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Fabbri M, Ledda C, Schirinzi T, Artusi CA, Avallone AR, Zenuni H, De Micco R, Aloisio S, Cani I, Malaguti MC, Di Biasio F, Calandra-Buonaura G, Stefani A, Lopiano L, Barone P, Picillo M. Multidisciplinary care use in neurodegenerative complex diseases: The example of progressive supranuclear palsy and advanced Parkinson's disease in real-life. Parkinsonism Relat Disord 2024; 125:107047. [PMID: 38964017 DOI: 10.1016/j.parkreldis.2024.107047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In spite of being considered the gold-standard of care, little is known about the real-life use of in-home and multidisciplinary care in atypical parkinsonism. OBJECTIVE Primary: Examine real-life multidisciplinary care use for Progressive Supranuclear Palsy (PSP). Secondary: a) Compare PSP care to advanced Parkinson's disease (APD) care; (b) Explore demographic and clinical variables associated with care needs in both groups. METHODS A cross-sectional multicenter observational study enrolled 129 PSP patients and 65 APD patients (Hoehn and Yahr ≥3), matched for sex and age. Univariate and multivariate regression analysis were performed. RESULTS Over the previous year, 40 % of PSP patients did not encounter a physical therapist, while only one-third met a speech and language therapist and 5 % an occupational therapist. More than 20 % received in-home care and 32 % needed home structural changes. Compared to APD, PSP patients required more day-time, night-time and home structural changes. When considering both PSP and APD in multivariate analysis, reduced functional autonomy and living without a family caregiver were both related to day-time home assistance and to the need of at least one home care service. A PSP diagnosis compared to APD was a risk factor for having at least four multidisciplinary visits in a year. Finally, PSP diagnosis and being from the Northern Italy were significantly related with home structural changes. CONCLUSIONS There's a significant gap in providing multidisciplinary care for PSP patients. Our findings emphasize the need for a shared, integrated care plan at a national level for patients with atypical parkinsonism.
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Affiliation(s)
- Margherita Fabbri
- Clinical Investigation Center CIC1436, Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Centre and NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse, INSERM, University of Toulouse 3, CHU of Toulouse, Toulouse, France; French Reference Center for Multiple System Atrophy, Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy; SC Neurologia 2U, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Tommaso Schirinzi
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy; SC Neurologia 2U, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Anna Rosa Avallone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, SA, 84081, Italy
| | - Henri Zenuni
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Simone Aloisio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Ilaria Cani
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Maria Chiara Malaguti
- Department of Neurology, Santa Chiara Hospital, Azienda Provinciale per I Servizi Sanitari Della Provincia Autonoma di Trento (APSS), Trento, Italy
| | | | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Alessandro Stefani
- Parkinson Centre, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy; SC Neurologia 2U, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, SA, 84081, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, SA, 84081, Italy.
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Scherbaum R, Tönges L. [Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment]. DER NERVENARZT 2024; 95:704-713. [PMID: 38755423 DOI: 10.1007/s00115-024-01666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The inpatient Parkinson's disease multimodal complex treatment (PD-MCT) was applied more than 15,000 times in 2022, in Germany. This number is increasing as is Parkinson's disease (PD), which affects more than 400,000 people in Germany and leads to 100,000 disability-adjusted life years. In recent years, several observational studies have been conducted on the effectiveness of this kind of multidisciplinary care. OBJECTIVE To summarize and discuss the evidence on the nature, benefits and potential of PD-MCT. METHODS A narrative review of selected empirical findings was carried out. RESULTS The PD-MCT frequently lasts for 2-3 weeks and aims to maintain the quality of life of people with PD. Disease symptoms and activities of daily living are jointly improved by pharmacological strategies and activating therapies (physiotherapy, occupational therapy, speech and language therapy, physical training, art therapy). The PD-MCT is a useful measure to avoid or mitigate crisis situations in the course of the disease. A total of eight observational studies (n = 1246) have shown good effectiveness with a total mean improvement of the International Parkinson and Movement Disorder Society unified Parkinson's disease rating scale III (MDS-UPDRS III) by 7.8 points. The transfer of effects into everyday life through intensive and specialized community-based care must be ensured in order to achieve sustained effects on the quality of life. Ideally, this transfer can be supported by integrated PD networks and digital technologies in the future. CONCLUSION There is potential for development in the standardization, patient selection and quality assurance of PD-MCT as well as in the embedding in care structures such as PD networks. Open research questions include a precise definition of the target group and higher quality evidence of short-term and long-term effectiveness.
