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Gotheridge H, Eccles FJR, Murray C, Henderson R, Simpson J. A systematic review of the factors associated with the psychological wellbeing of people with Parkinson's in the COVID-19 pandemic. Disabil Rehabil 2024:1-12. [PMID: 39258822 DOI: 10.1080/09638288.2024.2395460] [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: 11/06/2023] [Revised: 07/21/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE The lockdown and social distancing measures introduced as a result of the COVID-19 pandemic impacted the ability of people with Parkinson's to engage in normal health management practices. This led to documented reductions in psychological wellbeing. The aim of the present review was to identify factors associated with the psychological wellbeing of people with Parkinson's during the acute stage of the pandemic. MATERIALS AND METHODS Five academic databases (PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science) were searched and 23 articles were identified using pre-defined inclusion and exclusion criteria. The findings are stratified by risk factor and analysed using a narrative synthesis. RESULTS Worsening of motor symptoms, poor motor-related daily living experiences and motor symptoms during "off time" (when symptom suppressing medication has worn off) as well as less physical activity emerged as the most consistent risk factors of worsened or poorer psychological wellbeing. A deviation from pre-pandemic risk factors was identified, with age and gender not identified as consistent risk factors. CONCLUSIONS The implications of this review are not limited to preparing for future pandemics but can also be applied to more common concerns with comparable contextual characteristics such as yearly flu outbreaks, social isolation, and economic uncertainty.
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Affiliation(s)
- H Gotheridge
- Division of Health Research, Lancaster University, Lancaster, UK
| | - F J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - C Murray
- Division of Health Research, Lancaster University, Lancaster, UK
| | - R Henderson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - J Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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2
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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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3
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Gros P, Bhatt H, Gilmour GS, Lidstone SC. Rehabilitation for Functional Dystonia: Cases and Review of the Literature. Mov Disord Clin Pract 2024; 11:1018-1024. [PMID: 38853490 PMCID: PMC11329573 DOI: 10.1002/mdc3.14121] [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: 11/28/2023] [Revised: 04/16/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Functional dystonia (FD) is a common subtype of functional movement disorder. FD can be readily diagnosed based on positive signs and is potentially treatable with rehabilitation. Despite this, clinical outcomes remain variable and a gold standard approach to treatment is lacking. CASES Here we present four cases of axial and limb functional dystonia who were treated with integrated rehabilitation and improved. The therapy approach and clinical outcomes are described, including videos. LITERATURE REVIEW A literature review evaluated the published treatment strategies for the treatment of functional dystonia. Out of 338 articles, 25 were eligible for review and included mainly case reports and case series. Most patients received more than one treatment modality. Non-invasive therapies, commonly physiotherapy and psychological approaches were mostly associated with positive outcomes. Multiple treatments commonly used in dystonia were used, including botulinum toxin injections, pharmacotherapy and surgery, leading to variable outcomes. CONCLUSION Therapy should be personalized to the clinical presentation. In challenging cases, initiation of a multidisciplinary approach may provide benefit regardless of etiology. Pharmacotherapy should be used judiciously, and surgical therapy should be avoided.
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Affiliation(s)
- Priti Gros
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Department of Medicine, Division of NeurologyToronto Western Hospital and the University of TorontoTorontoOntarioCanada
| | - Haseel Bhatt
- Integrated Movement Disorders Program, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- KITE Research Institute, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Gabriela S. Gilmour
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Department of Medicine, Division of NeurologyToronto Western Hospital and the University of TorontoTorontoOntarioCanada
- Division of Neurology, Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Sarah C. Lidstone
- Integrated Movement Disorders Program, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- KITE Research Institute, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
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4
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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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5
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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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6
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Shurer J, Ivancic M, Nesspor V, Schmidt M, Li M, Lin YT, Schumock G, Xu R, Sklerov M, Pantelyat A. Determinants of care partner burden in atypical Parkinsonian syndromes: A retrospective, multi-center analysis. Clin Park Relat Disord 2024; 11:100266. [PMID: 39149560 PMCID: PMC11325345 DOI: 10.1016/j.prdoa.2024.100266] [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: 11/27/2023] [Revised: 05/29/2024] [Accepted: 07/13/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA) are rare neurodegenerative diseases associated with rapid decline and require complex symptom management. Caregiving responsibilities significantly increase with progression of these atypical Parkinsonian syndromes, yet care burden in these syndromes has not been researched extensively to date. Methods The Zarit Burden Interview (ZBI) was used to assess burden in care partners of patients clinically diagnosed with PSP, CBS, or MSA seen in specialty interdisciplinary clinics at two academic movement disorders centers. Univariable and multivariable regression analyses were performed to evaluate cross-sectional demographic and clinical determinants of care partner burden. Results A total of 139 care partners completed the ZBI (59.0% PSP, 28.1% MSA, 12.9% CBS). Cohorts at both medical centers were similar across all variables. Female gender of both patients and care partners was independently associated with higher ZBI scores. Additionally, MSA-Parkinsonian type was significantly associated with lower total care partner burden compared to PSP and CBS. Conclusion Several determinants of higher care partner burden in atypical Parkinsonian syndromes were identified, particularly female gender and diagnosis. Healthcare professionals can consider this information when assessing individualized needs of patients and care partners and referring to disease-specific resources. Additionally, this study's methods and results highlight the potential to further explore interdisciplinary care as a means of comprehensive evaluation and support for those with atypical Parkinsonism.
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Affiliation(s)
| | - Margaret Ivancic
- Department of Neurology, University of North Carolina at Chapel Hill, United States
| | - Vanessa Nesspor
- Department of Neurology, Johns Hopkins University, United States
| | - Maria Schmidt
- Department of Neurology, Johns Hopkins University, United States
| | - Mingyuan Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Yi-Ting Lin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Grant Schumock
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Richard Xu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Miriam Sklerov
- Department of Neurology, University of North Carolina at Chapel Hill, United States
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7
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Kalbe E, Bloem BR, Kalia LV, Nieuwboer A. Non-Pharmacological Interventions for People with Parkinson's Disease: Are We Entering a New Era? JOURNAL OF PARKINSON'S DISEASE 2024:JPD249006. [PMID: 38943399 DOI: 10.3233/jpd-249006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Affiliation(s)
- E Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands
| | - L V Kalia
- Krembil Research Institute, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - A Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium
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Handlery R, Handlery K, Kahl D, Koon L, Cabe SL, Regan EW. High Intensity Functional Training for People with Parkinson's & Their Care Partners: A Feasibility Study. Am J Health Promot 2024; 38:648-660. [PMID: 38311368 DOI: 10.1177/08901171241231085] [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] [Indexed: 02/10/2024]
Abstract
PURPOSE Various forms of exercise have proven health benefits for people with Parkinson's (pwPD) yet high intensity functional training (HIFT) has yet to be studied. The purpose of this study was to examine the feasibility, physical and psychosocial impacts of a HIFT program for pwPD and their care partners (CPs). DESIGN A single group, pre-post design with assessments before, in the middle (13 weeks), and after the 25-week intervention. SETTING Community fitness facility. PARTICIPANTS Fourteen pwPD (10 at Hoehn Yahr Stage ≤2, 4 females) and 10 CPs (5 females) were included (mean age = 71.5 (6.1)). INTERVENTION A 25-week HIFT program (≤49 exercise sessions, ≤75 min long). MEASURES Recruitment, retention, attendance, safety and exercise intensity (measured via session-Rating of Perceived Exertion (RPE)) was assessed in addition to cardiovascular endurance, lower extremity strength, walking speed, balance, exercise self-efficacy, balance confidence, social support for exercise and health-related quality of life. ANALYSIS Descriptive data was used to describe feasibility measures. Wilcoxon signed-rank test was used to compare pre- and post-program data. Effect size, r, was calculated. RESULTS Recruitment rates were ≥40% for pwPD and CPs and retention rates were 80% for pwPD and 62.5% for CPs. Average session attendance was 71.2% with 15 adverse events reported, including 7 non-injurious falls. Median session-RPE was 5 (IQR = 1) out of 10. PwPD demonstrated significant improvements in cardiovascular endurance, self-selected and fast walking speeds, balance and social support for exercise. CPs demonstrated significant improvements in cardiovascular endurance and lower extremity strength. Exercise self-efficacy, balance confidence and health-related quality of life did not significantly change for pwPD or CPs. CONCLUSION High intensity functional training appears feasible for pwPD and their CPs and may lead to health benefits. Healthcare providers should consider HIFT as another option to engage pwPD in community-based exercise.
