Inpatient Enhanced Multidisciplinary Care Effects on the Quality of Life for Parkinson Disease: A Quasi-Randomized Controlled Trial

Marumoto, Kohei; Yokoyama, Kazumasa; Inoue, Tomomi; Yamamoto, Hiroshi; Kawami, Yuki; Nakatani, Ayumi; Fukazawa, Yoshihiro; Hosoe, Yayoi; Yamasaki, Aki; Domen, Kazuhisa

doi:10.1177/0891988719841721

Cited by 27 publications

(21 citation statements)

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“…We included 48 records in the qualitative review, from which 37 studies met the inclusion and exclusion criteria. The study characteristics of 8 randomized, controlled trials (RCTs) included in the quantitative meta‐analysis and 19 other experimental studies included in the systematic review are presented in Table . The remaining 10 articles included in our systematic review were nonexperimental (ie, review articles or descriptions of care models) and are detailed separately in Supplementary Table 1 …”

Section: Resultsmentioning

confidence: 99%

“…2 for geographical map), although large parts of the world remained underrepresented. Table presents the characteristics and results of all studies, including the RCTs included in the meta‐analysis, as well as other studies included in the systematic review (nonrandomized, controlled trials, pretest/posttest designs, observational cohort studies, and retrospective chart reviews) . In the online supplementary materials, Supplementary Table 1 presents articles with detailed descriptions of proposed care models and other related reviews of care models specific to integrated care in PD .…”

Section: Resultsmentioning

confidence: 99%

“…Many studies (n = 26) focused on the process of care coordination including medical and surgical management, consultations, and allied health care . The other major theme was delivery of multidisciplinary rehabilitation in various settings (n = 11) . Among the care coordination models, 24 were primarily based in the outpatient setting with or without care coverage extending to home or community .…”

Section: Resultsmentioning

confidence: 99%

“…The inclusion of these specialties might increase awareness about the complexity of PD‐associated nonmotor symptoms and lead to initiation of more efficient referrals to the appropriate health care professionals . Indeed, a recent RCT showed extended multidisciplinary care to be better than standard multidisciplinary rehabilitation in PD …”

Section: Discussionmentioning

confidence: 99%

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Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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Background Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta‐analysis of PD integrated care models and develop recommendations for a representative model. Methods We conducted a systematic review of published integrated care models and a meta‐analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health‐related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Results Forty‐eight publications were identified, including 8 randomized, controlled trials with health‐related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population‐based integration elements. Meta‐analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P < 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health‐related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.03; P = 0.02). Conclusions Outpatient integrated PD care models may improve patient‐reported health‐related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, LLC. on behalf of International Parkinson and Movement Disorder Society.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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“…Recent studies demonstrated that the inclusion of specialized therapists can prevent major disease complications and hospital admissions and can help to reduce overall disease costs [ 16 ]. Two randomized controlled trials showed positive effects on the disease related quality of life in PD patients [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hartelt

Scherbaum

Kinkel³

et al. 2020

JCM

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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.

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