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Affiliation(s)
- Raphael Scherbaum
- Klinik für Neurologie, Ruhr-Universität Bochum, St. Josef-Hospital Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Lars Tönges
- Klinik für Neurologie, Ruhr-Universität Bochum, St. Josef-Hospital Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
- Zentrum für Proteindiagnostik (PRODI), Ruhr-Universität Bochum, Bochum, Deutschland.
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Weise D, Claus I, Dresel C, Kalbe E, Liepelt-Scarfone I, Lorenzl S, Redecker C, Urban PP. Multidisciplinary care in Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02807-w. [PMID: 39039238 DOI: 10.1007/s00702-024-02807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Parkinson's Disease (PD) is a multifaceted and progressive disorder characterized by a diverse range of motor and non-motor symptoms. The complexity of PD necessitates a multidisciplinary approach to manage both motor symptoms, such as bradykinesia, gait disturbances and falls, and non-motor symptoms, including cognitive dysfunction, sleep disturbances, and mood disorders, which significantly affect patients' quality of life. Pharmacotherapy, particularly dopaminergic replacement therapy, has advanced to alleviate many symptoms. However, these medications can also induce side effects or aggravate symptoms like hallucinations or orthostatic dysfunction, highlighting the need for comprehensive patient management. The optimal care for PD patients involves a team of specialists, including neurologists, physical and occupational therapists, speech-language pathologists, psychologists, and other medical professionals, to address the complex and individualized needs of each patient. Here, we illustrate the necessity of such a multidisciplinary approach in four illustrative PD cases with different disease stages and motor and non-motor complications. The patients were treated in different treatment settings (specialized outpatient clinic, day clinic, inpatient care including neurorehabilitation). The biggest challenge lies in organizing and implementing such comprehensive care effectively across different clinical settings.
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Affiliation(s)
- David Weise
- Department of Neurology, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany.
- Department of Neurology, University of Leipzig, Leipzig, Germany.
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, 48149, Münster, Germany
| | - Christian Dresel
- Department of Neurology, Section for Movement Disorders and Neurostimulation, Neuroimaging Center Mainz, Universitätsmedizin Mainz, Mainz, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, IB-Hochschule, Tübingen, Stuttgart, Germany
| | - Stefan Lorenzl
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Department of Palliative Care, Hospital Agatharied, Hausham, Germany
- Clinic of Palliative Care, Ludwig Maximilians University, Munich, Germany
| | - Christoph Redecker
- Department of Neurology, Klinikum Lippe Lemgo, Rintelner Str. 85, D-32657, Lemgo, Germany
| | - Peter P Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
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Kulisevsky J, Falup-Pecurariu C, Santens P, Jost WH. Towards improved access to device-aided therapies in advanced PD: the importance of cooperation of different disciplines. J Neural Transm (Vienna) 2023; 130:1433-1441. [PMID: 37439943 DOI: 10.1007/s00702-023-02664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
Managing the many issues in advanced Parkinson's disease (PD) requires education, continuous support, and specialized outpatient care involving a variety of allied healthcare professionals. It would be greatly appreciated if general neurologists and professionals from various disciplines who work with people diagnosed with Parkinson's disease (PwP) could remain knowledgeable about the existing therapies and their respective roles within the treatment continuum. The movement disorders specialist and the PD nurse are key actors in the coordination of a targeted and patient-empowering multidisciplinary approach for advanced PD. Affordable and timely access to these therapies for the PwP who may need them is presently a challenge for health systems. Education, training, and support for all the involved stakeholders in the process of PD care may improve quality of life both for PwP and caregivers, and reduce inadequate, expensive, time-consuming, and unsuccessful prolongation of standard medical therapies.
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Affiliation(s)
- Jaime Kulisevsky
- Parkinson and Movement Disorders Unit, Sant Pau Hospital, Universitat Autònoma de Barcelona, C/Mas Casanovas 90, 08041, Barcelona, Spain.
- Departament de Medicina, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- CIBERNED (Network Centre for Neurodegenerative Diseases), Barcelona, Spain.