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Affiliation(s)
- Reed Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Kaci Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Dana Kahl
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Lyndsie Koon
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, USA
| | - Samuell Leyton Cabe
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, AR, USA
| | - Elizabeth Wherley Regan
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, SC, USA
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9
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Foltynie T, Bruno V, Fox S, Kühn AA, Lindop F, Lees AJ. Medical, surgical, and physical treatments for Parkinson's disease. Lancet 2024; 403:305-324. [PMID: 38245250 DOI: 10.1016/s0140-6736(23)01429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 01/22/2024]
Abstract
Although dopamine replacement therapy remains a core component of Parkinson's disease treatment, the onset of motor fluctuations and dyskinetic movements might require a range of medical and surgical approaches from a multidisciplinary team, and important new approaches in the delivery of dopamine replacement are becoming available. The more challenging, wide range of non-motor symptoms can also have a major impact on the quality of life of a patient with Parkinson's disease, and requires careful multidisciplinary management using evidence-based knowledge, as well as appropriately tailored strategies according to the individual patient's needs. Disease-modifying therapies are urgently needed to prevent the development of the most disabling refractory symptoms, including gait and balance difficulties, cognitive impairment and dementia, and speech and swallowing impairments. In the third paper in this Series, we present the latest evidence supporting the optimal treatment of Parkinson's disease, and describe an expert approach to many aspects of treatment choice where an evidence base is insufficient.
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Affiliation(s)
- Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Veronica Bruno
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Susan Fox
- Edmond J Safra Program in Parkinson Disease, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrea A Kühn
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fiona Lindop
- University Hospitals of Derby and Burton NHS Foundation Trust, Specialist Rehabilitation, Florence Nightingale Community Hospital, Derby, UK
| | - Andrew J Lees
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK; Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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10
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Duvdevani M, Yogev-Seligmann G, Schlesinger I, Nassar M, Erich I, Hadad R, Kafri M. Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease. Isr J Health Policy Res 2024; 13:2. [PMID: 38173041 PMCID: PMC10763356 DOI: 10.1186/s13584-023-00588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes. METHODS A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life. RESULTS Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively). CONCLUSIONS In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic. CLINICALTRIALS gov/ct2/show/NCT05211700.
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Affiliation(s)
- Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel.
| | - Ilana Schlesinger
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Ilana Erich
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Rafi Hadad
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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11
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Cilia R, Dekker MCJ, Cubo E, Agoriwo MW. Delivery of Allied Health Therapies to People with Parkinson's Disease in Africa. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S227-S239. [PMID: 38143371 PMCID: PMC11380278 DOI: 10.3233/jpd-230262] [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: 12/26/2023]
Abstract
Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson's disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context.
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Affiliation(s)
- Roberto Cilia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Mary W Agoriwo
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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12
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Steendam-Oldekamp E, van Laar T. The Effectiveness of Inpatient Rehabilitation in Parkinson's Disease: A Systematic Review of Recent Studies. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S93-S112. [PMID: 38788087 PMCID: PMC11380234 DOI: 10.3233/jpd-230271] [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: 05/26/2024]
Abstract
Background Parkinson's disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency. Objective This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson's disease (PwPD), based on recent studies from 2020 onwards. Methods Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson's Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses. Results Twenty-two studies were included, consisting of 13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation. Conclusions This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future.
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Affiliation(s)
- Elien Steendam-Oldekamp
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
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13
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Pedrosa AJ, Feldmann S, Klippel J, Volberg C, Weck C, Lorenzl S, Pedrosa DJ. Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2024; 14:589-599. [PMID: 38457148 DOI: 10.3233/jpd-230311] [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: 03/09/2024]
Abstract
Background A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.
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Affiliation(s)
- Anna J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Sarah Feldmann
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jan Klippel
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Christiane Weck
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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14
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Goldman JG, Volpe D, Ellis TD, Hirsch MA, Johnson J, Wood J, Aragon A, Biundo R, Di Rocco A, Kasman GS, Iansek R, Miyasaki J, McConvey VM, Munneke M, Pinto S, St. Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement. JOURNAL OF PARKINSON'S DISEASE 2024; 14:135-166. [PMID: 38277303 PMCID: PMC10836578 DOI: 10.3233/jpd-230117] [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: 01/28/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
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Affiliation(s)
- Jennifer G. Goldman
- JPG Enterprises LLC, Medical Division, Chicago, IL, USA
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniele Volpe
- Fresco Parkinson Institute, Fiesole, Italy
- Fresco Parkinson Center Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
- NYU Grossman School of Medicine, New York, NY, USA
| | - Terry D. Ellis
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Mark A. Hirsch
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, USA
| | - Julia Johnson
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Julia Wood
- Lewy Body Dementia Association, Lilburn, GA, USA
| | - Ana Aragon
- Independent Consultant Occupational Therapist, Bath, UK
| | | | | | | | | | | | | | - Marten Munneke
- Radboudumc Center of Expertise for Movement Disorders, Nijmegen, Netherlands
| | - Serge Pinto
- The French National Centre for Scientific Research, Aix-Marseille University, Aix-en-Provence, France
| | | | - Santiago Toledo
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ronnie Todaro
- Voz Advisors, New York, NY, USA
- ^Parkinson’s Foundation, New York, NY, USA
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15
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Okun MS. U.S. Tax Credits to Promote Practical Proactive Preventative Care for Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:221-226. [PMID: 38457153 PMCID: PMC10977447 DOI: 10.3233/jpd-240046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
Persons with Parkinson's disease (PD) and society at large can profit from a strategic investment into a forward leaning, practical, preventative, and proactive multidisciplinary care policy. The American healthcare system is not easily bent to accommodate this type of care, and thus a tax benefit is an attractive option. An individual federal income tax benefit of $6200 each year for every person residing in the US with a diagnosis of PD, could among other offerings provide monthly access to a licensed clinical social worker and access to mental health services. The implementation of more coordinated care has the potential reduce the burden of depression, anxiety, and demoralization. Personal training would also be covered and directed by physical and occupational therapists. The combination of home-based and telemedicine services would have the added benefit of improving access. The tax benefit would also provide access to a dietician. This type of care strategy could be designed to proactively identify early signs of aspiration and urinary tract infections to 'head off' significant morbidity. A $6200/year individual tax benefit for those diagnosed with PD will thus translate into more fall prevention, more care in the home setting, less hospitalizations, less depression, less anxiety, less demoralization, better diets, and less persons placed in nursing facilities. Additionally, this tax benefit will provide the potential for billions of dollars in savings to the healthcare system. A tax benefit for PD is a practical preventative and proactive strategy which can serve to advantage both this generation and the next.
