The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel
Identifieur interne : 000C51 ( Pmc/Curation ); précédent : 000C50; suivant : 000C52The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel
Auteurs : Stephen W. Pedersen [Danemark] ; Martin Suedmeyer [Allemagne] ; Louis W C. Liu [Canada] ; Dirk Domagk [Allemagne] ; Alison Forbes [États-Unis] ; Lars Bergmann [États-Unis] ; Koray Onuk [États-Unis] ; Ashley Yegin [États-Unis] ; Teus Van Laar [Pays-Bas]Source :
- Journal of Multidisciplinary Healthcare [ 1178-2390 ] ; 2017.
Abstract
A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies.
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DOI: 10.2147/JMDH.S111369
PubMed: 28115853
PubMed Central: 5221801
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Pedersen</name><affiliation wicri:level="1"><nlm:aff id="af1-jmdh-10-013">Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen</wicri:regionArea></affiliation></author><author><name sortKey="Suedmeyer, Martin" sort="Suedmeyer, Martin" uniqKey="Suedmeyer M" first="Martin" last="Suedmeyer">Martin Suedmeyer</name><affiliation wicri:level="1"><nlm:aff id="af2-jmdh-10-013">Department of Neurology, University of Düesseldorf, Düesseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Düesseldorf, Düesseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Liu, Louis W C" sort="Liu, Louis W C" uniqKey="Liu L" first="Louis W C" last="Liu">Louis W C. 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Pedersen</name><affiliation wicri:level="1"><nlm:aff id="af1-jmdh-10-013">Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen</wicri:regionArea></affiliation></author><author><name sortKey="Suedmeyer, Martin" sort="Suedmeyer, Martin" uniqKey="Suedmeyer M" first="Martin" last="Suedmeyer">Martin Suedmeyer</name><affiliation wicri:level="1"><nlm:aff id="af2-jmdh-10-013">Department of Neurology, University of Düesseldorf, Düesseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Düesseldorf, Düesseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Liu, Louis W C" sort="Liu, Louis W C" uniqKey="Liu L" first="Louis W C" last="Liu">Louis W C. Liu</name><affiliation wicri:level="1"><nlm:aff id="af3-jmdh-10-013">Division of Gastroenterology, Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Gastroenterology, Department of Medicine, University of Toronto, University Health Network, Toronto, ON</wicri:regionArea></affiliation></author><author><name sortKey="Domagk, Dirk" sort="Domagk, Dirk" uniqKey="Domagk D" first="Dirk" last="Domagk">Dirk Domagk</name><affiliation wicri:level="1"><nlm:aff id="af4-jmdh-10-013">Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf</wicri:regionArea></affiliation></author><author><name sortKey="Forbes, Alison" sort="Forbes, Alison" uniqKey="Forbes A" first="Alison" last="Forbes">Alison Forbes</name><affiliation wicri:level="1"><nlm:aff id="af5-jmdh-10-013">PDNS consultant, AbbVie Inc., Roswell, GA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>PDNS consultant, AbbVie Inc., Roswell, GA</wicri:regionArea></affiliation></author><author><name sortKey="Bergmann, Lars" sort="Bergmann, Lars" uniqKey="Bergmann L" first="Lars" last="Bergmann">Lars Bergmann</name><affiliation wicri:level="1"><nlm:aff id="af6-jmdh-10-013">Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Global Medical Affairs, AbbVie Inc., North Chicago, IL</wicri:regionArea></affiliation></author><author><name sortKey="Onuk, Koray" sort="Onuk, Koray" uniqKey="Onuk K" first="Koray" last="Onuk">Koray Onuk</name><affiliation wicri:level="1"><nlm:aff id="af6-jmdh-10-013">Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Global Medical Affairs, AbbVie Inc., North Chicago, IL</wicri:regionArea></affiliation></author><author><name sortKey="Yegin, Ashley" sort="Yegin, Ashley" uniqKey="Yegin A" first="Ashley" last="Yegin">Ashley Yegin</name><affiliation wicri:level="1"><nlm:aff id="af6-jmdh-10-013">Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Global Medical Affairs, AbbVie Inc., North Chicago, IL</wicri:regionArea></affiliation></author><author><name sortKey="Van Laar, Teus" sort="Van Laar, Teus" uniqKey="Van Laar T" first="Teus" last="Van Laar">Teus Van Laar</name><affiliation wicri:level="1"><nlm:aff id="af7-jmdh-10-013">Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Neurology, University Medical Center Groningen, Groningen</wicri:regionArea></affiliation></author></analytic><series><title level="j">Journal of Multidisciplinary Healthcare</title><idno type="eISSN">1178-2390</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Carne, W" uniqKey="Carne W">W Carne</name></author><author><name sortKey="Cifu, D" uniqKey="Cifu D">D Cifu</name></author><author><name sortKey="Marcinko, P" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Multidiscip Healthc</journal-id><journal-id journal-id-type="iso-abbrev">J Multidiscip Healthc</journal-id><journal-id journal-id-type="publisher-id">Journal of Multidisciplinary Healthcare</journal-id><journal-title-group><journal-title>Journal of Multidisciplinary