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Braşov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Wolfgang H Jost
- University Hospital Carl Gustav Carus, Dresden, Saxony, Germany
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Nielsen TL, Kruse NB, Haahr A, Hjelle EG, Bragstad LK, Palmar‐Santos A, Navarta‐Sánchez MV, Pedraz‐Marcos A, Pires SB, Roberts HC, Portillo MC. Exploring health and social services in Denmark, Norway, Spain and the United Kingdom for the development of Parkinson's care pathways. A document analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3507-e3518. [PMID: 35975602 PMCID: PMC10087449 DOI: 10.1111/hsc.13970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
People with Parkinson's disease (PD) may find it difficult to identify and access the wide number of services they need and are entitled to along their complex PD journey. As part of the project OPTIM-PARK - Optimisation of community resources and systems of support to enhance the process of living with Parkinson's Disease, document analysis was developed to create overviews of existing resources and systems of support in Denmark, Norway, Spain and the United Kingdom. Documents on community resources, policies, guidelines and professional recommendations were the main sources of information. They were sought systematically at official websites of the public sector (national and regional levels) and websites of non-governmental organisations and scientific societies; searches were performed in October 2020 and updated in September 2021. A higher-level cross-national content analysis integrated all the country-specific information. Data- and concept-driven coding frames were developed; trial coding and peer review strengthened face validity and reliability. The analysis led to overviews of: (1) Key aims at patient and societal levels. (2) Key elements in form of professional approaches. (3) Community resources. (4) Legally anchored services. In general, clear descriptions of how to implement care pathways and tools to facilitate delivery were missing in the included documents, and pathways and guidelines did not include referral to general social support, social security support or labour and employment support. The results shed light on the complex support systems and resources and can inspire the planning of more comprehensive care pathways for people with PD and other long-term conditions.
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Affiliation(s)
- Tove Lise Nielsen
- Research Centre for Health and Welfare Technology, Programme for RehabilitationVIA University CollegeAarhusDenmark
- Department of Occupational Therapy in AarhusVIA University CollegeAarhusDenmark
| | - Naja Benigna Kruse
- Research Centre for Health and Welfare Technology, Programme for RehabilitationVIA University CollegeAarhusDenmark
- Department of Occupational Therapy in AarhusVIA University CollegeAarhusDenmark
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for RehabilitationVIA University CollegeAarhusDenmark
- Department of Public Health, Nursing and HealthcareAarhus UniversityAarhusDenmark
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of Oslo, NorwayOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Line Kildal Bragstad
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of Oslo, NorwayOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Ana Palmar‐Santos
- Departamento de EnfermeríaUniversidad Autónoma de Madrid, Facultad de MedicinaMadridSpain
| | | | - Azucena Pedraz‐Marcos
- Departamento de EnfermeríaUniversidad Autónoma de Madrid, Facultad de MedicinaMadridSpain
| | - Sandra Bartolomeu Pires
- NIHR Applied Research Collaboration Wessex, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Helen C. Roberts
- NIHR Applied Research Collaboration Wessex, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Mari Carmen Portillo
- NIHR Applied Research Collaboration Wessex, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Myra RS, Koerich MHADL, Gregório EC, Swarowsky A. Primary care for people with Parkinson's disease in Brazil: A referral flowchart based on risk of falls. Front Public Health 2022; 10:836633. [PMID: 35991031 PMCID: PMC9387551 DOI: 10.3389/fpubh.2022.836633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background People with Parkinson's disease (PD) need to exercise to have a better quality of life. The risk of falling needs to be considered when choosing and implementing exercise interventions. Flowcharts are used to facilitate referrals in Brazilian primary care network, but there is no specific one for PD. Aim To develop a referral flowchart for people with PD in Brazilian primary care based on the risk of falls and scientific evidence in the context of a multidisciplinary approach. Methods The development of the referral flowchart was accomplished in three steps; (1) relevant literature was reviewed (2) semi-structured interviews (in focus groups) were conducted with primary health care professionals to investigate the current care for people with Parkinson's disease, and (3) the information obtained from the previous steps were analyzed to inform the development of the referral flowchart. Results The fall risk-based flowchart uses the 3-step-fall-prediction tool. The primary health care professional should refer the person with a low risk of falls to activities with minimal supervision and those with a higher risk of falls to specialized neurology services. Neurology services are also the referral target for persons presenting significant mobility restrictions (i.e., restricted to a wheelchair or bed). The referral occurs according to what is available in Brazilian primary care. Conclusion This flowchart might be the first step to build a multidisciplinary approach for people with Parkinson's disease in Brazilian primary care. The next stage of this study is the validation and subsequent implementation of the flowchart through the primary care at Unified Health System in Brazil.