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Affiliation(s)
- Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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16
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Kalbe E, Bloem BR, Kalia LV, Nieuwboer A. Special Issue: Non-Pharmacological Interventions for People with Parkinson's Disease: Are We Entering a New Era? JOURNAL OF PARKINSON'S DISEASE 2024; 14:S1-S4. [PMID: 39150834 PMCID: PMC11380231 DOI: 10.3233/jpd-249009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Affiliation(s)
- E Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - L V Kalia
- Krembil Research Institute, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - A Nieuwboer
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
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17
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Terasawa Y, Ikuno K, Fujii S, Nishi Y, Tanizawa E, Nabeshima S, Okada Y. Unveiling the Impact of Outpatient Physiotherapy on Specific Motor Symptoms in Parkinson's Disease: A Prospective Cohort Study. BRAIN & NEUROREHABILITATION 2023; 16:e26. [PMID: 38047098 PMCID: PMC10689867 DOI: 10.12786/bn.2023.16.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023] Open
Abstract
Understanding how outpatient physiotherapy impacts on specific motor symptoms in Parkinson's disease (PD) is important for multidisciplinary care, but these points have not been clarified. We investigated the impact of outpatient physiotherapy on individual motor symptoms in PD patients. Fifty-five PD patients participated in the prospective cohort study, which examined the changes in motor symptoms after 90 min of outpatient physiotherapy program (1×/week for 10 weeks) and at 3 months follow-up. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score and tremor, rigidity, bradykinesia, and axial scores were assessed and compared pre-intervention, post-intervention, and at follow-up. Significant level was set at 0.05. Their MDS-UPDRS motor score and axial score significantly decreased post-intervention and at the follow-up. In the analysis differentiating effects based on the severity of motor symptoms according to the MDS-UPDRS motor score, only the moderate-severe group showed significant decreases in their MDS-UPDRS motor score, bradykinesia, and axial scores post-intervention, as well as in their MDS-UPDRS motor score, rigidity, bradykinesia, and axial scores at the follow-up. These findings suggest the outpatient physiotherapy might provide benefits, particularly in managing axial symptoms and bradykinesia, for community dwelling PD patients with moderate-severe motor symptoms within a multidisciplinary care framework.
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Affiliation(s)
- Yuta Terasawa
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Koki Ikuno
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shintaro Fujii
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Yuki Nishi
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Emi Tanizawa
- Nishiyamato Rehabilitation Hospital, Nara, Japan
| | | | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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18
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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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19
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Bergmans B, Clark V, Isaacson SH, Bäumer T. Recommendations for a paradigm shift in approach to increase the recognition and treatment of sialorrhea in Parkinson's disease. Clin Park Relat Disord 2023; 9:100223. [PMID: 38021341 PMCID: PMC10643485 DOI: 10.1016/j.prdoa.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes one of the most frequent and bothersome complaints of patients with Parkinson's disease (PD), affecting up to 84% of them. Sialorrhea is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, poor oral health, and aspiration pneumonia. To better understand the burden of sialorrhea on patients with PD, Parkinson's Europe carried out a worldwide patient survey which showed that sialorrhea remains an underrecognized and undertreated issue in patients with PD. This is especially problematic because effective therapeutic options are available. This article presents the results of the Parkinson's Europe Sialorrhea Survey, which were considered by a multidisciplinary panel of experts to provide recommendations for improving the awareness, diagnosis, management, and treatment of sialorrhea in patients with PD. A shift in the treatment paradigm for sialorrhea in patients with PD is emerging. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all those involved to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of botulinum toxin and speech and language therapy as first-line therapies.
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Affiliation(s)
- Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, 8000 Bruges, Belgium
- Department of Neurology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Veronica Clark
- Independent Researcher, Malta Parkinson’s, PO Box 17, Marsa MTP 1001, Malta
- Private Practice, UK
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, 951 NW 13th Street, Bldg. 5-E, Boca Raton, FL 33486, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, CBBM (Building 66), Ratzeburger Allee 160, 23562 Lübeck, Germany
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20
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van Munster M, Printz MR, Crighton E, Mestre TA, Pedrosa DJ. Impact of the COVID-19 pandemic on perceived access and quality of care in German people with parkinsonism. Front Public Health 2023; 11:1091737. [PMID: 37124823 PMCID: PMC10140578 DOI: 10.3389/fpubh.2023.1091737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/27/2023] [Indexed: 05/02/2023] Open
Abstract
Due to the heterogeneous clinical presentation, people with Parkinsonism (PwP) develop individual healthcare needs as their disease progresses. However, because of limited health resources during the COVID-19 pandemic, many patients were put at risk of inadequate care. All this occurred in the context of inequitable healthcare provision within societies, especially for such vulnerable populations. This study aimed to investigate factors influencing satisfaction and unmet need for healthcare among PwP during the COVID-19 pandemic in Germany. Analyses relied on an anonymous online survey with a 49-item questionnaire. We aimed at describing access to health services before and during the early stages of the pandemic. To this end, a generalized linear model was used to derive significant predictors and a stepwise regression to subsummarize the main factors of perceived inadequate care. In total, 551 questionnaires showed that satisfaction with Parkinsonism-related care decreased significantly during the pandemic (p < 0.001). In particular, factors such as lower educational level, lower perceived expertise of healthcare providers, less confidence in remote care, difficulties in obtaining healthcare, and restricted access to care before the pandemic but also lower densities of neurologists at residence and less ability to overcome barriers were indicative of higher odds to perceive unmet needs (p < 0.05). The results unveil obstacles contributing to reduced access to healthcare during the COVID-19 pandemic for PwP. These findings enable considerations for improved provision of healthcare services to PwP.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, Netherlands
| | - Marcel R. Printz
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Eric Crighton
- Department of Geography, Environment and Geomatics, University of Ottawa, University Private, Ottawa, ON, Canada
| | - Tiago A. Mestre
- Parkinson’s Disease and Movement Disorders Clinic, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - David J. Pedrosa
- Department of Neurology, Philipps University Marburg, Baldingerstraße, Marburg, Germany
- Centre of Mind, Brain and Behaviour, Philipps University Marburg, Hans Meerwein Straße, Marburg, Germany
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21
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Bhidayasiri R, Kalia LV, Bloem BR. Tackling Parkinson's Disease as a Global Challenge. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1277-1280. [PMID: 38143374 PMCID: PMC10741319 DOI: 10.3233/jpd-239005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
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
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Lorraine V. Kalia
- Division of Neurology, Department of Medicine, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Krembil Research Institute, Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Bastiaan R. Bloem
- Radbound University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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22
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Petrin J, Marrie RA, Devonshire V, Jichici D, Hrebicek O, Metz LM, Morrow SA, Oh J, Smyth P, Donkers SJ. Good multiple sclerosis (MS) care and how to get there in Canada: Perspectives of Canadian healthcare providers working with persons with MS. Front Neurol 2023; 14:1101521. [PMID: 36937527 PMCID: PMC10018146 DOI: 10.3389/fneur.2023.1101521] [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: 11/17/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The literature that has examined healthcare access and needs of the multiple sclerosis (MS) population is limited. Currently, no research has engaged healthcare providers delivering services to this population to examine their perspectives on the provision of MS care in Canada. We aimed to summarize what good MS care should look like according to Canadian healthcare providers working with people with MS, and to identify the supports and resources required, within their care setting, to enable this standard of care. Methods A qualitative descriptive approach was taken to analyze data from participants who responded to additional open-ended survey questions, within a larger "MS Models of Care Survey" targeting Canadian healthcare providers working with persons with MS. Results Currently, a gap exists between what healthcare providers working with persons with MS believe MS care should encompass and what they are able to offer. Participants emphasized that their MS clinics are currently understaffed and patient-to-provider ratios are high, leaving very little time to address the array of healthcare concerns their patients present with. The healthcare providers overwhelmingly described that moving toward multidisciplinary team-based MS care that includes appropriate numbers of MS-trained neurologists, nurses, physiotherapists, occupational therapists, and mental health providers working within one location would be their prioritized approach to comprehensively managing MS care. This model of care enables all professionals to effectively coordinate care and use their time efficiently by only focusing on their area of expertise, all while meeting the needs of their patient in one setting, reducing wait-times and improving overall care. Conclusion To meet the care needs of Canadians with MS, the healthcare system must consider standardizing and funding multidisciplinary team-based MS clinics, comparable to Stroke units, which continue to show favorable health outcomes after years of implementation.