Healthcare</journal-title></journal-title-group><issn pub-type="epub">1178-2390</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28115853</article-id><article-id pub-id-type="pmc">5221801</article-id><article-id pub-id-type="doi">10.2147/JMDH.S111369</article-id><article-id pub-id-type="publisher-id">jmdh-10-013</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Pedersen</surname><given-names>Stephen W</given-names></name><xref ref-type="aff" rid="af1-jmdh-10-013">1</xref><xref ref-type="corresp" rid="c1-jmdh-10-013"></xref></contrib><contrib contrib-type="author"><name><surname>Suedmeyer</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="af2-jmdh-10-013">2</xref></contrib><contrib contrib-type="author"><name><surname>Liu</surname><given-names>Louis W C</given-names></name><xref ref-type="aff" rid="af3-jmdh-10-013">3</xref></contrib><contrib contrib-type="author"><name><surname>Domagk</surname><given-names>Dirk</given-names></name><xref ref-type="aff" rid="af4-jmdh-10-013">4</xref></contrib><contrib contrib-type="author"><name><surname>Forbes</surname><given-names>Alison</given-names></name><xref ref-type="aff" rid="af5-jmdh-10-013">5</xref></contrib><contrib contrib-type="author"><name><surname>Bergmann</surname><given-names>Lars</given-names></name><xref ref-type="aff" rid="af6-jmdh-10-013">6</xref></contrib><contrib contrib-type="author"><name><surname>Onuk</surname><given-names>Koray</given-names></name><xref ref-type="aff" rid="af6-jmdh-10-013">6</xref></contrib><contrib contrib-type="author"><name><surname>Yegin</surname><given-names>Ashley</given-names></name><xref ref-type="aff" rid="af6-jmdh-10-013">6</xref></contrib><contrib contrib-type="author"><name><surname>van Laar</surname><given-names>Teus</given-names></name><xref ref-type="aff" rid="af7-jmdh-10-013">7</xref></contrib></contrib-group><aff id="af1-jmdh-10-013"><label>1</label>Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark</aff><aff id="af2-jmdh-10-013"><label>2</label>Department of Neurology, University of Düesseldorf, Düesseldorf, Germany</aff><aff id="af3-jmdh-10-013"><label>3</label>Division of Gastroenterology, Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada</aff><aff id="af4-jmdh-10-013"><label>4</label>Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany</aff><aff id="af5-jmdh-10-013"><label>5</label>PDNS consultant, AbbVie Inc., Roswell, GA, USA</aff><aff id="af6-jmdh-10-013"><label>6</label>Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA</aff><aff id="af7-jmdh-10-013"><label>7</label>Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands</aff><author-notes><corresp id="c1-jmdh-10-013">Correspondence: Stephen W Pedersen, Department of Neurology, Copenhagen University Hospital Glostrup, Nordre Ringvej 57, 2600 Glostrup, Denmark, Tel +45 2089 0056, Fax +45 3331 0248, Email <email>stephen.w.pedersen@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2017</year></pub-date><pub-date pub-type="epub"><day>04</day><month>1</month><year>2017</year></pub-date><volume>10</volume><fpage>13</fpage><lpage>27</lpage><permissions><copyright-statement>© 2017 Pedersen et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2017</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><p>A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies.</p></abstract><abstract abstract-type="graphical"><title>Video abstract</title><p><media xlink:href="jmdh-10-013-s.avi" xlink:type="simple" id="d35e171" position="anchor" mimetype="video"></media></p></abstract><kwd-group><title>Keywords</title><kwd>Parkinson’s disease</kwd><kwd>multidisciplinary team</kwd><kwd>advanced therapy</kwd><kwd>levodopa-carbidopa intestinal gel</kwd><kwd>carbidopa-levodopa enteral suspension</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-jmdh-10-013" position="float"><label>Figure 1</label><caption><p>Examples of multidisciplinary team networks aiming to provide comprehensive and collaborative care for people with PD.</p><p><bold>Notes: (A)</bold> Network interaction within the PD multidisciplinary team in Denmark supporting information exchange about patients. <bold>(B)</bold> The Rigshospitalet Glostrup model.</p><p><bold>Abbreviations:</bold> PD, Parkinson’s disease; DBS, deep brain stimulation; GP, general practitioner; MDS, movement disorder specialist; PDNS, Parkinson’s disease nurse specialist.</p></caption><graphic xlink:href="jmdh-10-013Fig1"></graphic></fig><fig id="f2-jmdh-10-013" position="float"><label>Figure 2</label><caption><p>The one-page, wall-mounted illustrated titration protocol clarifying the role and responsibilities of nurses throughout the titration process at the Hospital General Universitario Gregorio Marañón, Madrid, Spain.</p><p><bold>Notes:</bold> This poster is one component of the hospital’s “clinical pathway” that coordinates the protocols for each role in the MDT. Steps of this protocol reflect regional use and not necessarily label instructions for this product. Courtesy from Drs Carmen Funes Molina and Francisco Grandas, (translated from Spanish).