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Affiliation(s)
- Rafaela Simon Myra
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI), Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
| | | | - Elaine Cristina Gregório
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI), Center for Health and Sports Sciences (CEFID), Santa Catarina State University (UDESC), Florianópolis, Brazil
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Scherbaum R, Moewius A, Oppermann J, Geritz J, Hansen C, Gold R, Maetzler W, Tönges L. Parkinson's disease multimodal complex treatment improves gait performance: an exploratory wearable digital device-supported study. J Neurol 2022; 269:6067-6085. [PMID: 35864214 PMCID: PMC9553759 DOI: 10.1007/s00415-022-11257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Wearable device-based parameters (DBP) objectively describe gait and balance impairment in Parkinson's disease (PD). We sought to investigate correlations between DBP of gait and balance and clinical scores, their respective changes throughout the inpatient multidisciplinary Parkinson's Disease Multimodal Complex Treatment (PD-MCT), and correlations between their changes. METHODS This exploratory observational study assessed 10 DBP and clinical scores at the start (T1) and end (T2) of a two-week PD-MCT of 25 PD in patients (mean age: 66.9 years, median HY stage: 2.5). Subjects performed four straight walking tasks under single- and dual-task conditions, and four balance tasks. RESULTS At T1, reduced gait velocity and larger sway area correlated with motor severity. Shorter strides during motor-motor dual-tasking correlated with motor complications. From T1 to T2, gait velocity improved, especially under dual-task conditions, stride length increased for motor-motor dual-tasking, and clinical scores measuring motor severity, balance, dexterity, executive functions, and motor complications changed favorably. Other gait parameters did not change significantly. Changes in motor complications, motor severity, and fear of falling correlated with changes in stride length, sway area, and measures of gait stability, respectively. CONCLUSION DBP of gait and balance reflect clinical scores, e.g., those of motor severity. PD-MCT significantly improves gait velocity and stride length and favorably affects additional DBP. Motor complications and fear of falling are factors that may influence the response to PD-MCT. A DBP-based assessment on admission to PD inpatient treatment could allow for more individualized therapy that can improve outcomes. TRIAL REGISTRATION NUMBER AND DATE DRKS00020948 number, 30-Mar-2020, retrospectively registered.
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Affiliation(s)
- Raphael Scherbaum
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
| | - Andreas Moewius
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
| | - Judith Oppermann
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany.,Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, 44801, Bochum, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany. .,Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr University Bochum, 44801, Bochum, Germany.
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8
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Wood J, Henderson W, Foster ER. Occupational Therapy Practice Guidelines for People With Parkinson's Disease. Am J Occup Ther 2022; 76:23280. [PMID: 35648119 DOI: 10.5014/ajot.2022.763001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners address the occupational performance and participation needs of people with Parkinson's disease (PD) and their care partners. OBJECTIVE This Practice Guideline is informed by systematic reviews on the use of occupational therapy interventions to promote participation in occupations for people with PD and to facilitate their caregivers' participation in the caregiver role. This guideline is meant to support practitioners' clinical decision making when working with people with PD and their care partners. METHOD We examined and synthesized the results of four systematic reviews and integrated those results into clinical recommendations for practice. RESULTS Thirty-three articles from the systematic reviews served as the basis for the clinical recommendations in this Practice Guideline. Clinical recommendations are provided for interventions that have strong or moderate supporting evidence. CONCLUSION AND RECOMMENDATIONS Multidisciplinary, tailored, goal-oriented intervention is recommended for people with PD. Various forms of exercise can be used to improve activities of daily living and instrumental activities of daily living performance and social participation, and interventions should incorporate health behavior change techniques to support adequate physical activity levels in daily life. Mindfulness meditation and exercise can be used to support sleep, and task-oriented training can be used to improve performance of specific tasks. Occupational therapy practitioners should incorporate self-management, coaching, compensatory, cognitive-behavioral, and other approaches into multicomponent treatment plans depending on the client's needs and goals. Additional potentially appropriate intervention approaches or areas to address are discussed on the basis of existing or emerging evidence and expert opinion. What This Article Adds: This Practice Guideline provides a summary and applications of the current evidence supporting occupational therapy intervention for people with PD. It includes case examples and suggested decision-making algorithms to support practitioners in addressing client goals.