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Affiliation(s)
- Julie Petrin
- 1School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ruth Ann Marrie
- 2Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- 3Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Virginia Devonshire
- 4Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Draga Jichici
- 5Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Olinka Hrebicek
- 6Department of Neurology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Luanne M. Metz
- 7Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah A. Morrow
- 8Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Jiwon Oh
- 9Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Penelope Smyth
- 10Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - Sarah J. Donkers
- 1School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- *Correspondence: Sarah J. Donkers
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23
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Cavaglion A, Duvdevani M, Siegelman N, Kizony R, Yogev-Seligmann G. Occupational therapy for people with Parkinson’s disease in Israel: a SWOT analysis. Scand J Occup Ther 2022:1-11. [DOI: 10.1080/11038128.2022.2150305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Avital Cavaglion
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Na’ama Siegelman
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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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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Thaler A, Alcalay RN. Diagnosis and Medical Management of Parkinson Disease. Continuum (Minneap Minn) 2022; 28:1281-1300. [DOI: 10.1212/con.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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van Munster M, Stümpel J, Clemens T, Czabanowska K, Pedrosa DJ, Mestre TA. Telemedicine as an Untapped Opportunity for Parkinson’s Nurses Training in Personalized Care Approaches. J Pers Med 2022; 12:jpm12071057. [PMID: 35887553 PMCID: PMC9323181 DOI: 10.3390/jpm12071057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Parkinson nurses (PN) take over important functions in the telemedical care of person’s with Parkinson’s disease (PwPs). This requires special competencies that have so far been largely unexplored. The aim of the article is to identify competencies of PN operating in a personalized care model. (2) Methods: This study employed a qualitative approach. Based on the competency framework for telenursing, PN were asked about their competencies using a qualitative online survey. (3) Results: The results show that PN need competencies on a personal and organizational level, as well as in the relationship with PwPs. PN have developed these skills through professional exchange, training, and personal experience. In addition, both hindering and beneficial factors for the development of competencies could be identified. (4) Conclusions: Competency development for telemedical care is complex and must be designed and promoted in a targeted manner.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35043 Marburg, Germany;
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (T.C.); (K.C.)
- Correspondence:
| | - Johanne Stümpel
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, 50931 Cologne, Germany;
- Center for Life Ethics, University of Bonn, 53113 Bonn, Germany
| | - Timo Clemens
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (T.C.); (K.C.)
| | - Katarzyna Czabanowska
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (T.C.); (K.C.)
- Department of Health Policy Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, 31-066 Krakow, Poland
| | - David J. Pedrosa
- Department of Neurology, University Hospital Marburg, 35043 Marburg, Germany;
| | - Tiago A. Mestre
- Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON K1Y 4E9, Canada;
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Leung T, Akram F, Lee J, Klostermann EC, Hess SP, Myrick E, Levin M, Ouyang B, Wilkinson J, Hall D, Chodosh J. Peer Mentoring Program for Informal Caregivers of Homebound Individuals With Advanced Parkinson Disease (Share the Care): Protocol for a Single-Center, Crossover Pilot Study. JMIR Res Protoc 2022; 11:e34750. [PMID: 35481819 PMCID: PMC9185354 DOI: 10.2196/34750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homebound individuals with advanced Parkinson disease (PD) require intensive caregiving, the majority of which is provided by informal, family caregivers. PD caregiver strain is an independent risk factor for institutionalization. There are currently no effective interventions to support advanced PD caregivers. Studies in other neurologic disorders, however, have demonstrated the potential for peer mentoring interventions to improve caregiver outcomes. In the context of an ongoing trial of interdisciplinary home visits, we designed and piloted a nested trial of caregiver peer mentoring for informal caregivers of individuals with advanced PD. OBJECTIVE The aim of this study was to test the feasibility of peer mentoring for caregivers of homebound individuals with advanced PD and to evaluate its effects on anxiety, depression, and caregiver strain. METHODS This was a single-center, 16-week pilot study of caregiver peer mentoring nested within a year-long controlled trial of interdisciplinary home visits. We recruited 34 experienced former or current family caregivers who completed structured mentor training. Caregivers enrolled in the larger interdisciplinary home visit trial consented to receive 16 weeks of weekly, one-to-one peer mentoring calls with a trained peer mentor. Weekly calls were guided by a curriculum on advanced PD management and caregiver support. Fidelity to and satisfaction with the intervention were gathered via biweekly study diaries. Anxiety, depression, and caregiver strain were measured pre- and postmentoring intervention at home visits 2 and 3. RESULTS Enrollment and peer-mentor training began in 2018, and 65 caregivers enrolled in the overarching trial. The majority of mentors and mentees were White, female spouses or partners of individuals with PD; mentors had a mean of 8.7 (SD 6.4) years of caregiving experience, and 33 mentors were matched with at least 1 mentee. CONCLUSIONS This is the first study of caregiver peer mentoring in PD and may establish an adaptable and sustainable model for disease-specific caregiver interventions in PD and other neurodegenerative diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34750.
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Affiliation(s)
| | | | | | | | | | - Erica Myrick
- RUSH UNIVERSITY MEDICAL CENTER, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Melissa Levin
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Chicago Medical School, Rosalind Franklin University, North Chicago, US
| | - Bichun Ouyang
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Jayne Wilkinson
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Department of Neurology, University of Pennsylvania, Pennsylvania, US
| | - Deborah Hall
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 227 E. 30th St.TRB 839, New York, US.,VA New York Harbor Healthcare System, Medicine Service, New York, US
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Cherukupalli A, Yong M, Chan Y, Desrosiers M, Thamboo A. Identifying barriers to care for complex airway disease and multidisciplinary solutions to optimize therapy in Canada. J Otolaryngol Head Neck Surg 2022; 51:15. [PMID: 35428368 PMCID: PMC9012057 DOI: 10.1186/s40463-022-00576-8] [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: 02/10/2022] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Complex airway disease such as Chronic Rhinosinusitis with Asthma or Aspirin Exacerbated Respiratory Disease requires a multidisciplinary approach to management and treatment. Many centers in the USA have created collaborative multidisciplinary clinics to support the management of these patients; however, similar structures do not appear to exist in Canada. Methods This mixed methods study used a combination of structured interviews and a cross-sectional national survey. Interviewees included members of the Canadian Rhinology Working Group and survey participants were a combination of academic and community Rhinologists, Respirologists and Allergists. All participation was voluntary and selection criteria was based on their involvement in treating complex airway disease. Our objective was to identify the current state of diagnosis and treatment of complex airway patients in Canada between Rhinology, Respirology and Allergy and understand the barriers, challenges and propose solutions to establishing a multidisciplinary airway clinic in Canada. Results Four Rhinologists participated in qualitative interviews and a convenience sample of 42 specialists through our known network responded to our quantitative survey. From our survey, 54.8% believed multidisciplinary clinics were necessary in the management of complex airway disease, providing better outcomes and cost-savings (69%, 45.2%). Most specialties agreed that history, physical, pulmonary function and skin prick testing was important for diagnosis (92.9%, 92.9%, 88.1%). If clinicians were to participate in a multidisciplinary clinic, they would be willing to forego an average of 14.2% of their mean daily income for that clinic. The ideal clinic location was split between a neutral shared location vs. a Rhinology clinic space (38.1%, 45.2%). Conclusions Complex airway diseases are currently managed in subspecialty silos resulting in fragmented care. Our study highlights gaps in management, areas for improvement and support for establishing multidisciplinary complex airway disease clinics in Canada to better treat this population.