</p><p><bold>Abbreviations:</bold> IV, intravenous; PEG, percutaneous endoscopic gastrostomy; ECG, electrocardiography; LCIG, levodopa-carbidopa intestinal gel.</p></caption><graphic xlink:href="jmdh-10-013Fig2"></graphic></fig><table-wrap id="t1-jmdh-10-013" position="float"><label>Table 1</label><caption><p>Summary of studies investigating the effect of multidisciplinary interventions in people with PD</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Article</th><th valign="top" align="left" rowspan="1" colspan="1">Study title</th><th valign="top" align="left" rowspan="1" colspan="1">Methodology and study population</th><th valign="top" align="left" rowspan="1" colspan="1">Intervention</th><th valign="top" align="left" rowspan="1" colspan="1">Outcomes assessed</th><th valign="top" align="left" rowspan="1" colspan="1">Results</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Trend et al<xref rid="b4-jmdh-10-013" ref-type="bibr">4</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Short-term effectiveness of intensive multidisciplinary rehabilitation for people with PD and their caregivers.</td><td valign="top" align="left" rowspan="1" colspan="1">• Observational study (pre and post-intervention).<break></break>• Patients with PD (Hoehn and Yahr Stage 1–4), with no cognitive impairment, and their caregivers.</td><td valign="top" align="left" rowspan="1" colspan="1">• Multidisciplinary rehabilitation program 1 day per week for 6 weeks for patients and caregivers, involving group activities (relaxation and talks from experts, designed to broaden patients’ knowledge of PD and its treatment) and individualized treatment.<break></break>• MDT included a PDNS, consultant neurologist, physiotherapist, occupational therapist, and a speech and language therapist.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients and caregivers: anxiety/depression (HADS); HRQoL (EQ-5D); social service needs; perceptions of the program.<break></break>• Patients only: mobility (timed walk over 10 m); gait (number of paces in the normal timed walk over 10 m).<break></break>• Assessed at baseline and after 6 weeks.</td><td valign="top" align="left" rowspan="1" colspan="1">• Improvements in patients’ mobility, gait, speech, depression, and HRQoL after the program.<break></break>• Greater improvements in patients with more advanced disease at baseline.<break></break>• No significant improvements in depression or QoL in caregivers.<break></break>• A high unmet need for social services was identified in 31% of patients.<break></break>• Patients and caregivers reported increased knowledge and understanding of PD and its treatment and high levels of satisfaction with both individual therapies and group activities.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Wade et al<xref rid="b10-jmdh-10-013" ref-type="bibr">10</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Multidisciplinary rehabilitation for people with PD: a randomized controlled study.</td><td valign="top" align="left" rowspan="1" colspan="1">• Randomized, single-blind, controlled crossover study.<break></break>• 6 weeks of active intervention vs no active intervention.<break></break>• Patients with PD, without severe cognitive loss, able to travel to hospital.</td><td valign="top" align="left" rowspan="1" colspan="1">• Individualized program of one-to-one treatment over 5 weeks from a specialist team including a PDNS, a physiotherapist, a speech and language therapist, and an occupational therapist.<break></break>• Each week the patient received 2 hours of individual treatment in the morning, followed by group activities (eg, talks from experts and relaxation) in the afternoon.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients: disability (PD disability questionnaire); HRQoL (PDQ-39, SF-36, EQ-5D); the stand-walk-sit test; the nine hole peg test of manual dexterity; anxiety/depression (HADS); and selected items concerning speech from the UPDRS.<break></break>• Caregivers: CSI; EQ-5D • Outcomes assessed at baseline and after 24 weeks.</td><td valign="top" align="left" rowspan="1" colspan="1">• A short spell of multidisciplinary rehabilitation may improve mobility. Follow-up treatments may be needed to maintain any benefit.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carne et al<xref rid="b1-jmdh-10-013" ref-type="bibr">1</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Efficacy of a multidisciplinary treatment program on 1-year outcomes of individuals with PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Retrospective cohort study evaluating the impact of active management within a coordinated, multidisciplinary PD center on disease progression of individuals with established PD.<break></break>• Male veterans with PD who had been, or were being treated with levodopa or dopamine agonists at initial assessment and had a follow-up evaluation between 8 and 16 months after their initial assessment.<break></break>• Patients who had undergone surgical interventions (DBS/thalamotomy) were excluded.