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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. J Parkinsons Dis 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Geerlings AD, Kapelle WM, Sederel CJ, Tenison E, Wijngaards-Berenbroek H, Meinders MJ, Munneke M, Ben-Shlomo Y, Bloem BR, Darweesh SKL. Caregiver burden in Parkinson's disease: a mixed-methods study. BMC Med 2023; 21:247. [PMID: 37424022 PMCID: PMC10332089 DOI: 10.1186/s12916-023-02933-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Providing informal care for a person with Parkinson's disease (PD) can be a demanding process affecting several dimensions of a caregiver's life and potentially causing caregiver burden. Despite the emerging literature on caregiver burden in people with PD, little is known about the inter-relationship between quantitative and qualitative findings. Filling this knowledge gap will provide a more holistic approach to develop and design innovations aiming at reducing or even preventing caregiver burden. This study aimed to characterize the determinants of caregiver burden among informal caregivers of persons with PD, in order to facilitate the development of tailored interventions that reduce caregiver burden. METHODS We conducted a cross-sectional study in The Netherlands using a sequential mixed methods approach, entailing a quantitative study of 504 persons with PD and their informal caregivers as well as a qualitative study in a representative subsample of 17 informal caregivers. The quantitative study included a standardized questionnaire of caregiver burden (Zarit Burden Inventory) and patient-related (Beck Depression Inventory, State-Trait Anxiety Inventory, Acceptance of Illness Scale, MDS-Unified Parkinson's Disease Rating Scale part II on motor functions in daily life, Self-assessment Parkinson's Disease Disability Score), caregiver-related (Brief Coping Orientation to Problems Experience Inventory, Caregiver Activation Measurement, Multidimensional Scale of Perceived Social Support) and interpersonal determinants (sociodemographic variables including among others gender, age, education, marital status and working status). The qualitative study consisted of semi-structured interviews. Multivariable regression and thematic analysis were used to analyse quantitative and qualitative data, respectively. RESULTS A total of 337 caregivers were women (66.9%), and the majority of people with PD were men (N = 321, 63.7%). The mean age of persons with PD was 69.9 (standard deviation [SD] 8.1) years, and the mean disease duration was 7.2 (SD 5.2) years. A total of 366 (72.6%) persons with PD had no active employment. The mean age of informal caregivers was 67.5 (SD 9.2) years. Most informal caregivers were female (66.9%), had no active employment (65.9%) and were the spouse of the person with PD (90.7%). The mean Zarit Burden Inventory score was 15.9 (SD 11.7). The quantitative study showed that a lack of active employment of the person affected by PD was associated with a higher caregiver burden. The qualitative study revealed cognitive decline and psychological or emotional deficits of the person with PD as additional patient-related determinants of higher caregiver burden. The following caregiver-related and interpersonal determinants were associated with higher caregiver burden: low social support (quantitative study), concerns about the future (qualitative study), the caregiving-induced requirement of restrictions in everyday life (qualitative study), changes in the relationship with the person with PD (qualitative study) and a problem-focused or avoidant coping style (both studies). Integration of both data strands revealed that qualitative findings expanded quantitative findings by (1) distinguishing between the impact of the relationship with the person with PD and the relationship with others on perceived social support, (2) revealing the impact of non-motor symptoms next to motor symptoms and (3) revealing the following additional factors impacting caregiver burden: concern about the future, perceived restrictions and limitations in performing daily activities due to the disease, and negative feelings and emotional well-being. Qualitative findings were discordant with the quantitative finding demonstrating that problem-focused was associated with a higher caregiver burden. Factor analyses showed three sub-dimensions of the Zarit Burden Inventory: (i) role intensity and resource strain, (2) social restriction and anger and (3) self-criticism. Quantitative analysis showed that avoidant coping was a determinant for all three subscales, whereas problem-solved coping and perceived social support were significant predictors on two subscales, role intensity and resource strain and self-criticism. CONCLUSIONS The burden experienced by informal caregivers of persons with PD is determined by a complex interplay of patient-related, caregiver-related and interpersonal characteristics. Our study highlights the utility of a mixed-methods approach to unravel the multidimensional burden experienced by informal caregivers of persons with chronic disease. We also offer starting points for the development of a tailored supportive approach for caregivers.
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Affiliation(s)
- Angelika D Geerlings
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Willanka M Kapelle
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Charlotte J Sederel
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands.
