Referring Parkinson’s disease patients for deep brain stimulation: a RAND/UCLA appropriateness study
Identifieur interne : 001D62 ( Ncbi/Merge ); précédent : 001D61; suivant : 001D63Referring Parkinson’s disease patients for deep brain stimulation: a RAND/UCLA appropriateness study
Auteurs : Elena Moro [France] ; Michael Schüpbach [Suisse, France] ; Tobias W Chter [Allemagne] ; Niels Allert [Allemagne] ; Roberto Eleopra [Italie] ; Christopher R. Honey [Canada] ; Mauricio Rueda [Colombie] ; Mya C. Schiess [États-Unis] ; Yasushi Shimo [Japon] ; Peter Valkovic [Slovaquie] ; Alan Whone [Royaume-Uni] ; Herman Stoevelaar [Belgique]Source :
- Journal of Neurology [ 0340-5354 ] ; 2015.
English descriptors
- KwdEn :
- MESH :
- diagnosis : Parkinson Disease.
- standards : Practice Guidelines as Topic, Referral and Consultation.
- therapy : Parkinson Disease.
- Aged, Aged, 80 and over, Deep Brain Stimulation, Female, Humans, Male, Middle Aged, Severity of Illness Index.
Abstract
In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association,
Url:
DOI: 10.1007/s00415-015-7942-x
PubMed: 26530503
PubMed Central: 4723622
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PMC:4723622Le document en format XML
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<term>Aged, 80 and over</term>
<term>Deep Brain Stimulation</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Parkinson Disease (diagnosis)</term>
<term>Parkinson Disease (therapy)</term>
<term>Practice Guidelines as Topic (standards)</term>
<term>Referral and Consultation (standards)</term>
<term>Severity of Illness Index</term>
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<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Aged, 80 and over</term>
<term>Deep Brain Stimulation</term>
<term>Female</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en"><p>In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association, <italic>p</italic>
< 0.001), and cognitive impairment (negative association, <italic>p</italic>
< 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable ‘non-motor side effects of anti-PD medication’ was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.</p>
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<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
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</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff5">Center of Rehabilitation, Bad Gögging, Germany</nlm:aff>
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<wicri:noRegion>Bad Gögging</wicri:noRegion>
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<author><name sortKey="Allert, Niels" sort="Allert, Niels" uniqKey="Allert N" first="Niels" last="Allert">Niels Allert</name>
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</affiliation>
</author>
<author><name sortKey="Honey, Christopher R" sort="Honey, Christopher R" uniqKey="Honey C" first="Christopher R." last="Honey">Christopher R. Honey</name>
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<author><name sortKey="Rueda, Mauricio" sort="Rueda, Mauricio" uniqKey="Rueda M" first="Mauricio" last="Rueda">Mauricio Rueda</name>
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</affiliation>
</author>
<author><name sortKey="Schiess, Mya C" sort="Schiess, Mya C" uniqKey="Schiess M" first="Mya C." last="Schiess">Mya C. Schiess</name>
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<country xml:lang="fr">États-Unis</country>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Shimo, Yasushi" sort="Shimo, Yasushi" uniqKey="Shimo Y" first="Yasushi" last="Shimo">Yasushi Shimo</name>
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<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Neurology, Juntendo University School of Medicine, Tokyo</wicri:regionArea>
<placeName><settlement type="city">Tokyo</settlement>
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</author>
<author><name sortKey="Valkovic, Peter" sort="Valkovic, Peter" uniqKey="Valkovic P" first="Peter" last="Valkovic">Peter Valkovic</name>
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</author>
<author><name sortKey="Whone, Alan" sort="Whone, Alan" uniqKey="Whone A" first="Alan" last="Whone">Alan Whone</name>
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<country xml:lang="fr">Royaume-Uni</country>
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<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Stoevelaar, Herman" sort="Stoevelaar, Herman" uniqKey="Stoevelaar H" first="Herman" last="Stoevelaar">Herman Stoevelaar</name>
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<country xml:lang="fr">Belgique</country>
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<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
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<wicri:regionArea>Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble</wicri:regionArea>
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<author><name sortKey="Schupbach, Michael" sort="Schupbach, Michael" uniqKey="Schupbach M" first="Michael" last="Schüpbach">Michael Schüpbach</name>
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<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern</wicri:regionArea>
<placeName><settlement type="city">Berne</settlement>
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</placeName>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="Aff3">Assistance-Publique Hôpitaux de Paris; Centre d’Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie, Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France</nlm:aff>
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<author><name sortKey="W Chter, Tobias" sort="W Chter, Tobias" uniqKey="W Chter T" first="Tobias" last="W Chter">Tobias W Chter</name>
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<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen</wicri:regionArea>
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<author><name sortKey="Allert, Niels" sort="Allert, Niels" uniqKey="Allert N" first="Niels" last="Allert">Niels Allert</name>
<affiliation wicri:level="3"><nlm:aff id="Aff6">Neurological Rehabilitation Center Godeshoehe, Bonn, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Neurological Rehabilitation Center Godeshoehe, Bonn</wicri:regionArea>
<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"><nlm:aff id="Aff7">Department of Neurology, Santa Maria della Misericordia University Hospital, Udine, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Neurology, Santa Maria della Misericordia University Hospital, Udine</wicri:regionArea>
<wicri:noRegion>Udine</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Honey, Christopher R" sort="Honey, Christopher R" uniqKey="Honey C" first="Christopher R." last="Honey">Christopher R. Honey</name>
<affiliation wicri:level="1"><nlm:aff id="Aff8">Division of Neurosurgery, University of British Columbia, Vancouver, Canada</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Division of Neurosurgery, University of British Columbia, Vancouver</wicri:regionArea>
