical studies and volunteers to participate into them using an app and connected IoT devices. The platform includes a REST API, a web interface for researchers and an app that collects data during tasks volunteers are invited to contribute. Nine tasks have been developed: Forms, Positioning, Finger tapping, Pulse-oximetry, Peak Flow measurement, Activity tracking, Data query, Queen’s College step test and Six-minute walk test. These leverage sensors embedded in the phone, connected Bluetooth devices and additional APIs like HealthKit and Google Fit. Currently, the platform is used in two clinical studies by 25 patients: an asthma management study in the United Kingdom, and a neuropathic pain management study in Spain.

Place, publisher, year, edition, pages
ACM Digital Library, 2022
Keywords
clinical research, m-Health, IoT
National Category
Computer Sciences
Identifiers
urn:nbn:se:mau:diva-50618 (URN)10.1145/3494322.3494363 (DOI)000936000600025 ()2-s2.0-85127119368 (Scopus ID)978-1-4503-8566-4 (ISBN)
Conference
11th International Conference on the Internet of Things, November 8-11, 2021. St.Gallen, Switzerland
Funder
Knowledge Foundation, 20140035
Available from: 2022-03-14 Created: 2022-03-14 Last updated: 2026-05-05Bibliographically approved
3. Quantifying Parkinson's disease severity using mobile wearable devices and machine learning: the ParkApp pilot study protocol
Open this publication in new window or tab >>Quantifying Parkinson's disease severity using mobile wearable devices and machine learning: the ParkApp pilot study protocol
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e077766Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The clinical assessment of Parkinson's disease (PD) symptoms can present reliability issues and, with visits typically spaced apart 6 months, can hardly capture their frequent variability. Smartphones and smartwatches along with signal processing and machine learning can facilitate frequent, remote, reliable and objective assessments of PD from patients' homes.

AIM: To investigate the feasibility, compliance and user experience of passively and actively measuring symptoms from home environments using data from sensors embedded in smartphones and a wrist-wearable device.

METHODS AND ANALYSIS: In an ongoing clinical feasibility study, participants with a confirmed PD diagnosis are being recruited. Participants perform activity tests, including Timed Up and Go (TUG), tremor, finger tapping, drawing and vocalisation, once a week for 2 months using the Mobistudy smartphone app in their homes. Concurrently, participants wear the GENEActiv wrist device for 28 days to measure actigraphy continuously. In addition to using sensors, participants complete the Beck's Depression Inventory, Non-Motor Symptoms Questionnaire (NMSQuest) and Parkinson's Disease Questionnaire (PDQ-8) questionnaires at baseline, at 1 month and at the end of the study. Sleep disorders are assessed through the Parkinson's Disease Sleep Scale-2 questionnaire (weekly) and a custom sleep quality daily questionnaire. User experience questionnaires, Technology Acceptance Model and User Version of the Mobile Application Rating Scale, are delivered at 1 month. Clinical assessment (Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS)) is performed at enrollment and the 2-month follow-up visit. During visits, a TUG test is performed using the smartphone and the G-Walk motion sensor as reference device. Signal processing and machine learning techniques will be employed to analyse the data collected from Mobistudy app and the GENEActiv and correlate them with the MDS-UPDRS. Compliance and user aspects will be informing the long-term feasibility.

ETHICS AND DISSEMINATION: The study received ethical approval by the Swedish Ethical Review Authority (Etikprövningsmyndigheten), with application number 2022-02885-01. Results will be reported in peer-reviewed journals and conferences. Results will be shared with the study participants.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
health informatics, parkinson's disease, telemedicine
National Category
Neurology
Identifiers
urn:nbn:se:mau:diva-64860 (URN)10.1136/bmjopen-2023-077766 (DOI)001134943800008 ()38154904 (PubMedID)2-s2.0-85181165016 (Scopus ID)
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2026-05-05Bibliographically approved
4. Measuring finger dexterity in Parkinson's disease with mobile phones
Open this publication in new window or tab >>Measuring finger dexterity in Parkinson's disease with mobile phones
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2024 (English)In: 2024 IEEE International Conference on Pervasive Computing and Communications: workshops and other affiliated events, percom workshops, Institute of Electrical and Electronics Engineers (IEEE), 2024, p. 112-116Conference paper, Published paper (Refereed)
Abstract [en]

