ArticlesIntegrated multidisciplinary care in Parkinson's disease: a non-randomised, controlled trial (IMPACT)
Introduction
Parkinson's disease is increasingly recognised as a multidimensional disorder. In addition to classic motor symptoms, patients have a wide variety of non-motor symptoms that substantially affect quality of life but often remain unrecognised and untreated.1 Moreover, most non-motor features do not respond satisfactorily to dopaminergic drugs, and some might even get worse, such as orthostatic hypotension and cognitive function.1 Therefore, the possible benefits of non-pharmacological interventions are generating interest. A multidisciplinary approach combining pharmacological treatment with non-pharmacological interventions to manage a complex disorder such as Parkinson's disease might be beneficial.2 Despite the shortage of evidence for effectiveness,3 guidelines recommend regular access to a broad range of medical and allied health-care professionals.4, 5 Indeed, many centres deliver integrated and multidisciplinary care for patients with Parkinson's disease.2, 6 However, a standard template for multidisciplinary care in Parkinson's disease does not exist, and guidelines do not clarify how a team approach should be organised and structured.
We developed an integrated model to organise care for patients with Parkinson's disease, with two complementary elements: an individually tailored assessment by a multidisciplinary team that defines a comprehensive treatment plan (including advice on drug treatment and recommendations for non-pharmacological interventions); and subsequent implementation of this plan within a network of specifically trained allied health professionals, supervised by the referring neurologist.7 To assess the effectiveness of this model, we designed Integrated Multidisciplinary care for Parkinson's disease: a Controlled Trial (IMPACT) to compare outcomes in patients with Parkinson's disease who had access to this model of care with those in patients receiving standard care.
Section snippets
Study design and participants
We recruited patients for this non-randomised, controlled trial from neurological outpatient clinics in six community hospitals in the Netherlands—two in a region where the intervention was available (intervention region), and four in regions where it was not (control regions; appendix). The control regions were geographically separated from the intervention region.
Inclusion criteria were having Parkinson's disease (diagnosed by a neurologist according to UK Brain Bank criteria),8 being aged
Results
We recruited 301 patients (150 patients in the intervention group and 151 in the control group) between August, 2007, and December, 2009, of whom 285 completed follow-up (5% dropout rate; figure 2). The final follow-up measurement took place in July, 2010. Of the 150 participants in the intervention group, 101 (67%) received a multidisciplinary assessment. 49 (33%) patients opted not to visit the expert centre. Reasons to decline included lack of perceived benefit or an anticipated burden of
Discussion
Parkinson's disease is increasingly acknowledged as a multidimensional disorder, with disabling symptoms in physical, emotional, and cognitive domains.1, 4, 23 Because of this complexity, many specialised Parkinson's disease clinics worldwide use a multidisciplinary team approach, because this approach is felt to offer the best management of Parkinson's disease.2, 6, 24, 25 However, this assumption is supported by only a small amount of inconclusive scientific evidence.3, 26 Here, we assessed
References (50)
- et al.
Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment
Lancet Neurol
(2009) - et al.
Multidisciplinary care for patients with Parkinson's disease
Parkinsonism Relat Disord
(2009) - et al.
The use of an item response theory-based disability item bank across diseases: accounting for differential item functioning
J Clin Epidemiol
(2010) - et al.
Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial
Lancet Neurol
(2010) - et al.
Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial
Lancet Neurol
(2013) - et al.
Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial
Lancet Neurol
(2010) - et al.
Caregiver-burden in parkinson's disease is closely associated with psychiatric symptoms, falls, and disability
Parkinsonism Relat Disord
(2006) - et al.
Costs of illness and care in Parkinson's disease: an evaluation in six countries
Eur Neuropsychopharmacol
(2011) - et al.
Changes in walking activity and endurance following rehabilitation for people with Parkinson disease
Arch Phys Med Rehabil
(2009) - et al.
The integrative care of Parkinson's disease: a systematic review
J Parkinsons Dis
(2012)
NICE guideline for Parkinson's disease
Age Ageing
Multidisciplinaire richtlijn voor de ziekte van Parkinson
Multidisciplinary care for Parkinson's disease: not if, but how!
Postgrad Med J
Improving community healthcare for patients with Parkinson's disease: the Dutch model
Parkinsons Dis
Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases
J Neurol Neurosurg Psychiatry
From parallel practice to integrative health care: a conceptual framework
BMC Health Serv Res
The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population
Health Qual Life Outcomes
The AMC Linear Disability Score project in a population requiring residential care: psychometric properties
Health Qual Life Outcomes
Progression and prognostic factors of motor impairment, disability and quality of life in newly diagnosed Parkinson's disease
Mov Disord
The AMC Linear Disability Score in patients with newly diagnosed Parkinson disease
Neurology
Quality of life in patients with Parkinson's disease: development of a questionnaire
J Neurol Neurosurg Psychiatry
Two questionnaires for Parkinson's disease: are the PDQ-39 and PDQL equivalent?
Qual Life Res
The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations
Mov Disord
A disease-specific psychosocial questionnaire for Parkinson's disease caregivers
J Neurol
Handleiding voor kostenonderzoek: methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg, geactualiseerde versie
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