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Affiliation(s)
- Julia Wood
- Julia Wood, MOT, OTR/L, is Director of Professional and Community Education, Lewy Body Dementia Association, Lilburn, GA;
| | - Whitney Henderson
- Whitney Henderson, OTD, MOT, OTR/L, is Associate Clinical Professor in Occupational Therapy, University of Missouri, Columbia
| | - Erin R Foster
- Erin R. Foster, PhD, OTD, OTR/L, is Associate Professor in Occupational Therapy, Neurology and Psychiatry, Washington University School of Medicine, St. Louis, MO
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Ebina J, Ebihara S, Kano O. Similarities, differences and overlaps between frailty and Parkinson's disease. Geriatr Gerontol Int 2022; 22:259-270. [PMID: 35243739 DOI: 10.1111/ggi.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder clinically characterized by bradykinesia, rest tremor, rigidity, and postural and gait disturbances, which are frequently observed in older people. It also shows non-motor symptoms, such as depression, anxiety, cognitive impairment and dementia. The number of patients is gradually increasing worldwide. Aging is a risk factor for the onset of Parkinson's disease, and various physiological effects of aging influence its progression. Frailty is a geriatric syndrome in which the reversible and vulnerable status between robustness and disability is affected by various physiological stressors with aging. Frailty consists of physical, psychological and social aspects. Furthermore, sarcopenia, a syndrome characterized by the loss of muscle mass, strength and function, is also significantly associated with frailty. To maintain the quality of life of older people, frailty, including sarcopenia, should be quickly and appropriately managed. Polypharmacy is an important factor causing the progression of frailty in geriatric syndrome. Although Parkinson's disease and frailty have similar symptoms, and are considered to affect each other, the clinical features and mechanisms of both largely remain unclear. Nevertheless, little literature on the relationship between frailty and Parkinson's disease is currently available. This narrative review aims to clarify the relationships between Parkinson's disease and frailty, not only on the physical, but also on the mental, cognitive, and social aspects and issues regarding polypharmacy in Parkinson's disease explored by previous studies. Geriatr Gerontol Int 2022; 22: 259-270.
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Affiliation(s)
- Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
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10
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Mathur N, Bhatt H, Lidstone SC. Neuropsychiatric Treatments for Parkinson's Disease: Nonpharmacological Approaches. Semin Neurol 2022; 42:158-167. [PMID: 35114693 DOI: 10.1055/s-0041-1742266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although diagnosed by characteristic motor features, Parkinson's disease and other movement disorders are frequently accompanied by a wide range of neuropsychiatric symptoms that require a multidisciplinary approach for treatment. Neuropsychiatric symptoms such as depression, anxiety and cognitive symptoms strongly influence quality of life, motor symptoms, and non-motor bodily symptoms. This review summarizes our current understanding of the neuropsychiatric symptoms in movement disorders and discusses the evidence base for treatments focusing on rehabilitation and nonpharmacological approaches. A practical approach is then proposed for patient selection for specific treatments based on disease stage. The article focuses mostly on Parkinson's disease as a prototypical movement disorder with the largest evidence base but the principles discussed herein are applicable to a range of other movement disorders.
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Affiliation(s)
- Neha Mathur
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Haseel Bhatt
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Department of Medicine, Division of Neurology Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Sarah C Lidstone
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Department of Medicine, Division of Neurology Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
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11
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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12
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Bloem BR, Eimers M, van Galen MS, Munneke M, Darweesh SKL. From trials to clinical practice: Temporal trends in the coverage of specialized allied health services for Parkinson's disease. Eur J Neurol 2020; 28:775-782. [PMID: 33141474 DOI: 10.1111/ene.14627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To determine how the coverage of specialized allied health services for patients with Parkinson's disease (PD) has developed in the Netherlands since the publication of trials that demonstrated cost-effectiveness. METHODS We used healthcare expenditure-based data on all insured individuals in the Netherlands to determine the annual proportion of patients with PD who received either specialized or generic allied health services (physiotherapy, occupational therapy, speech-language therapy) in 2 calendar years separated by a 5-year interval (2012 and 2017). Specialized allied health services were delivered through the ParkinsonNet approach, which encompassed professional training and concentration of care among specifically trained professionals. RESULTS Between 2012 and 2017, there was an increase in the number of patients with any physiotherapy (from 17,843 [62% of all patients with PD that year] to 22,282 [68%]), speech-language therapy (from 2171 [8%] to 3378 [10%]), and occupational therapy (from 2813 [10%] to 5939 [18%]). Among therapy-requiring patients, the percentage who were treated by a specialized therapist rose substantially for physiotherapy (from 36% in 2012 to 62% in 2017; χ2 = 2460.2; p < 0.001), speech-language therapy (from 59% to 85%; χ2 = 445.4; p < 0.001), and occupational therapy (from 61% to 77%; χ2 = 231.6; p < 0.001). By contrast, the number of patients with generic therapists did not change meaningfully. By 2017, specialized care delivery had extended to regions that had been poorly covered in 2012, essentially achieving nationwide coverage. CONCLUSIONS Following the publication of positive trials, specialized allied healthcare delivery was successfully scaled for patients with PD in the Netherlands, potentially serving as a template for other healthcare innovations for patients with PD elsewhere.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marietta Eimers
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Marten Munneke
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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13
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Sharpe G, Macerollo A, Fabbri M, Tripoliti E. Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review. Front Neurol 2020; 11:576569. [PMID: 33101185 PMCID: PMC7546346 DOI: 10.3389/fneur.2020.576569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments. Objective: The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD. Results: Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii FitTM training for cognition. Conclusions: Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these "orphan" symptoms, from the very beginning of the disease. The concept "the sooner the better" should be applied to multidisciplinary non-pharmacological management in PD.