</td><td valign="top" align="left" rowspan="1" colspan="1">• Management of PD medications; physician visits (neurologist, psychiatrist); neuropsychological evaluation; nursing visits; functional diagnostic testing (ie, gait laboratory, computerized posturography); rehabilitation therapy (physical therapy, occupational therapy, kinesiotherapy, and speech and language pathology); a home exercise program; a support group; and health and wellness education.</td><td valign="top" align="left" rowspan="1" colspan="1">• Change in UPDRS Part III motor functioning score from initial assessment to 1-year follow-up examination.</td><td valign="top" align="left" rowspan="1" colspan="1">• Overall mean improvement of –5.4 UPDRS Part III points over mean follow-up of 12.2 months.<break></break>• 69.8% (n=30) patients showed improvement in motor functioning, 4.7% (n=2) were unchanged, and 25.6% (n=11) had worsened.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carne et al<xref rid="b2-jmdh-10-013" ref-type="bibr">2</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Long-term extension of Carne et al<xref rid="b1-jmdh-10-013" ref-type="bibr">1</xref> (3-year follow-up).</td><td valign="top" align="left" rowspan="1" colspan="1">• Management of PD medications; physician visits (neurologist, physiatrist); neuropsychological evaluation; nursing visits; functional diagnostic testing (ie, gait laboratory, computerized posturography); rehabilitation therapy (physical therapy, occupational therapy, kinesiotherapy, and speech and language pathology); a home exercise program; a support group; and health and wellness education.</td><td valign="top" align="left" rowspan="1" colspan="1">• Change in UPDRS Part III motor functioning score from initial assessment to 1- to 3-year follow-up examinations.</td><td valign="top" align="left" rowspan="1" colspan="1">• Improvements in UPDRS Part III scores were observed up to 3 years of follow-up.<break></break>• 1-year follow-up (n=28): 78.6% (n=22) patients improved; 21.4% (n=6) worsened.<break></break>• 2-year follow-up (n=15): 66.7% (n=10) patients improved; 33.3% (n=5) patients worsened.<break></break>• 3-year follow-up (n=6): 83.3% (n=5) patients improved; 16.7% (n=1) worsened.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ellis et al<xref rid="b6-jmdh-10-013" ref-type="bibr">6</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Effectiveness<break></break>of an inpatient multidisciplinary rehabilitation program for people with PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Observational study (pre and post-intervention) evaluating the effectiveness of an inpatient multidisciplinary rehabilitation program.<break></break>• Patients with idiopathic PD, Hoehn and Yahr Stage 1–5, who were admitted to an inpatient rehabilitation hospital.</td><td valign="top" align="left" rowspan="1" colspan="1">• Multidisciplinary rehabilitation program administered for duration of hospital stay (mean stay: 20.8±7.8 days).<break></break>• Program involved a combination of individualized physical therapy, occupational therapy, and speech therapy for ≥3 hours per day, 5–7 days per week.<break></break>• MDT included a consultant neurologist (specializing in movement disorders), attending neurologist (specializing in neurorehabilitation), movement disorders fellow, physical therapist, occupational therapist, speech-language therapist, nurse, and case manager.</td><td valign="top" align="left" rowspan="1" colspan="1">• Primary outcome: physical and cognitive disability (FIM total score).<break></break>• Secondary outcomes: motor function (FIM motor score, finger-tapping test); cognition (FIM cognition score); mobility (2-minute walk test, Timed Up and Go test).</td><td valign="top" align="left" rowspan="1" colspan="1">• Significant and clinically meaningful improvements observed across all outcomes assessed (motor function, cognition, and mobility).</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">White et al<xref rid="b11-jmdh-10-013" ref-type="bibr">11</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Changes in walking activity and endurance following rehabilitation for people with PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• RCT comparing changes in walking activity and endurance following multidisciplinary rehabilitation vs no active rehabilitation.<break></break>• Patients with idiopathic PD, Hoehn and Yahr Stage 2 and 3, aged ≥40 years, without significant cognitive impairment (MMSE score >26) and no substantial depression.</td><td valign="top" align="left" rowspan="1" colspan="1">• Multidisciplinary rehabilitation program lasting 6 weeks.<break></break>• Patients received: 0, 3, or 4.5 hours rehabilitation per week.<break></break>• MDT included a physical therapist, occupational therapist, and speech therapist, with expertise in self-management for people with PD.<break></break>• Rehabilitation sessions were group-based, with the exception of the extra 1.5 hours received by the 4.5 hours/week group. These patients received individualized rehabilitation at home from a physical or occupational therapist.