Effectiveness of multidisciplinary care for Parkinson's disease: a randomized, controlled trial.
Identifieur interne : 000A10 ( Main/Exploration ); précédent : 000A09; suivant : 000A11Effectiveness of multidisciplinary care for Parkinson's disease: a randomized, controlled trial.
Auteurs : Marjolein A. Van Der Marck [Pays-Bas] ; Bastiaan R. Bloem ; George F. Borm ; Sebastiaan Overeem ; Marten Munneke ; Mark GuttmanSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2013.
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Abstract
Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand-alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ-39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery-Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease-Psychosocial; SCOPA-PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ-39 (difference, 3.4; 95% confidence interval [CI]: 0.5-6.2) and UPDRS motor scores (4.1; 95% CI: 0.8-7.3). UPDRS total score (5.6; 95% CI: 0.9-10.3), MADRS (3.7; 95% CI: 1.4-5.9), and SCOPA-PS (2.1; 95% CI: 0.5-3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost-effectiveness of integrated approaches. © 2012 Movement Disorder Society.
DOI: 10.1002/mds.25194
PubMed: 23165981
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Van Der Marck</name><affiliation wicri:level="3"><nlm:affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Bloem, Bastiaan R" sort="Bloem, Bastiaan R" uniqKey="Bloem B" first="Bastiaan R" last="Bloem">Bastiaan R. Bloem</name></author><author><name sortKey="Borm, George F" sort="Borm, George F" uniqKey="Borm G" first="George F" last="Borm">George F. 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Van Der Marck</name><affiliation wicri:level="3"><nlm:affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Bloem, Bastiaan R" sort="Bloem, Bastiaan R" uniqKey="Bloem B" first="Bastiaan R" last="Bloem">Bastiaan R. Bloem</name></author><author><name sortKey="Borm, George F" sort="Borm, George F" uniqKey="Borm G" first="George F" last="Borm">George F. Borm</name></author><author><name sortKey="Overeem, Sebastiaan" sort="Overeem, Sebastiaan" uniqKey="Overeem S" first="Sebastiaan" last="Overeem">Sebastiaan Overeem</name></author><author><name sortKey="Munneke, Marten" sort="Munneke, Marten" uniqKey="Munneke M" first="Marten" last="Munneke">Marten Munneke</name></author><author><name sortKey="Guttman, Mark" sort="Guttman, Mark" uniqKey="Guttman M" first="Mark" last="Guttman">Mark Guttman</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Activities of Daily Living</term><term>Aged</term><term>Analysis of Variance</term><term>Disease Management</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>Psychiatric Status Rating Scales</term><term>Questionnaires</term><term>Severity of Illness Index</term><term>Single-Blind Method</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Activities of Daily Living</term><term>Aged</term><term>Analysis of Variance</term><term>Disease Management</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Psychiatric Status Rating Scales</term><term>Questionnaires</term><term>Severity of Illness Index</term><term>Single-Blind Method</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand-alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ-39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery-Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease-Psychosocial; SCOPA-PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ-39 (difference, 3.4; 95% confidence interval [CI]: 0.5-6.2) and UPDRS motor scores (4.1; 95% CI: 0.8-7.3). UPDRS total score (5.6; 95% CI: 0.9-10.3), MADRS (3.7; 95% CI: 1.4-5.9), and SCOPA-PS (2.1; 95% CI: 0.5-3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost-effectiveness of integrated approaches. © 2012 Movement Disorder Society.</div></front></TEI><affiliations><list><country><li>Pays-Bas</li></country><region><li>Gueldre</li></region><settlement><li>Nimègue</li></settlement></list><tree><noCountry><name sortKey="Bloem, Bastiaan R" sort="Bloem, Bastiaan R" uniqKey="Bloem B" first="Bastiaan R" last="Bloem">Bastiaan R. Bloem</name><name sortKey="Borm, George F" sort="Borm, George F" uniqKey="Borm G" first="George F" last="Borm">George F. Borm</name><name sortKey="Guttman, Mark" sort="Guttman, Mark" uniqKey="Guttman M" first="Mark" last="Guttman">Mark Guttman</name><name sortKey="Munneke, Marten" sort="Munneke, Marten" uniqKey="Munneke M" first="Marten" last="Munneke">Marten Munneke</name><name sortKey="Overeem, Sebastiaan" sort="Overeem, Sebastiaan" uniqKey="Overeem S" first="Sebastiaan" last="Overeem">Sebastiaan Overeem</name></noCountry><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Van Der Marck, Marjolein A" sort="Van Der Marck, Marjolein A" uniqKey="Van Der Marck M" first="Marjolein A" last="Van Der Marck">Marjolein A. Van Der Marck</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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