This work aims to link finger tapping and drawing tests performed on mobile phone screens with clinical ratings of Parkinson's Disease (PD). Thirty PD patients were recruited and instructed to carry out these tests in their homes. Features were extracted and used to assess the validity of the data vis a vis clinical scales (MDS-UPDRS). Statistical tests show that several features correlate with clinical scores (max correlation 0.54) and significant differences between data collected before and after medication intake (p<0.05), demonstrating the clinical validity of smartphone data. The use of Machine Learning (ML) algorithms to regress Part-3 of MDS-UPDRS further supports the validity with an absolute mean error of 6.25 (over a 0-72 scale).

Place, publisher, year, edition, pages
Institute of Electrical and Electronics Engineers (IEEE), 2024
Series
IEEE Annual Conference on Pervasive Computing and Communications Workshops, ISSN 2836-5348
National Category
Other Computer and Information Science
Identifiers
urn:nbn:se:mau:diva-69978 (URN)10.1109/PerComWorkshops59983.2024.10503245 (DOI)001216220000036 ()2-s2.0-85192479973 (Scopus ID)979-8-3503-0436-7 (ISBN)979-8-3503-0437-4 (ISBN)
Conference
IEEE International Conference on Pervasive Computing and Communications (PerCom), MAR 11-15, 2024, Biarritz, FRANCE
Available from: 2024-07-30 Created: 2024-07-30 Last updated: 2026-05-05Bibliographically approved
5. Usability of a Mobile Application for Patients with Parkinson's Disease
Open this publication in new window or tab >>Usability of a Mobile Application for Patients with Parkinson's Disease
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2024 (English)In: 2024 46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Institute of Electrical and Electronics Engineers (IEEE), 2024, p. 1-6Conference paper, Published paper (Refereed)
Abstract [en]

This paper investigates usability aspects of a mobile application aimed at monitoring symptoms of Parkinson’s disease (PD) patients. Thirty PD patients collected data through mobile-based questionnaires and activity tasks aimed at measuring motor and non-motor symptoms for a duration of two months. We report the results about usability conducted within this study. A combination of methods consisting of the uMARS questionnaire and interviews with PD patients inform the usability aspects of the mobile application. Results indicate that the app is overall received well and is usable (median uMARS score=4). Interviews reveal usability issues related to the size of textual instructions and buttons, and to the context of use of the app, particularly when the phone is used as a sensor. These findings highlight the need of co-design and preliminary testing when developing apps for PD.

Place, publisher, year, edition, pages
Institute of Electrical and Electronics Engineers (IEEE), 2024
Series
Annual International Conference of the IEEE Engineering in Medicine and Biology Society, ISSN 2375-7477, E-ISSN 2694-0604
Keywords
Parkinson’s disease, mobile app, usability, uMARS
National Category
Computer and Information Sciences
Identifiers
urn:nbn:se:mau:diva-72836 (URN)10.1109/embc53108.2024.10782276 (DOI)40039368 (PubMedID)2-s2.0-85214996203 (Scopus ID)979-8-3503-7149-9 (ISBN)
Conference
46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Orlando, FL, USA , 15-19 July 2024
Funder
Knowledge Foundation
Available from: 2024-12-19 Created: 2024-12-19 Last updated: 2026-05-05Bibliographically approved
6. Validation of a smartphone-based tremor measurement tool for Parkinson's disease
Open this publication in new window or tab >>Validation of a smartphone-based tremor measurement tool for Parkinson's disease
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2025 (English)In: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, Institute of Electrical and Electronics Engineers (IEEE), 2025Conference paper, Published paper (Refereed)
Abstract [en]

This study validates a smartphone app for hand tremor assessment in Parkinson's disease (PD). Twenty-eight PD patients performed a weekly tremor test using the app while wearing a wrist-worn actigraphy device (GeneActiv), of which twenty-one yielded usable actigraphy data for comparative analysis. Features were extracted from both devices to compare smartphone application derived data against actigraphy measurements. Further analysis examined the validity of the smartphone data in ON versus OFF medication states and against clinical scales (MDS-UPDRS). Statistical tests show high correlations between the app and GeneActiv features whereas app-derived features show statistical significant differences on data between medication states (p < 0.05), and correlations (maximum correlation 0.47) with clinical scores (MDS-UPDRS). The findings support the clinical validity of smartphone-based tremor assessments in PD, which shows potential for ongoing symptom monitoring in individuals with PD from at-home environments.