</td><td valign="top" align="left" rowspan="1" colspan="1">• Outcomes were assessed at baseline and after 6 weeks.<break></break>• Walking activity was estimated using an activity monitor to record time spent walking and number of walking periods lasting at least 10 seconds, over a 24-hour period.<break></break>• Walking endurance was measured using the 2-minute walk test.</td><td valign="top" align="left" rowspan="1" colspan="1">• Overall, no significant change in walking activity, and endurance was observed following multidisciplinary rehabilitation.<break></break>• Higher doses of rehabilitation resulted in improvement in walking endurance for patients with low baseline walking endurance levels and improvement in walking activity for patients with high baseline walking activity levels.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Guo et al<xref rid="b3-jmdh-10-013" ref-type="bibr">3</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Group education with personal rehabilitation for idiopathic PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Single-blind RCT, with pretest/posttest quasi-experimental design, assessing the effects on patients with early-to-moderate idiopathic PD, Hoehn and Yahr Stage 1–3, without significant cognitive impairment.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients randomized to intervention received three group lectures covering nutrition (by a dietitian), mood (by a psychologist), and movement.<break></break>• Patients also attended a personalized rehabilitation program (24 × 30-minute sessions over 8 weeks) conducted by a physical and occupational therapist.</td><td valign="top" align="left" rowspan="1" colspan="1">• Outcomes assessed at baseline, and after 4 and 8 weeks of intervention.<break></break>• Outcomes: HRQoL (PDQ-39); motor function (UPDRS Part III); activities of daily living (UPDRS Part II and SEADL); depression (SDS); patient mood (PMS); caregiver’s mood status.</td><td valign="top" align="left" rowspan="1" colspan="1">• After 8 weeks of intervention: 37% improvement in PDQ-39 scores; UPDRS Part II and III scores improved; significant improvement in patients’ and caregivers’ moods reported.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Tickle-Degnen et al<xref rid="b7-jmdh-10-013" ref-type="bibr">7</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Self-management rehabilitation and health-related QoL in PD: a randomized controlled trial.</td><td valign="top" align="left" rowspan="1" colspan="1">• RCT to assess the benefits of a self-management rehabilitation program on HRQoL.<break></break>• Patients with idiopathic PD, Hoehn and Yahr Stage 2 and 3, without cognitive impairment (MMSE >26), aged >40 years.<break></break>• Participants had not received surgical interventions (eg, DBS) for PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients randomized to one of three 6-week interventions: 0, 18, or 27 hours of rehabilitation.<break></break>• Intervention delivered by MDT including a physical therapist, occupational therapist, and a speech therapist.</td><td valign="top" align="left" rowspan="1" colspan="1">• Outcomes assessed at baseline, after 6 weeks of intervention, and at 2 and 6 months of follow-up.<break></break>• Outcomes: HRQoL (PDQ-39).</td><td valign="top" align="left" rowspan="1" colspan="1">• Beneficial effect of multidisciplinary intervention observed immediately post-intervention and at 2 and 6 months of follow-up.<break></break>• Post-intervention: 54% of patients in rehabilitation groups showed significant improvement in HRQoL vs 18% of patients in control group.<break></break>• 2 months of follow-up: 34% of patients in rehabilitation groups showed significant improvement in HRQoL vs 20% of patients in control group.<break></break>• 6 months of follow-up: 38% of patients in rehabilitation groups showed significant improvement in HRQoL vs 10% of patients in control group.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">van der Marck et al<xref rid="b5-jmdh-10-013" ref-type="bibr">5</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Effectiveness of multidisciplinary care for PD: a randomized, controlled trial.</td><td valign="top" align="left" rowspan="1" colspan="1">• Single-blind RCT to compare outcomes for PD management following multidisciplinary care vs stand alone care from a neurologist.<break></break>• Patients with PD, without dementia.</td><td valign="top" align="left" rowspan="1" colspan="1">• Intervention group received multidisciplinary care from a movement disorders specialist, PD nurse, and social worker for 8 months.<break></break>• Control group received care delivered by a general neurologist for 8 months.</td><td valign="top" align="left" rowspan="1" colspan="1">• Outcomes assessed at baseline, 4 and 8 months.<break></break>• Primary outcome: HRQoL (PDQ-39 score).<break></break>• Secondary outcome: motor function (UPDRS Part III score).