Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinsons disease

Abstract

Abstract-We examined the impact of multidisciplinary clinical management of the Parkinson's Disease Research, Education, and Clinical Center program on Parkinson's disease progression. Initial and follow-up scores on the Part III Motor Examination subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) were examined. Overall, 37 (75.5%) of the 49 patients demonstrated stable or improved UPDRS motor scores at 1-to 3-year follow-up; in the 1-year group (n = 28), 22 patients (78.6%) improved, while 6 (21.4%) worsened. In the 2-year group (n = 15), 10 (66.7%) improved, while 5 (33.3%) worsened. In the 3-year group (n = 6), 5 (83.3%) improved, while 1 (16.7%) worsened. Multidisciplinary interventions included neurology (95.9% of patients), physiatry (93.9%), nursing (87.8%), psychology (42.9%), medication changes (59.2% increases, 18.4% decreases), rehabilitation therapies (physical, occupational, speech-language, 67.3%), functional diagnostic testing (18.4%), support group (16.3%), home exercise instruction (85.7%), and disease and wellness education (81.6%). Improved and worsened patients did not significantly differ on the individual program components. Clinical implications and study limitations are discussed.

Caregiver distress in parkinsonism

“…The caregivers (N = 49) of all consecutive subjects referred with a movement disorder and seen for an initial or follow-up neuropsychological screening from [19]. We obtained approval for this study from the local VAMC institutional review board.…”

Multidisciplinary care of patients with Parkinson's disease

“…11 There are several studies of multidisciplinary care in Parkinson's disease comparing outcomes before and after the intervention. Outpatient multidisciplinary care programmes have reported shortterm improvements in UPDRS motor score, 12 gait speed and stride length, [13][14] speech, depression and health-related quality of life. 13 low up) have also been reported, and the authors comment that close multidisciplinar y working was key to success.…”

“…13 low up) have also been reported, and the authors comment that close multidisciplinar y working was key to success. 15 Inpatient multidisciplinar y rehabilitation for Parkinson's disease has also been reported to be effective in studies using a trial design comparing pre-and postintervention outcomes. Using the Nottingham Health Profile (a measure of health-related quality of life), Sitzia et al found improvements in 'pain', 'emotional reactions' and 'physical mobility' and in overall quality of life.…”

“…These meetings allow sharing of pertinent information and ensure the team is working towards shared goals for any given patient. 15 More than this, the meetings encourage the growth and maintenance of rapport and respect between team members, make team members more aware of the roles and potentials of other disciplines, and avoid the duplication of effort. Shared Parkinson's disease-oriented notes and adequate IT and administrative support are also important for team effectiveness.…”

Integrated care of chronic degenerative non-communicable diseases and rehabilitation: the odd couple?

“…In Germany, a Parkinson network has led to a greatly improved interaction and communication between the movement disorders specialists and the general neurologists, enabling more efficient initiation of advanced therapies. Also intensive multidisciplinary rehabilitation interventions for people with PD have been shown particularly effective at improving quality of life and motor function [11][12][13].…”