Place, publisher, year, edition, pages
Institute of Electrical and Electronics Engineers (IEEE), 2025
Keywords
GeneActiv, Parkinson's disease, smartphone app, tremor
National Category
Neurology
Identifiers
urn:nbn:se:mau:diva-83040 (URN)10.1109/EMBC58623.2025.11253144 (DOI)001673004000639 ()41337445 (PubMedID)2-s2.0-105023806033 (Scopus ID)9798331586188 (ISBN)
Conference
47th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2025, 14-18 Jul 2025, Copenhagen, Denmark
Available from: 2026-03-09 Created: 2026-03-09 Last updated: 2026-05-05Bibliographically approved
7. The lived experiences and data speculations of people with Parkinson's disease using active tests for symptom-tracking
Open this publication in new window or tab >>The lived experiences and data speculations of people with Parkinson's disease using active tests for symptom-tracking
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2025 (English)In: ACM Transactions on Computing for Healthcare, ISSN 2637-8051Article in journal (Refereed) Epub ahead of print
Abstract [en]

Keeping track of symptoms is a familiar yet often complex task for people living with chronic conditions. In the context of Parkinson's disease, sensor-based technologies are becoming more common to track motor symptoms. These technologies typically rely on passive monitoring but can also be combined with active tests, in which users intentionally perform measuring tasks like finger-tapping or drawing. In this paper, we explore how people with Parkinson's experienced using such active tests through a smartphone app over the course of eight weeks. Drawing on 26 semi-structured interviews, our findings indicate that active tests impact bodily awareness, come with frictions of integration into daily life and may be reframed as motivations for exercises. Speculations on the resulting data suggest that these are partly seen as a useful resource for self-care, but also as a potential cause for anxiety and ambivalence when facing worsening symptoms and decline.

Place, publisher, year, edition, pages
Association for Computing Machinery (ACM), 2025
National Category
Medical Engineering
Identifiers
urn:nbn:se:mau:diva-81259 (URN)10.1145/3779306 (DOI)
Available from: 2025-12-18 Created: 2025-12-18 Last updated: 2026-05-05Bibliographically approved
8. Replicating the standard Parkinson’s disease rating scale using a cross-platform tailored smartphone application
Open this publication in new window or tab >>Replicating the standard Parkinson’s disease rating scale using a cross-platform tailored smartphone application
(English)Manuscript (preprint) (Other academic)
National Category
Computer and Information Sciences
Identifiers
urn:nbn:se:mau:diva-83997 (URN)
Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-05-05Bibliographically approved
9. From Active Tests to Co-Interpretation: Design Considerations for Data Representations in Parkinson's Care
Open this publication in new window or tab >>From Active Tests to Co-Interpretation: Design Considerations for Data Representations in Parkinson's Care
(English)Manuscript (preprint) (Other academic)
National Category
Computer and Information Sciences
Identifiers
urn:nbn:se:mau:diva-83998 (URN)
Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-05-05Bibliographically approved
10. Association between Wrist-Worn Actigraphy and the MDS-UPDRS Parkinson’s disease rating scale through Machine Learning: an exploratory study
Open this publication in new window or tab >>Association between Wrist-Worn Actigraphy and the MDS-UPDRS Parkinson’s disease rating scale through Machine Learning: an exploratory study
(English)Manuscript (preprint) (Other academic)
National Category
Computer and Information Sciences
Identifiers
urn:nbn:se:mau:diva-83999 (URN)
Available from: 2026-05-05 Created: 2026-05-05 Last updated: 2026-05-05Bibliographically approved

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1232 of 3
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