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Affiliation(s)
- A Cherukupalli
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Diamond Healthcare Center, University of British Columbia, 4th Floor, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada.
| | - M Yong
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Diamond Healthcare Center, University of British Columbia, 4th Floor, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada
| | - Y Chan
- Department of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - M Desrosiers
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - A Thamboo
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Diamond Healthcare Center, University of British Columbia, 4th Floor, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada
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Benson M, Albanese A, Bhatia KP, Cavillon P, Cuffe L, König K, Reinhard C, Graessner H. Development of a patient journey map for people living with cervical dystonia. Orphanet J Rare Dis 2022; 17:130. [PMID: 35313909 PMCID: PMC8935780 DOI: 10.1186/s13023-022-02270-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/20/2022] [Indexed: 01/18/2023] Open
Abstract
Background Patient journey maps are increasingly used as a tool that enables healthcare providers to refine their service provision to best meet patient needs. We developed a cervical dystonia patient journey map (CDPJM) that describes the holistic patient experience from pre-diagnosis through to long-term treatment. Methods The CDPJM was developed in 2 stages; a patient survey (open questions and multichoice) of 15 patients with CD was conducted to inform the design of the CDPJM, which was then refined and validated by an expert-patient focus group. Results Qualitative analysis of the patient survey supported five key stages of the patient journey: symptom onset, diagnosis and therapeutic relationship with healthcare professionals, initiation of care for CD, start of CD treatment, and living with treated CD. Following symptom onset, survey respondents described having multiple visits to their family doctor who prescribed strong pain killers and muscle relaxants and referred their patient to up to 10 different specialists for diagnosis. Over half (53.3%) of respondents had received ≥ 1 misdiagnosis. Respondents reported relief at having a diagnosis but a lack of understanding of the prognosis and treatment options; 46.7% said their neurologist did not spend enough time addressing their concerns. Survey respondents reported using a variety of alternative sources of information, including the internet (86.7%), self-help groups (66.7%) and information leaflets provided by health care professionals (60.0%). While botulinum toxin (BoNT) was consistently discussed as the main treatment option, some neurologists also mentioned physiotherapy, counselling, and other complementary approaches. However, patients were often left to seek complementary services themselves. Patients reported a ‘rollercoaster’ of relief with BoNT treatment with symptoms (and subsequent impact on daily life) returning towards the end of an injection cycle. “When BoNT works well I can return to an almost normal life … when the injections stop working so well, I have to rest more and avoid going to work and experience life restrictions.” Conclusions We present the first patient journey map for CD that can be used to guide local service mapping and to compare current provision with what patients say they want and need. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02270-4.
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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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Connor KI, Siebens HC, Mittman BS, Ganz DA, Barry F, McNeese-Smith DK, Cheng EM, Vickrey BG. Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS) in meeting challenges in care management. BMC Neurol 2022; 22:36. [PMID: 35073865 PMCID: PMC8785022 DOI: 10.1186/s12883-021-02481-5] [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: 06/02/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) complexity poses challenges for individuals with Parkinson's, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature. METHODS These analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model's six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson's modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson's care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges. RESULTS All Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson's moderator types. Through card sorting, four Parkinson's care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson's care management. CHAPS activities and stakeholder perceptions addressed all these themes. CONCLUSIONS CHAPS, a supportive nurse-led proactive Parkinson's care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson's care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I Connor
- Veterans Affairs Parkinson's Disease Research, Education and Clinical Center, Los Angeles, CA, USA. .,UCLA David Geffen School of Medicine, Los Angeles, CA, USA. .,, Novato, CA, 94945, USA.
| | | | - Brian S Mittman
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - David A Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Eric M Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Rose DC, Poliakoff E, Hadley R, Guérin SMR, Phillips M, Young WR. Levelling the Playing Field: The Role of Workshops to Explore How People With Parkinson's Use Music for Mood and Movement Management as Part of a Patient and Public Involvement Strategy. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:873216. [PMID: 36188900 PMCID: PMC9397793 DOI: 10.3389/fresc.2022.873216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022]
Abstract
From a humanistic perspective, participatory processes in research find support on both ethical and moral grounds. In practical terms however, it is often difficult to establish protocols that best honour (i.e., elicit, capture, and integrate) the opinions of individuals and groups that represent the various specific stakeholders (e.g., from allied health, scientific, and academic disciplines) needed to investigate complex phenomena. Here, we describe a consultation process (funded by Parkinson's UK) devised to explore use of music among people with Parkinson's in relation to potential applications to enhance quality of life. People with Parkinson's were paired with researchers in order to discuss music on an equal footing so as to enable participant empowerment. We describe outcomes that demonstrate avenues of success as a result of this approach and additional insights gained through these processes in the hope of informing future practise. It has been our experience that researchers must establish a balance between (a) ensuring methodological rigour within an appropriate framework, and (b) facilitating informal "playtime" that develops connectivity between participants and enables both creative thinking and reflexive practise amongst stakeholders. We encourage researchers not to underestimate "playtime" as an important vehicle to foster this social interactivity and fuel the good will required to conduct inclusive and relevant research.
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Affiliation(s)
- Dawn C. Rose
- School of Music, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
- *Correspondence: Dawn C. Rose
| | - Ellen Poliakoff
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
| | | | - Ségolène M. R. Guérin
- Univ. Lille, UMR 9193–SCALab–Sciences Cognitives et Sciences Affectives, Lille, France
| | | | - William R. Young
- School of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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Sylvie G, Farré Coma J, Ota G, Aoife L, Anna S, Johanne S, Tiago M. Co-designing an Integrated Care Network With People Living With Parkinson's Disease: From Patients' Narratives to Trajectory Analysis. QUALITATIVE HEALTH RESEARCH 2021; 31:2585-2601. [PMID: 34629008 PMCID: PMC8649812 DOI: 10.1177/10497323211042605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
An integrated care model for people living with Parkinson's disease (PD) offers the promise of meeting complex care needs in a person-centered way that addresses fragmentation and improves quality of life. The purpose of our research was to co-design a care delivery model that supports both social and medical care from the perspective of patients and care partners. In the first step of our co-design approach, participants from five countries were invited to share their experiences of living with PD during a narrative interview. A qualitative analysis of these narrative interviews based on the Corbin and Strauss model was done to map out patients' trajectories. Three typical trajectories were identified: (a) the "unpredictable" trajectory, (b) the "situated" trajectory, and (c) the "demanding" trajectory. Based on the analysis of these trajectories, we were able to integrate various patient experiences into the design of an integrated care network.
