Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field. The comments received are individual opinions and do not represent NICE's view.

All of the specialist commentators were familiar with laser technology for the treatment of freezing of gait and 2 of the 7 specialists had used Path Finder before.

Level of innovation

Most of the commentators noted that the use of a laser to provide a visual cue is not a novel concept, but the hands-free design of Path Finder is the technology's main innovation. Two commentators noted that Path Finder was a minor variation to standard care because of this. Laser canes and walkers were identified as comparable technologies by commentators, neither of which are hands-free. Agilitas was identified as a comparable hands-free wearable technology by 3 commentators, all of whom noted that this Australian device is not currently available in the UK. It uses a laser attached to a belt and 1 commentator added that it uses a flashing dot as a cue rather than a laser line. Auditory metronomes were also mentioned by 3 commentators as alternative non-laser, hands-free cueing devices.

Potential patient impact

Less frequent freezing of gait episodes and subsequent reduction in the risk of falls were identified as potential benefits to patients. Improved quality of life and increased confidence in walking, as well as helping to maintain mobility and independence for longer and assisting in rehabilitation of admitted patients, were other potential benefits noted by commentators. The hands-free nature of the device was noted as a patient benefit by 2 commentators and the relative ease of use of the device by 1 other. Some commentators thought that the technology could have the potential to lead to reduced hospital admissions, earlier discharge from rehabilitation, fewer medication changes and reduced need for physiotherapy and occupational therapy sessions. However, most noted that these benefits are speculative because of the lack of available evidence. One of the commentators did not believe the technology would lead to a change in the current care pathway or clinical outcomes. People with Parkinson's disease who do not need walking aids but have freezing of gait were identified by 3 commentators as individuals who would particularly benefit from the technology. Those with substantial freezing of gait symptoms that do not respond to standard medical therapy were also identified by 2 commentators. Two of the commentators thought that the technology could potentially benefit those with atypical Parkinson's disease or vascular gait disorders in whom freezing of gait symptoms may be present.

Potential system impact

The potential to reduce physiotherapy needs, as well as the number of falls, fractures and the healthcare costs associated were system benefits identified by some of the commentators. One commentator felt that the technology is unlikely to have a major effect on the healthcare system and another did not feel it would reduce routine outpatient physiotherapy sessions unless the technology was able to reduce the incidence of falls. One commentator noted that its use as a training tool in physiotherapy is likely to be limited because there is often a poor carry-over effect when use is stopped. The same commentator did not think it would have a major effect on physiotherapy times and costs, because patients with freezing are typically only seen once or twice as an outpatient. One commentator thought it would cost the same as standard care, while 3 commentators agreed that adopting the technology would be cost incurring in the short term. One of these commentators noted that the cost of Path Finder was comparable to other cueing devices and another added that the cost of Path Finder was relatively small when compared with the total treatment costs for a person with Parkinson's disease. All other commentators felt that, without good evidence to show the reduction in falls, the cost impact of the technology was uncertain. Six commentators thought the technology would be an addition to standard of care, while 1 thought the device would replace the laser cane for those that did not need a walking aid. Most commentators agreed that there would be little resource impact apart from the cost needed to buy the device, and no extra staff or other equipment would be needed to adopt this technology. Four commentators did not think that training would be needed, while 3 felt that some level of training would be needed.

General comments

Most commentators noted that Path Finder is not yet widely used in the NHS, but were not aware of any major barriers to adoption other than cost and lack of good quality evidence. None of the commentators were aware of any safety issues however, 1 commentator noted a potential risk of worsening gait freezing if patients were distracted by the attached device and were not able to concentrate fully on the laser line. Specialists highlighted that patients with poor dexterity or eyesight may have difficulty using the device, and may need some level of support. One commentator felt that the technology may only have benefits for indoor use, as the laser line may be harder to see in bright outdoor light. Specialists noted the huge variation in current physiotherapy provision across the UK, and 1 commentator felt that Path Finder may play a role in empowering physiotherapists in understanding the difference physiotherapy can make for people with Parkinson's disease. It was also noted that if the same device was to be used by multiple people, healthcare professionals would need to consider infection control measures. All commentators highlighted the need for further research in a larger cohort of patients. Commentators felt that long-term data (6 to 12 months) from randomised controlled trials and real-world studies were needed to address key uncertainties around the benefits of the technology, in particular whether a reduction in freezing of gait with Path Finder is associated with a decrease in falls, improved quality of life and cost-savings.