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Affiliation(s)
- Gabriella Sharpe
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Antonella Macerollo
- Department of Neurology, The Walton Center for Neurology and Neurosurgery, Liverpool, United Kingdom
- Department of Neurosciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Margherita Fabbri
- Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network, NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Elina Tripoliti
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
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14
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Fabbri M, Kauppila LA, Ferreira JJ, Rascol O. Challenges and Perspectives in the Management of Late-Stage Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:S75-S83. [PMID: 32568114 PMCID: PMC7592689 DOI: 10.3233/jpd-202096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder, with a continuously increasing prevalence. With improved clinical and therapeutic management of PD, more patients reach later stages of the disease, meaning they may face new clinical problems that were not commonly approached. This gave way to the description of a new PD stage, late-stage PD (LSPD), which is clinically discernible from the advanced-stage one. Therefore, LSPD patients have new and different needs, regarding pharmacological and non pharmacological interventions, including palliative care and multidisciplinary teams. LSPD patients constitute an‘orphan population’, who traditionally was excluded from previous studies, due to its high disability. With this manuscript, we intend to review specific management challenges of LSPD patients, covering this new concept and its clinical features, how to assess these patients, therapeutic recommendations, as well as discussing ongoing research and future perspectives.
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Affiliation(s)
- Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and Neuro Toul COEN Centre; Toulouse University Hospital; INSERM; University of Toulouse 3; Toulouse, France.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Linda Azevedo Kauppila
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Olivier Rascol
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and Neuro Toul COEN Centre; Toulouse University Hospital; INSERM; University of Toulouse 3; Toulouse, France
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15
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Fabbri M, Caldas AC, Ramos JB, Sanchez-Ferro Á, Antonini A, Růžička E, Lynch T, Rascol O, Grimes D, Eggers C, Mestre TA, Ferreira JJ. Moving towards home-based community-centred integrated care in Parkinson's disease. Parkinsonism Relat Disord 2020; 78:21-26. [PMID: 32674024 DOI: 10.1016/j.parkreldis.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
People living with Parkinson's disease (PwP) experience a wide range of motor and non-motor symptoms associated with increasing complexity of care delivery. A multispecialty approach has been presented as an intuitive solution for tailored and comprehensive care delivery. Nevertheless, past trials of both multidisciplinary or interdisciplinary care models in PD suggested no measurable change to a small benefit in quality of life (QoL) and failed to show economic sustainability. We propose a home-based community-centred integrated care (iCARE-PD) for PwP as a pragmatic solution to harness the potential of existing care resources using an integrated care strategy, enable self-management support and implement technology-enabled care. The iCARE-PD model is based on Freeman's concept of continuity of care and the expanded Chronic Care Model for organization of care strategies. A home-based community-centred integrated care has immediate implications for clinical practice, with potential benefits in rural areas or lower-income countries, by enhancing access to care with optimized costs. There is a need to establish which and how interventions may be used as an instrument of care in each local deployment of the iCARE-PD model. We put forward a multidisciplinary framework to generate the evidence supportive of its implementation as the standard of care in the future and delineate the core strategies to secure the implementation of this care approach across different health care systems to ensure feasibility and economic sustainability. We envision this model becoming a paradigm of personalized care transferable to people with atypical forms of neurodegenerative parkinsonism.
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Affiliation(s)
- Margherita Fabbri
- Instituto de Medicina Molecular, Facultade de Medicina, University of Lisbon, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Facultade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, TOULOUSE University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Ana Castro Caldas
- Laboratory of Clinical Pharmacology and Therapeutics, Facultade de Medicina, Universidade de Lisboa, Lisbon, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Joana B Ramos
- Serviço de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Álvaro Sanchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta Del Sur, Universidad CEU-San Pablo, Madrid, Spain
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Timothy Lynch
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Oliver Rascol
- Services de Neurologie et de Pharmacologie Clinique, Centre de Reference AMS, Centre D'Investigation Clinique, Réseau NS-Park/FCRIN et Centre of Excellence for Neurodegenerative Disorders (COEN) de Toulouse, CHU de Toulouse, Toulouse 3 University, Toulouse, France
| | - David Grimes
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Facultade de Medicina, University of Lisbon, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Facultade de Medicina, Universidade de Lisboa, Lisbon, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.