<wicri:noRegion>Vancouver</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Rueda, Mauricio" sort="Rueda, Mauricio" uniqKey="Rueda M" first="Mauricio" last="Rueda">Mauricio Rueda</name>
<affiliation wicri:level="1"><nlm:aff id="Aff9">Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia</nlm:aff>
<country xml:lang="fr">Colombie</country>
<wicri:regionArea>Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga</wicri:regionArea>
<wicri:noRegion>Bucaramanga</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Schiess, Mya C" sort="Schiess, Mya C" uniqKey="Schiess M" first="Mya C." last="Schiess">Mya C. Schiess</name>
<affiliation wicri:level="2"><nlm:aff id="Aff10">Department of Neurology, University of Texas Medical School at Houston, Texas, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurology, University of Texas Medical School at Houston, Texas</wicri:regionArea>
<placeName><region type="state">Texas</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Shimo, Yasushi" sort="Shimo, Yasushi" uniqKey="Shimo Y" first="Yasushi" last="Shimo">Yasushi Shimo</name>
<affiliation wicri:level="3"><nlm:aff id="Aff11">Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan</nlm:aff>
<country xml:lang="fr">Japon</country>
<wicri:regionArea>Department of Neurology, Juntendo University School of Medicine, Tokyo</wicri:regionArea>
<placeName><settlement type="city">Tokyo</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Valkovic, Peter" sort="Valkovic, Peter" uniqKey="Valkovic P" first="Peter" last="Valkovic">Peter Valkovic</name>
<affiliation wicri:level="1"><nlm:aff id="Aff12">2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia</nlm:aff>
<country xml:lang="fr">Slovaquie</country>
<wicri:regionArea>2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava</wicri:regionArea>
<wicri:noRegion>Bratislava</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Whone, Alan" sort="Whone, Alan" uniqKey="Whone A" first="Alan" last="Whone">Alan Whone</name>
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<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Neurology, Frenchay Hospital, Bristol</wicri:regionArea>
<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Stoevelaar, Herman" sort="Stoevelaar, Herman" uniqKey="Stoevelaar H" first="Herman" last="Stoevelaar">Herman Stoevelaar</name>
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<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Centre for Decision Analysis and Support, Ismar Healthcare, Lier</wicri:regionArea>
<wicri:noRegion>Lier</wicri:noRegion>
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</analytic>
<series><title level="j">Journal of Neurology</title>
<idno type="ISSN">0340-5354</idno>
<idno type="eISSN">1432-1459</idno>
<imprint><date when="2015">2015</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><p>In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association, <italic>p</italic>
< 0.001), and cognitive impairment (negative association, <italic>p</italic>
< 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable ‘non-motor side effects of anti-PD medication’ was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.</p>
</div>
</front>
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<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Referring Parkinson's disease patients for deep brain stimulation: a RAND/UCLA appropriateness study.</title>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Referring Parkinson's disease patients for deep brain stimulation: a RAND/UCLA appropriateness study.</title>
<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
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<country xml:lang="fr">France</country>
<wicri:regionArea>Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Schupbach, Michael" sort="Schupbach, Michael" uniqKey="Schupbach M" first="Michael" last="Schüpbach">Michael Schüpbach</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern, Switzerland.</nlm:affiliation>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern</wicri:regionArea>
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<author><name sortKey="Honey, Christopher R" sort="Honey, Christopher R" uniqKey="Honey C" first="Christopher R" last="Honey">Christopher R. Honey</name>
<affiliation wicri:level="1"><nlm:affiliation>Division of Neurosurgery, University of British Columbia, Vancouver, Canada.</nlm:affiliation>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Division of Neurosurgery, University of British Columbia, Vancouver</wicri:regionArea>
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<author><name sortKey="Rueda, Mauricio" sort="Rueda, Mauricio" uniqKey="Rueda M" first="Mauricio" last="Rueda">Mauricio Rueda</name>
<affiliation wicri:level="1"><nlm:affiliation>Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.</nlm:affiliation>
<country xml:lang="fr">Colombie</country>
<wicri:regionArea>Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga</wicri:regionArea>
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</author>
<author><name sortKey="Schiess, Mya C" sort="Schiess, Mya C" uniqKey="Schiess M" first="Mya C" last="Schiess">Mya C. Schiess</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Neurology, University of Texas Medical School at Houston, Texas, USA.</nlm:affiliation>
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<author><name sortKey="Shimo, Yasushi" sort="Shimo, Yasushi" uniqKey="Shimo Y" first="Yasushi" last="Shimo">Yasushi Shimo</name>
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<author><name sortKey="Whone, Alan" sort="Whone, Alan" uniqKey="Whone A" first="Alan" last="Whone">Alan Whone</name>
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<series><title level="j">Journal of neurology</title>
<idno type="eISSN">1432-1459</idno>
<imprint><date when="2016" type="published">2016</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Aged, 80 and over</term>
<term>Deep Brain Stimulation</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Parkinson Disease (diagnosis)</term>
<term>Parkinson Disease (therapy)</term>
<term>Practice Guidelines as Topic (standards)</term>
<term>Referral and Consultation (standards)</term>
<term>Severity of Illness Index</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Practice Guidelines as Topic</term>
<term>Referral and Consultation</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Aged, 80 and over</term>
<term>Deep Brain Stimulation</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
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<front><div type="abstract" xml:lang="en">In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson's disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on-off fluctuations, dyskinesias and refractory tremor (positive association, p < 0.001), and cognitive impairment (negative association, p < 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable 'non-motor side effects of anti-PD medication' was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.</div>
</front>
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