Parkinson’s Disease Multimodal Complex Treatment (PD-MCT): Analysis of Therapeutic Effects and Predictors for Improvement

Abstract

Parkinson’s disease Multimodal Complex Treatment (PD-MCT) is a multidisciplinary inpatient treatment approach that has been demonstrated to improve motor function and quality of life in patients with Parkinson’s disease (PD). In this study, we assessed the efficacy of PD-MCT and calculated predictors for improvement. We performed a prospective analysis in a non-randomized, open-label observational patient cohort. Study examinations were done at baseline (BL), at discharge after two-weeks of inpatient treatment (DC) and at a six-week follow-up examination (FU). Besides Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III as a primary outcome, motor performance was measured by the Timed Up-and-Go (TUG), the Berg Balance Scale (BBS) and the Perdue Pegboard Test (PPT). Until DC, motor performance improved significantly in several parameters and was largely maintained until FU (MDS-UPDRS III BL-to-DC: −4.7 ± 1.2 (SE) p = 0.0012, BL-to-FU: −6.1 ± 1.3 p = 0.0001; TUG BL-to-DC: −2.5 ± 0.9 p = 0.015, BL-to-FU: 2.4 ± 0.9 p = 0.027; BBS BL-to-DC: 2.4 ± 0.7 p = 0.003, BL-to-FU: 1.3 ± 0.7 p = 0.176, PPT BL-to-DC: 3.0 ± 0.5 p = 0.000004, BL-to-FU: 1.7 ± 0.7 p = 0.059). Overall, nontremor items were more therapy responsive than tremor items. Motor complications evaluated with MDS-UPDRS IV occurred significantly less frequent at DC (−1.8 ± 0.5 p = 0.002). Predictor analyses revealed an influence of initial motor impairment and disease severity on the treatment response in different motor aspects. In summary, we demonstrate a significant positive treatment effect of PD-MCT on motor function of PD patients which can be maintained in several parameters for an extended time period of six weeks and identify predictors for an improvement of motor function.

Short- and Long-Term Effect of Parkinson’s Disease Multimodal Complex Treatment

“…This corresponds to an absolute reduction of −9.55 points, which is above the minimal clinically important difference for improvement of −3.25 points and is correspondingly clinically significant [ 11 ]. This is in line with earlier studies showing improvement of motor function after PD-MCT [ 4 , 5 , 6 ]. We found that improvement of MDS-UPDRS III after PD-MCT in patients with PD is more likely to occur in patients with higher MDS-UPDRS III at admission, lower age, and less depression.…”

“…In Germany, the majority of patients are treated for at least 14 days (OPS8-97d.1) [ 3 ]. The longer treatments (OPS8-97d.1 and OPS8-97d.2) have a positive effect on motor and nonmotor symptoms, as shown in two smaller nonrandomized studies with 126 and 47 PD patients [ 4 , 5 , 6 ]. Only one of the two studies also analyzed whether this positive effect persisted after hospital discharge in a follow-up examination of 47 patients after six weeks [ 4 , 5 ].…”

“…The longer treatments (OPS8-97d.1 and OPS8-97d.2) have a positive effect on motor and nonmotor symptoms, as shown in two smaller nonrandomized studies with 126 and 47 PD patients [ 4 , 5 , 6 ]. Only one of the two studies also analyzed whether this positive effect persisted after hospital discharge in a follow-up examination of 47 patients after six weeks [ 4 , 5 ]. Data regarding the effectiveness of the shorter OPS8-97d.0 (7–13 days) are missing, as well as data regarding the long-term effect of PD-MCT.…”

Building a Parkinson-Network–Experiences from Germany

“…The Multimodal Complex Treatment is an in-patient treatment program geared towards more advanced patients and very complicated cases. The treatment compromises on average, fourteen days of in-patient care with a multimodal assessment at the beginning and end [ 26 , 27 ]. Patients receive at least 7.5 h of therapy per week by various therapists, specifically tailored to their needs.…”

A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson’s disease

“…Barriers to the application of the composite clinical motor score in routine clinical practice include the necessity to measure all three constituents (MDS-UPDRS III, Purdue Pegboard Test and TUG); of questionable feasibility considering typical time constraints, though used by a number of research studies to date 22 44. Refinement of the composite clinical motor score, through the identification and exclusion of redundant constituents or their subitems, may be the subject of future work.…”