Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

Abstract

Background Inpatient as well as outpatient care does often not meet PD-patients’ individual needs. Introduction Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap. Methods This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS–UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention. Results MDS–UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly. Conclusions A multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.

Prognostic Evaluation and Rehabilitation Treatment of Intracerebral Hemorrhage and Falls

“…Published by Francis Academic Press, UK -61-ICH patients. The commonly used prognostic assessment methods in clinical practice currently include Krause, Patricia's multidisciplinary scoring system for improving clinical nursing in both motor and non motor aspects [1], and Virhammar, Johan's neurological deficit severity scoring system in the study of cerebrospinal fluid and central nervous system injury [2]. Ramspek and Chava L also conducted external validation of the prognostic evaluation model, elaborating on the relevant issues of "what, why, how, when, and where" [3].…”

The Effectiveness of Inpatient Rehabilitation in Parkinson’s Disease: A Systematic Review of Recent Studies

“…Only 7 studies; 5 in the MR group [47,50,52,53,55] and 2 in the non-MR [56,59] (Table 2) measured cognitive function, using different tests including MMSE, SCOPA-COG, MMST, MoCA, Go/no go, and D-KEFS.…”

“…Short-term cognitive improvement was seen in 4 studies within the MR group (Table 3); 27% in a controlled study [47], 4% in a non-controlled study [50] and only 1% in a retrospective study [52]. One retrospective study showed 1.5% worsening of cognition [53].…”

“…Quality of life was assessed in 6 studies of the MR group [14,17,[49][50][51][52] and in 2 studies of the non-MR group [59,63], measured by PDQ-8, PDQ-39, SF-12, and SF-36 (Table 2).…”

“…Although an optimal medication regimen is very important to support PwPD, not all interventions included medication optimization as an endpoint. LEDD changes were only registered in 6 studies [17,47,48,52,53,55] of the MR group (Table 2) Two controlled studies [47,48] showed a LEDD increase of 45% [47] and an unchanged LEDD [48]. Three noncontrolled studies [17,52,53] showed an increase in between 7.5-and 18%.…”