<break></break>• Tertiary outcomes: UPDRS total score; depression (MADRS); psychosocial functioning (SCOPA-PS); caregiver: CSI.</td><td valign="top" align="left" rowspan="1" colspan="1">• Compared to the control group, the intervention group improved significantly at 8 months on PDQ-39 score, UPDRS Part III score, UPDRS total score, SCOPA-PS score, and MADRS score.<break></break>• No difference in caregiver strain was observed between groups.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">van der Marck et al<xref rid="b8-jmdh-10-013" ref-type="bibr">8</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Integrated multidisciplinary care in PD: a non-randomized, controlled trial</td><td valign="top" align="left" rowspan="1" colspan="1">• Non-RCT to compare an integrated multidisciplinary approach for the management of PD vs usual care.<break></break>• Patients with PD, aged 20–80 years, Hoehn and Yahr Stage 1–4, without significant cognitive impairment.<break></break>• Patients receiving DBS were excluded.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients in intervention region offered an individually tailored comprehensive assessment in an expert tertiary referral center.<break></break>• MDT members met face-to-face to agree a treatment plan to be discussed with the patient and caregiver.<break></break>• Patient subsequently referred to a regional network of allied health professionals (physiotherapists, occupational therapists, and speech and language therapists).<break></break>• Patients in control regions also received some multidisciplinary care, but at a lower rate than in the intervention region.</td><td valign="top" align="left" rowspan="1" colspan="1">• Primary outcomes assessed at 4, 6, and 8 months: activities of daily living (ALDS); HRQoL (PDQL).<break></break>• Secondary outcomes: motor function (UPDRS Part III) at 4 months; caregiver burden at 4 and 8 months; and costs.<break></break>• Tertiary outcomes: HRQoL (SF-36v2); anxiety/depression (HADS); falls efficacy scale-international; freezing of gait questionnaire; disability (SPDDS); overall well-being 100-point visual analog scale; nonmotor symptoms scale; disease severity (UPDRS Part IV); patient-specific index for physiotherapy in PD; balance; turning; Parkinson’s activity scale; fall frequency; quality of care questionnaire.<break></break>• Caregivers: anxiety/depression (HADS); HRQoL (SF-36v2); view of patients’ ALDS.</td><td valign="top" align="left" rowspan="1" colspan="1">• ALDS and PDQL showed small improvements in favor of the intervention, but correction for baseline disease severity removed these differences.<break></break>• UPDRS Part III and caregiver burden did not differ between control and intervention groups.<break></break>• Significant improvements in HADS, SPDDS, NMSS score, SF-36, perceived general health and quality of care scores observed in intervention group vs control group.<break></break>• There was no significant difference in mean costs per patient between groups.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Monticone et al<xref rid="b58-jmdh-10-013" ref-type="bibr">58</xref></td><td valign="top" align="left" rowspan="1" colspan="1">In patient multidisciplinary rehabilitation for PD: a randomized controlled trial</td><td valign="top" align="left" rowspan="1" colspan="1">• Parallel group, single-blinded RCT to compare multidisciplinary rehabilitative care vs general physiotherapy.<break></break>• Patients had idiopathic PD, were aged >50 years, Hoehn and Yahr Stage 2.5–4, with a decline in function, without dementia, other neurological/psychological disorders, or surgical interventions for PD.</td><td valign="top" align="left" rowspan="1" colspan="1">• Experimental group received multidisciplinary rehabilitative care including motor training (task, transfers, balance, and gait), cognitive training (attention/memory, psychomotor, executive function, visuospatial, and calculation), and ergonomic education (facilitation of new ADLs).<break></break>• Control group received neuromotor techniques, mobilization, strengthening, stretching, resistance, and velocity training.</td><td valign="top" align="left" rowspan="1" colspan="1">• Primary outcome measures were assessed before treatment and 8 and 12 months following treatment: motor impairment (MDS-UPDRS Part III), balance (Italian BBS), ADL by the Italian FIM, QoL by the PDQ-39.</td><td valign="top" align="left" rowspan="1" colspan="1">• After training, there was a significant between-group difference in MDS-UPDRS Part III, BBS scores, FIM, and QoL in favor of the experimental group.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Frazzitta et al<xref rid="b56-jmdh-10-013" ref-type="bibr">56</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Multidisciplinary intensive rehabilitation treatment improves sleep quality in PD</td><td valign="top" align="left" rowspan="1" colspan="1">• Retrospective study of a database of people with PD.