Effectiveness of multidisciplinary care for Parkinson's disease: A randomized,controlled trial |
| |
Authors: | Marjolein A van der Marck MSc Bastiaan R Bloem MD PhD George F Borm PhD Sebastiaan Overeem MD PhD Marten Munneke PhD Mark Guttman MD FRCPC |
| |
Institution: | 1. Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, , Nijmegen, The Netherlands;2. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, , Nijmegen, The Netherlands;3. Radboud University Nijmegen Medical Centre, Department of Epidemiology, Biostatistics and HTA, , Nijmegen, The Netherlands;4. Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, , Nijmegen, The Netherlands;5. University of Toronto, Division of Neurology, Department of Medicine, , Toronto, Ontario, Canada |
| |
Abstract: | Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand‐alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ‐39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery‐Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease‐Psychosocial; SCOPA‐PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ‐39 (difference, 3.4; 95% confidence interval CI]: 0.5–6.2) and UPDRS motor scores (4.1; 95% CI: 0.8–7.3). UPDRS total score (5.6; 95% CI: 0.9–10.3), MADRS (3.7; 95% CI: 1.4–5.9), and SCOPA‐PS (2.1; 95% CI: 0.5–3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost‐effectiveness of integrated approaches. © 2012 Movement Disorder Society |
| |
Keywords: | Parkinson disease randomized controlled trial quality of life multidisciplinary care patient care team |
|
|