Objective assessment of functional and motor-cognitive outcomes among asymptomatic primary hyperparathyroidism patients undergoing parathyroidectomy using wearable technologies: a pilot study towards better informed clinical decision-making
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For the past 40 years, most patients with Primary Hyperparathyroidism (PHPT) have presented with the asymptomatic form of PHPT. Despite the dominance of the asymptomatic PHPT phenotype, current National Institutes of Health (NIH) indications for parathyroidectomy fail to identify as many as 80% of patients afflicted with asymptomatic PHPT. To date, studies of the therapeutic benefits of parathyroidectomy among asymptomatic PHPT patients have relied on general health questionnaires and patient reports of their satisfaction with the surgery. The purpose of the present study was to implement objective, quantifiable metrics in assessing whether or not asymptomatic PHPT patients experience improvements in domains salient to them such as mobility and cognitive function following parathyroidectomy. This information may help set the foundation for more accurately identifying patients who would benefit from parathyroidectomy. We hypothesized that asymptomatic patients would exhibit improvement in motor-cognitive outcomes following successful parathyroidectomy. We performed a single-center prospective assessment of gait, frailty, and motor-cognitive function among patients diagnosed with PHPT. Demographics, medical history, and perioperative labs were recorded. Pre- and post-surgical measures included the Fried frailty criteria, the PROMIS 10 Global Health Scale, and gait analysis under habitual (ST), walking while performing working memory test (dual-task: DT), and fast-walking conditions, an upper extremity frailty (UEF) test, and an interactive trail-making task (iTMT) . Descriptive statistics, Chi-squared, 2-sample t tests, and repeated measures analysis of variance were applied where appropriate. 22 parathyroidectomy patients (male 7; 31.8%); median age of 54.9 (standard deviation=15.5) years participated. The prevalence of frailty/pre-frailty was 60% at baseline and reduced to 33% at 3 weeks post-op. PROMIS 10 physical health improved significantly by 3 months post-op (d=0.93, p=0.010). DT and fast walk velocities were significantly increased by 3 weeks post-op (p<0.050) with highest effect size observed during DT conditions (24%, Cohen's effect size d=1.30 , p=0.017). ST velocity increased but not significantly (17.5%, d=0.46, p=0.422). Results from UEF tests and iTMT did not achieve statistical significance at any visit date. Asymptomatic PHPT patients experience significant resolution of motor-cognitive symptoms as measured by DT gait and PROMIS 10 Global Health Scale following parathyroidectomy performed by a skilled surgeon.