Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications

Abstract

Background Specialized versus generic physiotherapy (PT) reduces Parkinson's disease (PD)–related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S&LT), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications. Objectives To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S&LT was associated with the incidence rate of PD‐related complications. Methods We used claims data of all insured persons with PD in the Netherlands between January 1, 2010, and December 31, 2018. ParkinsonNet‐trained therapists were classified as specialized, and other therapists as generic. We used mixed‐effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics. Results The population of 51,464 persons with PD (mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD‐related complications during follow‐up (median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74–0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77–0.99]; P = 0.03). We found a trend of an association between specialized S&LT and a lower rate of PD‐related complications (IRR = 0.88 [0.74–1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42–0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73–0.82]; P < 0.0001) and of S&LT with pneumonia (IRR = 0.70 [0.53–0.93]; P = 0.03). Conclusions These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Time trends in demographic characteristics of participants and outcome measures in Parkinson’s disease research: A 19-year single-center experience

“…We observed that the mean age within most PD studies is 66 years, which is 6 years lower than found in a medical claims data study (n > 51,000) which reported an average age of 72 years [9] . Under-representation of older patients is further supported by the observation that the mean age of death of people in the Netherlands increased by 3.3 years (75.6 years in 2003 to 78.9 years in 2020 [11] but this was not reflected in an increase in the mean age of participants in PD studies.…”

“…Another paper found that females are underrepresented in PD clinical trials, namely 40 % of participants is female in PD randomized controlled trials [7] . Two large studies with data of more than 4,000 [8] and 51,000 [9] PwP in the Netherlands using medical claims data, both reported the proportion of females as 42 %. The proportion of females in our analysis (39 %) is close to these external estimates, suggesting that the proportion of females appears to have been roughly representative of the spectrum of PwP.…”

Experiences of health service access: A qualitative interview study of people living with Parkinson's disease in Ireland

“…In addition, creating regional posts for allied health professionals with specialist PD training is necessary. This is important, given the view from participants in the current study that non‐specialists do not confer as much benefit, and arguments that PD‐specialised clinical therapists will achieve better patient outcomes 25–28 . The Proactive and Integrated Management and Empowerment (PRIME) Parkinson's model of care, has been specifically designed to manage PD issues proactively, to deliver integrated multidisciplinary care, as well as to empower patients to engage in greater self‐management 25,29 .…”

“…This is important, given the view from participants in the current study that non‐specialists do not confer as much benefit, and arguments that PD‐specialised clinical therapists will achieve better patient outcomes. 25 , 26 , 27 , 28 The Proactive and Integrated Management and Empowerment (PRIME) Parkinson's model of care, has been specifically designed to manage PD issues proactively, to deliver integrated multidisciplinary care, as well as to empower patients to engage in greater self‐management. 25 , 29 A clinical trial evaluating this new model is presently underway in the United Kingdom to evaluate a wide range of patient and carer outcomes, and cost‐effectiveness.…”

Compensation strategies for gait impairment in Parkinson’s disease. Towards personalized gait rehabilitation

“…5 The added benefit of the (multidisciplinary) ParkinsonNet approach has been cemented by a recent investigation, demonstrating a marked reduction in complications for patients who were treated by specialized ParkinsonNet physiotherapists, compared to those who received generic allied health therapy. 81 The ParkinsonNet infrastructure offers the opportunity to provide high-quality care from local practices close to the patient's home, rather than university hospitals spread across the country. However, in a highly complex and heterogenous disease such as PD, primary care therapists sometimes wish to receive additional support from experts in secondary or tertiary centers.…”