Table 1.

Identified challenges and potential solutions associated with rating motor symptoms of Parkinson’s disease via video

	Challenges	Potential Solutions
Video quality	In a recently completed study using state-of-the-art tablet technology in which the MDS-UPDRS was conducted via Facetime on 10 participants with PD, neurologists still reported difficulty in detecting quick involuntary movements and small amplitude tremor due to the quality and resolution of videos [12].	Wifi/ 5G Secure web based uploads. High resolution video cameras
Patient Burden	More elderly people are the most infrequent users of technology and the internet [23] and therefore, patients may have issues accessing technology devices and the internet in their own homes, particularly if they have cognitive impairment [24].	Assistance for remote monitoring of more disabled patients with PD is essential. Moreover, these latter individuals represent the group most at risk of poor outcomes if exposed to infections such as COVID19.
	The majority of the current research comparing video-based and face-to-face analyses of PD, focuses on samples that are relatively younger, highly educated, familiar with the Internet and present with milder symptoms of PD [8–10, 12, 13, 16, 17].	Replicate studies in the broader population living with PD.
Inadequate patient visualisation	Studies conducting video-assessments of motor symptoms in patient’s own homes have presented challenges with the environment such as space constraints [13, 22]. This may make it difficult to visualise the patient’s entire body, which is required for full assessment of the MDS-UPDRS [13] and their gait.	Ensure adequate camera position and request (if possible) a family member to support the set up of video equipment.
Inconsistent Video setting	Some studies are carried out at designated facilities with nurses on hand to assist with video set-up and in-person administration of the MDS-UPDRS [9, 17], which may not be conflated with findings from video assessments carried out in the home environment, which is unlikely to have the presence of a qualified clinician. Other studies that demonstrate the MDS-UPDRS conducted via videoconference in patient’s own homes [12, 13, 16, 22] is of course of greater relevance in the context of patients potentially shielding from COVID-19. On one hand, conducting an assessment in the patient’s natural environment may provide ecological validity of the clinical picture. However, longitudinal comparisons of scores may need to consider the context in which the video examination was performed.	Compromise may be necessary on occasion according to disease stage/ purpose of evaluation.
Short-term evidence	The majority of research considering video-based assessment of PD is limited by short-term studies. Concrete conclusions cannot be made about the long-term use of videos to analyse PD symptoms, nor the validity of video-based methods in replacing face-to-face assessment.	Future longitudinal research may give insight into the efficacy of longer-term video-based assessment of motor symptoms with built in mechanisms to trigger face to face clinical examinations when necessary.
	By contrast, one longitudinal study that compared in-person assessments with virtual visits in 195 patients with PD found no difference between groups in MDS-UPDRS score changes as well as no difference between groups in standardized measures of quality of life over 12 months [8]. This suggests that video-based analyses of PD can be used over a medium term period with low risk to patient’s clinical outcomes or quality of care.