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16
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Aye YM, Liew S, Neo SX, Li W, Ng HL, Chua ST, Zhou WT, Au WL, Tan EK, Tay KY, Tan LCS, Xu Z. Patient-Centric Care for Parkinson's Disease: From Hospital to the Community. Front Neurol 2020; 11:502. [PMID: 32582014 PMCID: PMC7296117 DOI: 10.3389/fneur.2020.00502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is a chronic neurodegenerative disease with complex motor and non-motor symptoms often leading to significant caregiver burden. An integrated, multidisciplinary care setup involving different healthcare professionals is the mainstay in the holistic management of PD. Many challenges in delivering multidisciplinary team (MDT) care exist, such as insufficient expertise among different healthcare professionals, poor interdisciplinary collaboration, and communication. The need to attend different clinics, incurring additional traveling and waiting time for allied health therapies can also make MDT care more burdensome. By shifting MDT care to local community settings and into patients' homes, patient-centered care can be achieved. In Singapore, the National Neuroscience Institute created the Community Care Partners Programme in 2007 to bring the allied MDT team to the community and nurse-led Integrated Community Care Programme for Parkinson's Disease in 2012 to provide care in community and at patient's home. However, attaining MDT care in the community setting is difficult to achieve where there is a shortage of PD-trained professionals. As such, interdisciplinary and transdisciplinary management would be other best practice options to deliver patient-centric care in PD. Telemedicine could be another viable option to bring the MDT closer to the patient.
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Affiliation(s)
- Yin Minn Aye
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Sylvia Liew
- Parkinson Society Singapore, Singapore, Singapore
| | - Shermyn Xiumin Neo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wei Li
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Hwee-Lan Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Shu-Ting Chua
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wen-Tao Zhou
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Louis Chew-Seng Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Centre of Excellence, National Neuroscience Institute, Singapore, Singapore.,Parkinson Society Singapore, Singapore, Singapore
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17
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Lidstone SC, Bayley M, Lang AE. The evidence for multidisciplinary care in Parkinson’s disease. Expert Rev Neurother 2020; 20:539-549. [DOI: 10.1080/14737175.2020.1771184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sarah C. Lidstone
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
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18
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Access to Allied Health Care Services in Canadian Interdisciplinary Complex Nerve Injury Programs. Can J Neurol Sci 2020; 47:830-833. [PMID: 32450923 DOI: 10.1017/cjn.2020.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nerve transfer surgery for patients with nerve and spinal cord injuries can result in dramatic functional improvements. As a result, interdisciplinary complex nerve injury programs (CNIPs) have been established in many Canadian centers, providing electrodiagnostic and surgical consultations in a single encounter. We sought to determine which allied health care services are included in Canadian CNIPs, at the 3rd Annual Canadian Peripheral Nerve Symposium. Twenty CNIPs responded to a brief survey and reported access as follows: occupational therapy = 60%, physiotherapy = 40%, social work = 20%, and mental health = 10%. Access to allied health services is variable in CNIPs across Canada, possibly resulting in heterogeneity in patient care.
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19
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Bhidayasiri R, Phokaewvarangkul O, Sakdisornchai K, Boonpang K, Chaudhuri KR, Parsons J, Lolekha P, Chairangsaris P, Srivanitchapoom P, Benedierks S, Panyakaew P, Boonmongkol T, Thongchuam Y, Kantachadvanich N, Phumphid S, Evans AH, Viriyavejakul A, Pisarnpong A, van Laar T, Jagota P. Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson's disease management in developing countries. Expert Rev Neurother 2020; 20:523-537. [PMID: 32421371 DOI: 10.1080/14737175.2020.1770598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The increasing global burden of Parkinson's disease (PD) poses a particular challenge for developing countries, such as Thailand, when delivering care to a geographically diverse populace with limited resources, often compounded by a lack of expertise in the use of certain PD medications, such as device-aided therapies (DAT). AREAS COVERED A panel of local, regional, and international PD experts convened to review the unmet needs of PD in Thailand and share insights into effective delivery of DAT, focusing on experience with apomorphine infusion. Despite its proven efficacy and safety, implementation of apomorphine infusion as a new option was not straightforward. This has prompted a range of health-care professional and patient-focused initiatives, led by the Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders in Bangkok, to help establish a more coordinated approach to PD management throughout the country and ensure patients have access to suitable treatments. EXPERT OPINION Overcoming the challenges of education, proficiency, resource capacity and standard of care for PD patients in developing countries requires a coordinated effort both nationally and beyond. The best practices identified in Thailand following the introduction of apomorphine infusion might be helpful for other countries when implementing similar programs.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Karn Sakdisornchai
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Jan Parsons
- The Walton Centre for Neurology and Neurosurgery , Liverpool, UK
| | - Praween Lolekha
- Division of Neurology, Department of Medicine, Thammasat University Hospital , Pathumthani, Thailand
| | - Parnsiri Chairangsaris