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Affiliation(s)
- Grosjean Sylvie
- University of Ottawa, Ottawa, Ontario, Canada
- Grosjean Sylvie, University of Ottawa, 55 Laurier east, Desmanarais Building, 11112, Ottawa, Ontario, Canada K1N 6N5.
| | | | - Gal Ota
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital, Charles University, Prague, Czech Republic
| | - Laffan Aoife
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Stuempel Johanne
- University of Cologne, Cologne Centre for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Cologne, Germany
| | - Mestre Tiago
- Parkinson’s Disease and Movement Disorders Clinic, Division of Neurology, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
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35
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Fereshtehnejad SM, Rodríguez-Violante M, Martinez-Ramirez D, Ramirez-Zamora A. Editorial: Managing Parkinson's Disease With a Multidisciplinary Perspective. Front Neurol 2021; 12:799017. [PMID: 34899588 PMCID: PMC8661532 DOI: 10.3389/fneur.2021.799017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Mancini GMS, Smits DJ, Dekker J, Schot R, de Wit MCY, Lequin MH, Dremmen M, Brooks AS, van Ham T, Verheijen FW, Fornerod M, Dobyns WB, Wilke M. Multidisciplinary interaction and MCD gene discovery. The perspective of the clinical geneticist. Eur J Paediatr Neurol 2021; 35:27-34. [PMID: 34592643 DOI: 10.1016/j.ejpn.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
The increasing pace of gene discovery in the last decade has brought a major change in the way the genetic causes of brain malformations are being diagnosed. Unbiased genomic screening has gained the first place in the diagnostic protocol of a child with congenital (brain) anomalies and the detected variants are matched with the phenotypic presentation afterwards. This process is defined as "reverse phenotyping". Screening of DNA, through copy number variant analysis of microarrays and analysis of exome data on different platforms, obtained from the index patient and both parents has become a routine approach in many centers worldwide. Clinicians are used to multidisciplinary team interaction in patient care and disease management and this explains why the majority of research that has led to the discovery of new genetic disorders nowadays proceeds from clinical observations to genomic analysis and to data exchange facilitated by open access sharing databases. However, the relevance of multidisciplinary team interaction has not been object of systematic research in the field of brain malformations. This review will illustrate some examples of how diagnostically driven questions through multidisciplinary interaction, among clinical and preclinical disciplines, can be successful in the discovery of new genes related to brain malformations. The first example illustrates the setting of interaction among neurologists, geneticists and neuro-radiologists. The second illustrates the importance of interaction among clinical dysmorphologists for pattern recognition of syndromes with multiple congenital anomalies. The third example shows how fruitful it can be to step out of the "clinical comfort zone", and interact with basic scientists in applying emerging technologies to solve the diagnostic puzzles.
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Affiliation(s)
- Grazia M S Mancini
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam.
| | - Daphne J Smits
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jordy Dekker
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Rachel Schot
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam
| | - Marie Claire Y de Wit
- Department of Child Neurology, Sophia Children's Hospital, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Rotterdam, NL, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam
| | - Maarten H Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marjolein Dremmen
- Department of Radiology, Sophia Children's Hospital, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam
| | - Alice S Brooks
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Tjakko van Ham
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Frans W Verheijen
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam
| | - Maarten Fornerod
- Department of Cell Biology, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - William B Dobyns
- Department of Pediatrics (Genetics), University of Minnesota, 420 Delaware Street SE, MMC75, Minneapolis, MN, 55454, USA
| | - Martina Wilke
- Department of Clinical Genetics, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; ENCORE Expertise Center for Genetic Neurocognitive Developmental Disorders, Erasmus, MC, Rotterdam
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van Halteren AD, Munneke M, Smit E, Thomas S, Bloem BR, Darweesh SKL. Personalized Care Management for Persons with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:S11-S20. [PMID: 32925110 PMCID: PMC7592650 DOI: 10.3233/jpd-202126] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is a growing awareness that delivery of integrated and personalized care is necessary to meet the needs of persons living with Parkinson's disease. In other chronic diseases than Parkinson's disease, care management models have been deployed to deliver integrated and personalized care, yielding positive effects on patients' health outcomes, quality of life and health care utilization. However, care management models have been highly heterogeneous, as there is currently no clear operationalization of its core elements. In addition, most care management models are disease-specific and not tailored to the individual needs and preferences of a patient. In this viewpoint we present an integrated and personalized care management model for persons with Parkinson's disease costing of five core elements: (1) care coordination, (2) patient navigation, (3) information provision, (4) early detection of signs and symptoms through proactive monitoring and (5) process monitoring. Following the description of each core element, implications for implementing the model into practice are discussed. Finally, we provide clinical and methodological considerations on the evaluation of care management models.
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Affiliation(s)
- Angelika D van Halteren
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Eva Smit
- Radboud University Medical Center, Adviesbureau Procesverbetering en Implementatie, Nijmegen, The Netherlands
| | - Sue Thomas
- Parkinson's Academy Faculty, Sheffield, United Kingdom
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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Silva-Batista C, Coelho DB, Júnior RCF, Almeida LR, Guimarães A, Nóbrega KCC, Machado Sanchez H, Lindquist ARR, Israel VL, Kanegusuku H, Guimarães R, Beckmann Bosaipo N, Barbosa R, Correa CL, Finatto MJ, Mendes FADS, Piemonte MEP. Multidimensional Factors Can Explain the Clinical Worsening in People With Parkinson's Disease During the COVID-19 Pandemic: A Multicenter Cross-Sectional Trial. Front Neurol 2021; 12:708433. [PMID: 34393984 PMCID: PMC8362931 DOI: 10.3389/fneur.2021.708433] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Self-reported clinical worsening by people with Parkinson's disease (PD) during social distancing may be aggravated in Brazil, where the e/tele-health system is precarious. Objectives: This study aims to investigate self-reported changes in motor and non-motor aspects during social distancing in people with PD living in Brazil and to investigate the factors that might explain these changes. Methods: In this multicenter cross-sectional trial, 478 people with a diagnosis of idiopathic PD (mean age = 67, SD = 9.5; 167 female) were recruited from 14 centers distributed throughout the five geographical regions of Brazil. The evaluators from each center applied a questionnaire by telephone, which included questions (previous and current period of social distancing) about the motor and non-motor experiences of daily living, quality of life, daily routine, and physical activity volume. Results: Self-reported clinical worsening in non-motor and motor aspects of daily life experiences (Movement Disorder Society-Unified PD Rating Scale—parts IB and II—emotional and mental health, and fear of falling) and in the quality of life was observed. Only 31% of the participants reported a guided home-based physical activity with distance supervision. Perceived changes in the quality of life, freezing of gait, decreased physical activity volume, daily routine, and fear of falling explained the self-reported clinical worsening (P < 0.05). Conclusions: Self-reported clinical worsening in people with PD living in Brazil during social distancing can also be aggravated by the precarious e/tele-health system, as perception of decreased physical activity volume and impoverishment in daily routine were some of the explanatory factors. Considering the multifaceted worsening, the implementation of a remote multi-professional support for these people is urgent.
