A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease
Identifieur interne : 000212 ( France/Analysis ); précédent : 000211; suivant : 000213A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease
Auteurs : Elena Moro [Canada] ; Niels Allert [Allemagne] ; Roberto Eleopra [Italie] ; Jean-Luc Houeto [France] ; Tra-Mi Phan [Suisse] ; Herman Stoevelaar [Belgique]Source :
- Journal of neurology [ 0340-5354 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Décision.
English descriptors
Abstract
Background and objective Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration. Methods Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile. Results Referral was considered appropriate for 33 % of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age ≥ 70 years and presence of cognitive impairment showed the strongest negative impact. Conclusions The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.
Affiliations:
- Allemagne, Belgique, Canada, France, Italie, Suisse
- District de Cologne, Ontario, Rhénanie-du-Nord-Westphalie
- Bonn, Toronto
- Université de Toronto
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Pascal:09-0108066Le document en format XML
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last="Allert">Niels Allert</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Neurologisches Rehabilitationszentrum Godeshohe Waldstrasse 2-10</s1><s2>53177 Bonn-Bad Godesberg</s2><s3>DEU</s3><sZ>2 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Cologne</region><settlement type="city">Bonn</settlement></placeName></affiliation></author><author><name sortKey="Eleopra, Roberto" sort="Eleopra, Roberto" uniqKey="Eleopra R" first="Roberto" last="Eleopra">Roberto Eleopra</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Ospedale Umberto 1 Dept. of Neurology Via Circonvallazione 50</s1><s2>30174 Venezia Mestre</s2><s3>ITA</s3><sZ>3 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Ospedale Umberto 1 Dept. of Neurology Via Circonvallazione 50</wicri:noRegion></affiliation></author><author><name sortKey="Houeto, Jean Luc" sort="Houeto, Jean 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first="Herman" last="Stoevelaar">Herman Stoevelaar</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Ismar Healthcare Centre for Decision Analysis and Support Duwijckstraat 17</s1><s2>2500 Lier</s2><s3>BEL</s3><sZ>6 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>Ismar Healthcare Centre for Decision Analysis and Support Duwijckstraat 17</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Journal of neurology</title><title level="j" type="abbreviated">J. neurol.</title><idno type="ISSN">0340-5354</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of neurology</title><title level="j" type="abbreviated">J. neurol.</title><idno type="ISSN">0340-5354</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Decision</term><term>Deep brain stimulation</term><term>Nervous system diseases</term><term>Parkinson disease</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Décision</term><term>Stimulation cérébrale profonde</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Décision</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and objective Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration. Methods Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile. Results Referral was considered appropriate for 33 % of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age ≥ 70 years and presence of cognitive impairment showed the strongest negative impact. Conclusions The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Canada</li><li>France</li><li>Italie</li><li>Suisse</li></country><region><li>District de Cologne</li><li>Ontario</li><li>Rhénanie-du-Nord-Westphalie</li></region><settlement><li>Bonn</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></region></country><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Allert, Niels" sort="Allert, Niels" uniqKey="Allert N" first="Niels" last="Allert">Niels Allert</name></region></country><country name="Italie"><noRegion><name sortKey="Eleopra, Roberto" sort="Eleopra, Roberto" uniqKey="Eleopra R" first="Roberto" last="Eleopra">Roberto Eleopra</name></noRegion></country><country name="France"><noRegion><name sortKey="Houeto, Jean Luc" sort="Houeto, Jean Luc" uniqKey="Houeto J" first="Jean-Luc" last="Houeto">Jean-Luc Houeto</name></noRegion></country><country name="Suisse"><noRegion><name sortKey="Phan, Tra Mi" sort="Phan, Tra Mi" uniqKey="Phan T" first="Tra-Mi" last="Phan">Tra-Mi Phan</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Stoevelaar, Herman" sort="Stoevelaar, Herman" uniqKey="Stoevelaar H" first="Herman" last="Stoevelaar">Herman Stoevelaar</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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