<break></break>• All patients had a diagnosis of clinically probable idiopathic PD, Hoehn–Yahr Stage 2 or 3, and subjective complaints of sleep disturbances.<break></break>• They did not have any other neurological conditions, and had scores <8 on the Hamilton Depression scale.</td><td valign="top" align="left" rowspan="1" colspan="1">• Group 1 received multidisciplinary intensive rehabilitation treatment consisting of a 4-week physical therapy with three daily sessions, 5 days a week. Session 1 included cardiovascular activities and muscle stretches, Session 2 included activities to improve balance and gait, and Session 3 was designed to assist with ADL.<break></break>• Group 2 received pharmacological therapy only.</td><td valign="top" align="left" rowspan="1" colspan="1">• UPDRS III and II scores at enrollment and Day 28.<break></break>• Sleep complaints were assessed using the Italian version of the PDSS.</td><td valign="top" align="left" rowspan="1" colspan="1">• After 28 days, the baseline UPDRS scores significantly decreased in Group 1 (UPDRS III, <italic>P</italic><0.0001; UPDRS II, <italic>P</italic><0.0001), whereas they did not change in Group 2.<break></break>• Significant improvements were observed in total PDSS scores in Group 1 (<italic>P</italic><0.0001), particularly sleep quality, motor symptoms, and daytime somnolence. Group 2 did not show any improvement in PDSS scores.</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Giardini et al<xref rid="b57-jmdh-10-013" ref-type="bibr">57</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Toward proactive active living: patients with PD experience a multidisciplinary intensive rehabilitation treatment</td><td valign="top" align="left" rowspan="1" colspan="1">• Qualitative study of audio recordings from semi-structured interviews with people with PD, undergoing multidisciplinary rehabilitation.<break></break>• Patients had diagnosis of idiopathic PD, Hoehn and Yahr Stage 3, without cognitive impairment, psychotic symptoms or DBS.</td><td valign="top" align="left" rowspan="1" colspan="1">• A multidisciplinary intensive rehabilitation treatment consisting of 4 weeks of physical therapy with three daily sessions, 5 days a week. Session 1 included muscle stretches and exercises, Session 2 included aerobic exercises, and Session 3 was with an occupational therapist with activated to promote autonomy.<break></break>• The semi-structured interview was performed during inpatients’ 4-week rehabilitation program, a few days before discharge. Questions focused mainly on adherence to medical prescriptions, comments about the rehabilitation program, and motivation for continuing it at home.</td><td valign="top" align="left" rowspan="1" colspan="1">• The analysis of interviews was supported by grounded theory methodology following which core categories and a hierarchic organization of issues were identified.</td><td valign="top" align="left" rowspan="1" colspan="1">• Patients described an overall satisfaction with treatment.<break></break>• Intensive rehabilitation was reported to counteract the symptoms of deterioration and disease progression.<break></break>• Patients perceived physical improvements and functionality, which exceeded expectations.<break></break>• Many patients also reported an improvement in their mood as a result of the rehabilitation.<break></break>• The majority of patients expressed the intention to continue with the prescribed rehabilitation at home.</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-jmdh-10-013"><p><bold>Abbreviations:</bold> ADLs, activities of daily living; ALDS, Academic Medical Center linear disability score; BBS, Berg Balance Scale; CSI, Caregiver Strain Index; DBS, Deep Brain Stimulation; EQ-5D, European Quality of Life Group – five dimensions; FIM, Functional Independence Measure; HADs, Hospital Anxiety and Depression Scale; QoL, quality of life; HRQoL, health-related quality of life; MADRS, Montgomery–Asberg Depression Scale; MDS, Movement Disorder Society; MDT, Multidisciplinary Team; MMSE, Mini–Mental State Examination; NMSS, Non-Motor Symptom Scale; PD, Parkinson’s disease; PDNS, Parkinson’s disease nurse specialist; PDQ-39, 39-item Parkinson’s Disease Questionnaire; PDSS, Parkinson’s Disease Sleep Scale; PMS, Global patient’s mood status; RCT, randomized controlled trial; SCOPA-PS, Scales for Outcomes in Parkinson’s Disease – Psychosocial; SDS, Zung Self-Rating Depression Scale; SEADL, Schwab and England Activities of Daily Living; SF-36, Short Form 36-item health survey; SPDDS, Self-Assessment Parkinson’s Disease Disability Scale; UPDRS, Unified Parkinson’s Disease Rating Scale.