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Affiliation(s)
- Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, Sao Bernardo do Campo, Brazil
| | | | - Lorena Rosa Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Brazil.,Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Adriana Guimarães
- Department of Physical Education, State University of Santa Catarina, Florianópolis, Brazil
| | | | | | | | - Vera Lúcia Israel
- Department of Physiotherapy, Federal University of Parana, Curitiba, Brazil
| | - Hélcio Kanegusuku
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, Sáo Paulo, Brazil
| | - Rachel Guimarães
- Laboratory of Neuroimaging, University of Campinas, Sáo Paulo, Brazil
| | - Nayanne Beckmann Bosaipo
- Setor de Distúrbios do Movimento e Neurologia Comportamental do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Sáo Paulo, Brazil
| | - Richelma Barbosa
- Department of Physiotherapy, University of Pará State, Santarém, Brazil
| | - Clynton Lourenço Correa
- Graduate Program of Physical Education, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria José Finatto
- Department of Linguistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Personalized Medicine in Parkinson's Disease: New Options for Advanced Treatments. J Pers Med 2021; 11:jpm11070650. [PMID: 34357117 PMCID: PMC8303729 DOI: 10.3390/jpm11070650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) presents varying motor and non-motor features in each patient owing to their different backgrounds, such as age, gender, genetics, and environmental factors. Furthermore, in the advanced stages, troublesome symptoms vary between patients due to motor and non-motor complications. The treatment of PD has made great progress over recent decades and has directly contributed to an improvement in patients’ quality of life, especially through the progression of advanced treatment. Deep brain stimulation, radiofrequency, MR–guided focused ultrasound, gamma knife, levodopa-carbidopa intestinal gel, and apomorphine are now used in the clinical setting for this disease. With multiple treatment options currently available for all stages of PD, we here discuss the most recent options for advanced treatment, including cell therapy in advanced PD, from the perspective of personalized medicine.
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van Munster M, Stümpel J, Thieken F, J. Pedrosa D, Antonini A, Côté D, Fabbri M, Ferreira JJ, Růžička E, Grimes D, Mestre TA. Moving towards Integrated and Personalized Care in Parkinson's Disease: A Framework Proposal for Training Parkinson Nurses. J Pers Med 2021; 11:623. [PMID: 34209024 PMCID: PMC8304750 DOI: 10.3390/jpm11070623] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022] Open
Abstract
Delivering healthcare to people living with Parkinson's disease (PD) may be challenging in face of differentiated care needs during a PD journey and a growing complexity. In this regard, integrative care models may foster flexible solutions on patients' care needs whereas Parkinson Nurses (PN) may be pivotal facilitators. However, at present hardly any training opportunities tailored to the care priorities of PD-patients are to be found for nurses. Following a conceptual approach, this article aims at setting a framework for training PN by reviewing existing literature on care priorities for PD. As a result, six prerequisites were formulated concerning a framework for training PN. The proposed training framework consist of three modules covering topics of PD: (i) comprehensive care, (ii) self-management support and (iii) health coaching. A fourth module on telemedicine may be added if applicable. The framework streamlines important theoretical concepts of professional PD management and may enable the development of novel, personalized care approaches.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany; (F.T.); (D.J.P.)
| | - Johanne Stümpel
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, 50931 Cologne, Germany;
- Research Unit Ethics, University Hospital Cologne, 50931 Cologne, Germany
| | - Franziska Thieken
- Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany; (F.T.); (D.J.P.)
| | - David J. Pedrosa
- Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany; (F.T.); (D.J.P.)
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, University of Padua, 35122 Padua, Italy;
| | - Diane Côté
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;
| | - Margherita Fabbri
- 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, 31062 Toulouse, France;
| | - Joaquim J. Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- CNS—Campus Neurológico Sénior Torres Vedras, 2560-280 Torres Vedras, Portugal
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, General University Hospital in Prague, CZ-121 08 Prague, Czech Republic;
| | - David Grimes
- Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON K1Y 4E9, Canada; (D.G.); (T.A.M.)
| | - Tiago A. Mestre
- Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON K1Y 4E9, Canada; (D.G.); (T.A.M.)
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Katunina EA. [Amantadine in the treatment of Parkinson's disease. New opportunities in the context of COVID-19]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:101-106. [PMID: 34037362 DOI: 10.17116/jnevro2021121041101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents data from recent studies on the mechanisms of action and clinical efficacy of amantadines, and also describes a possible protective effect against COVID-19.
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Affiliation(s)
- E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center for Brain and Neurotechnology, Moscow, Russia
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The Impact of Depression Symptoms in Patients with Parkinson's Disease: A Novel Case-Control Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052369. [PMID: 33804349 PMCID: PMC7967746 DOI: 10.3390/ijerph18052369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 02/08/2023]
Abstract
Parkinson's disease is a common neurodegenerative disease and it is known to cause motor disturbances associated with musculoskeletal problems of the locomotor apparatus, and non-motor symptoms, that are believed to have a harmful effect on health, social functioning and mobility. The aim of this study was to evaluate depression in patients with Parkinson's Disease (PD) compared to subjects who do not have it. The sample consisted of 124 participants (mean age 69.18 ± 9.12). Patients with PD were recruited from a center of excellence for Parkinson's disease (cases n = 62) and healthy subjects without PD from their relatives and caregivers (control n = 62). The Spanish version of Beck's Depression Inventory (BDI) scores and categories were collected. A clear statistically significant difference (p < 0.05) was evident in the BDI scores between both groups. Parkinson's patients presented worse results on the BDI = 15.48 ± 7.24 points compared to healthy subjects with BDI = 7.03 ± 6.99 points. Regarding BDI categories, there were statistically significant differences (p < 0.001) for the greater BDI categories in the Parkinson's group compared with healthy subjects. The depression represents an important potential risk for increased symptoms and negative impact among patients with PD compared with healthy subjects.
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Promoting Self-Care in Nursing Encounters with Persons Affected by Long-Term Conditions-A Proposed Model to Guide Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052223. [PMID: 33668201 PMCID: PMC7956321 DOI: 10.3390/ijerph18052223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
Background: Nursing interventions for persons affected by long-term conditions should focus on providing support to enhance the ability to manage disease in everyday life. Many clinical nurses feel they have inadequate training or experience to provide self-management support in a beneficial and structured way. This study explores the process towards independent self-care and management of disease in persons affected by Parkinson’s disease and the support required from healthcare to achieve this. It presents a nursing model to guide nurses in providing self-management support in the clinical care encounter. Methods: The results from three previously published articles investigating a self-management support program for persons with Parkinson’s disease were combined to form a new data set, and analyzed using qualitative thematic analysis. Results: Three separate, but interrelated, themes were identified, which described the process towards self-management of disease as expressed by the participants of the self-management program. Themes describe the factors important for developing and improving self-management abilities and actions. The results were applied to Orem’s Self-care deficit theory to suggest a model of self-management support in the clinical nursing encounter. Conclusion: This study investigated factors important for self-management and highlighted the unique contribution and focus of nursing support to promote independent self-care.
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Rafferty MR, Nettnin E, Goldman JG, MacDonald J. Frameworks for Parkinson's Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 2021; 21:12. [PMID: 33615420 PMCID: PMC8215896 DOI: 10.1007/s11910-021-01096-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the evidence on rehabilitation for people with Parkinson's disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care. RECENT FINDINGS Clinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson's disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery. There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits. We propose a framework of three pathways for rehabilitation care: (1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities; (2) restorative rehabilitation to promote functional improvements; and (3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Jennifer G Goldman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Roberts AC, Rafferty MR, Wu SS, Miao G, Cubillos F, Simuni T. Patterns and predictors of referrals to allied health services for individuals with Parkinson's disease: A Parkinson's foundation (PF) QII study. Parkinsonism Relat Disord 2021; 83:115-122. [PMID: 33339716 PMCID: PMC11283279 DOI: 10.1016/j.parkreldis.2020.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/27/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Rehabilitation therapies are critical for optimizing quality-of-life and daily functions for individuals living with Parkinson's disease (PD). Thus, understanding the patterns of and under what conditions physicians make rehabilitation referrals is important for optimizing care. METHOD We analyzed data from 5020 participants (4 countries) collected from 1/3/2016 to 4/20/2018 as part of the Parkinson's Foundation Quality Improvement Initiative (PF QII). Data were analyzed for single discipline and multidiscipline referrals to speech language pathology (SLP), physical therapy (PT), and occupational therapy (OT). Group comparisons (referred vs. not-referred) and regression procedures were implemented to determine demographic and clinical variables that were associated with an increased likelihood of rehabilitation referral. RESULTS 35.3% of participants were referred to rehabilitation services. Of these, 25.1% received a multidiscipline referral. There was a statistically significant effect of disease stage on both single discipline (χ2(2) = 45.1, p < 0.0001) and multidiscipline (χ2(2) = 74.2, p < 0.0001) referrals, with higher rates in later stages. Referred vs. not-referred participants differed significantly on a number of variables; however, only falls in the 6-months prior, advanced- and moderate-stage disease, older age, hospital admissions, and higher caregiver burden were associated with an increased likelihood of rehabilitation referral (adjusted odds ratios ≥ 1, Range = 1.08 to 1.62). CONCLUSIONS Despite evidence supporting multidiscipline and proactive rehabilitation in PD, the majority of referrals were made to a single service and may be reactions to falls or advancing disease. Data suggest there may be missed opportunities for optimizing care through proactive rehabilitation interventions.