- Division of Neurology, Department of Medicine, Phra Mongkutklao Hospital , Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | | | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Thanatat Boonmongkol
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Nitinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Andrew H Evans
- Department of Neurology, Royal Melbourne Hospital , Melbourne, Australia
| | | | - Apichart Pisarnpong
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Teus van Laar
- Department of Neurology, University of Groningen , Groningen, The Netherlands
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
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20
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Eggers C, Wolz M, Warnecke T, Prell T, Tönges L. [Parkinson Networks in Germany: Future or Utopia?]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:586-589. [PMID: 32252111 DOI: 10.1055/a-1113-7751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Parkinson's disease requires a close interaction between different care partners from the point of diagnosis in order to provide the best possible care for patients. However, the treatment reality shows that there are often still significant gaps in care. In recent years it has been recognised that the formation of networks can contribute to improving the care of Parkinson's patients. OBJECTIVES To present the current status of the development of Parkinson's networks in Germany, the available evidence and the future of Parkinson's networks. MATERIAL AND METHODS Experiences from existing networks in Germany were systematically recorded on the basis of personal reports and publications. The existing national and international evidence was summarised, and critical success factors and hurdles were analysed. In addition, possible future scenarios were developed. RESULTS There are many integrated approaches to improve the care of Parkinson's patients. However, this is usually subject to the initiative at individual locations, without binding conditions being created for this by the legislator or the funding agencies outside of model projects. DISCUSSION It must be noted that it is currently very difficult to implement a problem-free and cost-efficient development of intersectoral network structures within the existing possibilities of the German health care system. The high personal commitment of individual actors currently forms the basis of existing regional networks. An overarching health policy concept is needed to further promote the content and infrastructure of Parkinson's disease networks.
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Affiliation(s)
| | - Martin Wolz
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | | | - Tino Prell
- Klinik für Neurologie, Universitätsklinikum Jena, Jena
| | - Lars Tönges
- Klinik für Neurologie, Ruhr-Universität Bochum, St. Josef-Hospital
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21
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Radder DL, Nonnekes J, van Nimwegen M, Eggers C, Abbruzzese G, Alves G, Browner N, Chaudhuri KR, Ebersbach G, Ferreira JJ, Fleisher JE, Fletcher P, Frazzitta G, Giladi N, Guttman M, Iansek R, Khandhar S, Klucken J, Lafontaine AL, Marras C, Nutt J, Okun MS, Parashos SA, Munneke M, Bloem BR. Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1087-1098. [PMID: 32444563 PMCID: PMC7415700 DOI: 10.3233/jpd-202078] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Optimal management in expert centers for Parkinson's disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely. OBJECTIVE To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD. METHODS Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center's multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed. RESULTS We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation. CONCLUSION We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.
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Affiliation(s)
- Danique L.M. Radder
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Nijmegen, The Netherlands
| | - Marlies van Nimwegen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Alves
- The Norwegian Center for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Browner
- University of North Carolina, Movement Disorders Center, Chapel Hill, NC, USA
| | - K. Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation International Center of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Georg Ebersbach
- Movement Disorder Clinic Beelitz-Heilstaetten, Beelitz, Germany
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- CNS – Campus Neurológico Sénior, Torres Vedras, Portugal
| | | | | | | | - Nir Giladi
- Neurological Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Suketu Khandhar
- Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
- Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill Movement Disorders Clinic, McGill University, Montreal, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson’s disease and the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Canada
| | - John Nutt
- Oregon & Health Science University Hospital, Portland, OR, USA
| | - Michael S. Okun
- University of Florida Department of Neurology, Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
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Abstract
This review elaborates on multidisciplinary care for persons living with Parkinson disease by using gait and balance impairments as an example of a treatable target that typically necessitates an integrated approach by a range of different and complementary professional disciplines. Using the International Classification of Functioning, Disability, and Health model as a framework, the authors discuss the assessment and multidisciplinary management of reduced functional mobility due to gait and balance impairments. By doing so, they highlight the complex interplay between motor and nonmotor symptoms, and their influence on rehabilitation. They outline how multidisciplinary care for Parkinson disease can be organized.
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Valent F, Devigili G, Rinaldo S, Del Zotto S, Tullio A, Eleopra R. The epidemiology of Parkinson’s disease in the Italian region Friuli Venezia Giulia: a population-based study with administrative data. Neurol Sci 2018; 39:699-704. [DOI: 10.1007/s10072-018-3273-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
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