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-jmdh-10-013" position="float"><label>Table 2</label><caption><p>Members of the MDT listed by the European Parkinson’s Disease Standards of Care Consensus Statement and their role in the care and management of people with PD<xref rid="b12-jmdh-10-013" ref-type="bibr">12</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">MDT member</th><th valign="top" align="left" rowspan="1" colspan="1">Role</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">General practitioner</td><td valign="top" align="left" rowspan="1" colspan="1">To provide day-to-day clinical management</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Movement disorder specialist/neurologist</td><td valign="top" align="left" rowspan="1" colspan="1">To plan and monitor treatment</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Geriatrician</td><td valign="top" align="left" rowspan="1" colspan="1">To provide general in- and outpatient management</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PDNS</td><td valign="top" align="left" rowspan="1" colspan="1">To manage care and coordinate with the hospital and community services</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Physiotherapist</td><td valign="top" align="left" rowspan="1" colspan="1">To maximize functional ability</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Speech and language therapist</td><td valign="top" align="left" rowspan="1" colspan="1">To manage difficulties with speech, communication, eating, drinking, and swallowing</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Occupational therapist</td><td valign="top" align="left" rowspan="1" colspan="1">To advise on measures to retain independence</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Nutritionist</td><td valign="top" align="left" rowspan="1" colspan="1">To ensure optimal nutrition</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Psychologist</td><td valign="top" align="left" rowspan="1" colspan="1">To treat depression, other mental health problems</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pharmacists</td><td valign="top" align="left" rowspan="1" colspan="1">To ensure supplies of specialist medications</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Complementary therapists</td><td valign="top" align="left" rowspan="1" colspan="1">To provide massage and relaxation therapies</td></tr></tbody></table><table-wrap-foot><fn id="tfn2-jmdh-10-013"><p><bold>Note:</bold> Data from The European Parkinson’s Disease Standards of Care Consensus Statement.<xref rid="b12-jmdh-10-013" ref-type="bibr">12</xref></p></fn><fn id="tfn3-jmdh-10-013"><p><bold>Abbreviations:</bold> PD, Parkinson’s disease; MDT, multidisciplinary team; PDNS, Parkinson’s disease nurse specialist.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-jmdh-10-013" position="float"><label>Table 3</label><caption><p>Matrix used in the Netherlands to help decide upon the most suitable advanced therapy for each individual with PD</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Factor</th><th valign="top" align="left" rowspan="1" colspan="1">Apomorphine</th><th valign="top" align="left" rowspan="1" colspan="1">LCIG</th><th valign="top" align="left" rowspan="1" colspan="1">DBS</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Age >75 years</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Postural instability</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hallucinations</td><td valign="top" align="left" rowspan="1" colspan="1">−/+</td><td valign="top" align="left" rowspan="1" colspan="1">−/0</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ICD</td><td valign="top" align="left" rowspan="1" colspan="1">−/+</td><td valign="top" align="left" rowspan="1" colspan="1">+</td><td valign="top" align="left" rowspan="1" colspan="1">+</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Excessive daytime sleepiness</td><td valign="top" align="left" rowspan="1" colspan="1">−</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Dementia</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Need to stop oral medication</td><td valign="top" align="left" rowspan="1" colspan="1">−</td><td valign="top" align="left" rowspan="1" colspan="1">+</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Moderate depression</td><td valign="top" align="left" rowspan="1" colspan="1">+</td><td valign="top" align="left" rowspan="1" colspan="1">+/0</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Suicide attempts</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Restless legs</td><td valign="top" align="left" rowspan="1" colspan="1">+</td><td valign="top" align="left" rowspan="1" colspan="1">+</td><td valign="top" align="left" rowspan="1" colspan="1">0/−</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Weight gain</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">−</td></tr></tbody></table><table-wrap-foot><fn id="tfn4-jmdh-10-013"><p><bold>Notes:</bold> +, factor strengthens the decision to select the device-aided therapy; 0, factor does not influence the decision; −, factor argues against selecting the device-aided therapy.</p></fn><fn id="tfn5-jmdh-10-013"><p><bold>Abbreviations:</bold> PD, Parkinson’s disease; LCIG, levodopa–carbidopa intestinal gel; DBS, deep brain stimulation; ICD, impulse control disorder.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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