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Affiliation(s)
- Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60025, USA.
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Northwestern University Department of Physical Medicine and Rehabilitation and Department of Psychiatry and Behavioral Science, 355 E Erie St. 19th Floor, Chicago, IL, 60611, USA.
| | - Samuel S Wu
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Guanhuong Miao
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Fernando Cubillos
- Parkinson's Foundation, 200 SE 1st Street Ste 800, Miami, FL, 33131, USA
| | - Tanya Simuni
- Feinberg School of Medicine, Department of Neurology, Northwestern University Parkinson's Disease and Movement Disorders Center, Room 1900, NMH/259 E Erie, Chicago, IL, 60611, USA
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Loewenbrück KF, Stein DB, Amelung VE, Bitterlich R, Brumme M, Falkenburger B, Fehre A, Feige T, Frank A, Gißke C, Helmert C, Kerkemeyer L, Knapp A, Lang C, Leuner A, Lummer C, Minkman MMN, Müller G, van Munster M, Schlieter H, Themann P, Zonneveld N, Wolz M. Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson's Disease in the Region of Eastern Saxony, Germany. J Clin Med 2020; 9:E2906. [PMID: 32911841 PMCID: PMC7563971 DOI: 10.3390/jcm9092906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson's disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborative intersectoral structured care pathway. Additional components encompass personalized case management, an electronic health record, and communicative and educative measures. To reach an intersectoral consensus of the future collaboration in PANOS, a structured consensus process was conducted in three sequential workshops. Community-based physicians, PD specialists, therapists, scientists and representatives of regulatory authorities and statutory health insurances were asked to rate core pathway-elements and supporting technological, personal and communicative measures. For the majority of core elements/planned measures, a consensus was reached, defined as an agreement by >75% of participants. Additionally, six representatives from all partners involved in the network-design independently assessed PANOS based on the Development Model for Integrated Care (DMIC), a validated model addressing the comprehensiveness and maturity of integrated care concepts. The results show that PANOS is currently in an early maturation state but has the potential to comprehensively represent the DMIC if all planned activities are implemented successfully. Despite the favorable high level of consensus regarding the PANOS concept and despite its potential to become a balanced integrated care concept according to the DMIC, its full implementation remains a considerable challenge.
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Affiliation(s)
- Kai F. Loewenbrück
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Doron B. Stein
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Volker E. Amelung
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Robert Bitterlich
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Martin Brumme
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Björn Falkenburger
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Annekathrin Fehre
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Tim Feige
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
| | - Anika Frank
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany; (R.B.); (B.F.); (T.F.); (A.F.)
- Clinical Trial Unit, German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Carola Gißke
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Claudia Helmert
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Andreas Knapp
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Caroline Lang
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Annegret Leuner
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
| | - Carina Lummer
- Institute for Applied Health Services Research (inav), Schiffbauerdamm 12, 10117 Berlin, Germany; (D.B.S.); (V.E.A.); (M.B.); (L.K.); (C.L.)
| | - Mirella M. N. Minkman
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (C.H.); (A.K.); (C.L.); (G.M.)
| | - Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35043 Marburg, Germany;
| | - Hannes Schlieter
- Chair of Business Informatics, esp. Systems Development, Faculty of Business and Economics, Technical University of Dresden, 01062 Dresden, Germany; (C.G.); (H.S.)
| | - Peter Themann
- Department of Neurology, Klinik am Tharandter Wald Hetzdorf, Herzogswalder Straße 1, 09633 Halsbrücke, Germany;
| | - Nick Zonneveld
- Vilans, National Centre of Expertise in Long Term Care, 3527 GV Utrecht, The Netherlands; (M.M.N.M.); (N.Z.)
- Tilburg University/TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany; (A.F.); (A.L.); (M.W.)
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Structured Care and Self-Management Education for Persons with Parkinson's Disease: Why the First Does Not Go without the Second-Systematic Review, Experiences and Implementation Concepts from Sweden and Germany. J Clin Med 2020; 9:jcm9092787. [PMID: 32872258 PMCID: PMC7563525 DOI: 10.3390/jcm9092787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022] Open
Abstract
Integrated care is regarded as a key for care delivery to persons with chronic long-term conditions such as Parkinson’s disease. For persons with Parkinson’s disease, obtaining self-management support is a top priority in the context of integrated care. Self-management is regarded as a crucial competence in chronic diseases since the affected persons and their caregivers inevitably take up the main responsibility when it comes to day-to-day management. Formal self-management education programs with the focus on behavioral skills relevant to the induction and maintenance of behavioral change have been implemented as a standard in many chronic long-term conditions. However, besides the example of the Swedish National Parkinson School, the offers for persons with Parkinson’s disease remain fragmented and limited in availability. Today, no such program is implemented as a nationwide standard in Germany. This paper provides (1) a systematic review on structured self-management education programs specifically designed or adopted for persons with Parkinson’s disease, (2) presents the Swedish National Parkinson School as an example for a successfully implemented nationwide program and (3) presents a concept for the design, evaluation and long-term implementation of a future-orientated self-management education program for persons with Parkinson’s disease in Germany.
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48
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van Munster M, Tönges L, Loewenbrück KF, Warnecke T, Eggers C. Building a Parkinson-Network-Experiences from Germany. J Clin Med 2020; 9:E2743. [PMID: 32854328 PMCID: PMC7563415 DOI: 10.3390/jcm9092743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease is a complex neurodegenerative disease that can be best treated with a multi-disciplinary care approach. Building care networks has been shown as a useful tool to facilitate the integration of care services and improve outcomes for patients and care providers. However, experiences and practices relating to building a network are very limited in the field of Parkinson's disease. This paper portrays existing Parkinson networks in Germany. With the help of a standardized template, description of networks and their building-blocks, so-called modules, were collected from all over Germany. Modules were rated in terms of their expected benefit and the required effort when implementing them, with the help of an expert survey. The rating showed that some modules were perceived as more important than others, but all modules were recognized as beneficial for patients and care providers. Overall, the German experience shows that building a Parkinson network facilitates the integration of care and provides a benefit to all stakeholders involved.
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Affiliation(s)
- Marlena van Munster
- Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany;
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44801 Bochum, Germany;
- Neurodegeneration Research, Center for Protein Diagnostics (ProDi), Ruhr University, 44801 Bochum, Germany
| | - Kai F. Loewenbrück
- Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital of Münster, 48149 Münster, Germany;
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany;
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