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Lithander FE, Tenison E, Ypinga J, Halteren A, Smith MD, Lloyd K, Richfield EW, Brazier DE, Breasail MÓ, Smink AJ, Metcalfe C, Hollingworth W, Bloem B, Munneke M, Ben-Shlomo Y, Darweesh SKL, Henderson EJ. Proactive and Integrated Management and Empowerment in Parkinson's Disease protocol for a randomised controlled trial (PRIME-UK) to evaluate a new model of care. Trials 2023; 24:147. [PMID: 36849987 PMCID: PMC9969590 DOI: 10.1186/s13063-023-07084-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People living with Parkinson's disease experience progressive motor and non-motor symptoms, which negatively impact on health-related quality of life and can lead to an increased risk of hospitalisation. It is increasingly recognised that the current care models are not suitable for the needs of people with parkinsonism whose care needs evolve and change as the disease progresses. This trial aims to evaluate whether a complex and innovative model of integrated care will increase an individual's ability to achieve their personal goals, have a positive impact on health and symptom burden and be more cost-effective when compared with usual care. METHODS This is a single-centre, randomised controlled trial where people with parkinsonism and their informal caregivers are randomised into one of two groups: either PRIME Parkinson multi-component model of care or usual care. Adults ≥18 years with a diagnosis of parkinsonism, able to provide informed consent or the availability of a close friend or relative to act as a personal consultee if capacity to do so is absent and living in the trial geographical area are eligible. Up to three caregivers per patient can also take part, must be ≥18 years, provide informal, unpaid care and able to give informed consent. The primary outcome measure is goal attainment, as measured using the Bangor Goal Setting Interview. The duration of enrolment is 24 months. The total recruitment target is n=214, and the main analyses will be intention to treat. DISCUSSION This trial tests whether a novel model of care improves health and disease-related metrics including goal attainment and decreases hospitalisations whilst being more cost-effective than the current usual care. Subject to successful implementation of this intervention within one centre, the PRIME Parkinson model of care could then be evaluated within a cluster-randomised trial at multiple centres.
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Affiliation(s)
- Fiona E. Lithander
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, 1142 New Zealand ,grid.9654.e0000 0004 0372 3343Department of Nutrition and Dietetics, University of Auckland, Auckland, 1142 New Zealand
| | - Emma Tenison
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Jan Ypinga
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Angelika Halteren
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Matthew D. Smith
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Katherine Lloyd
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Edward W. Richfield
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Danielle E. Brazier
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Mícheál Ó. Breasail
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Agnes J. Smink
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Chris Metcalfe
- grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - William Hollingworth
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - Bas Bloem
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marten Munneke
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Sirwan K. L. Darweesh
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Emily J. Henderson
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.413029.d0000 0004 0374 2907Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG UK
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Talebi AH, Ypinga JHL, De Vries NM, Nonnekes J, Munneke M, Bloem BR, Heskes T, Ben-Shlomo Y, Darweesh SKL. Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications. Mov Disord 2023; 38:223-231. [PMID: 36424819 DOI: 10.1002/mds.29274] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Specialized versus generic physiotherapy (PT) reduces Parkinson's disease (PD)-related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S<), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications. OBJECTIVES To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S< was associated with the incidence rate of PD-related complications. METHODS We used claims data of all insured persons with PD in the Netherlands between January 1, 2010, and December 31, 2018. ParkinsonNet-trained therapists were classified as specialized, and other therapists as generic. We used mixed-effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics. RESULTS The population of 51,464 persons with PD (mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD-related complications during follow-up (median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74-0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77-0.99]; P = 0.03). We found a trend of an association between specialized S< and a lower rate of PD-related complications (IRR = 0.88 [0.74-1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42-0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73-0.82]; P < 0.0001) and of S< with pneumonia (IRR = 0.70 [0.53-0.93]; P = 0.03). CONCLUSIONS These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Amir H Talebi
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jan H L Ypinga
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sirwan K L Darweesh
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
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Geerlings AD, Janssen Daalen JM, Ypinga JHL, Bloem BR, Meinders MJ, Munneke M, Darweesh SKL. Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis. PLoS One 2023; 18:e0282590. [PMID: 37058492 PMCID: PMC10104285 DOI: 10.1371/journal.pone.0282590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/18/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND There is no systematic insight into the effect of case management on common complications of chronic diseases, including depressive symptoms and symptoms of anxiety. This is a significant knowledge gap, given that people with a chronic disease such as Parkinson Disease or Alzheimer's Disease have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by crucial patient characteristics, such as their age, gender, or disease characteristics. Such insights would shift from "one size fits all" healthcare resource allocation to personalized medicine. OBJECTIVE We systematically examined the effectiveness of case management interventions on two common complications associated PD and other chronic health conditions: Depressive symptoms and symptoms of anxiety. METHODS We identified studies published until November 2022 from PubMed and Embase databases using predefined inclusion criteria. For each study, data were extracted independently by two researchers. First, descriptive and qualitative analyses of all included studies were performed, followed by random-effects meta-analyses to assess the impact of case management interventions on anxiety and depressive symptoms. Second, meta-regression was performed to analyze potential modifying effects of demographic characteristics, disease characteristics and case management components. RESULTS 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on symptoms of anxiety (8 studies) or depressive symptoms (26 studies). Across meta-analyses, we observed a statistically significant effect of case management on reducing symptoms of anxiety (Standardized Mean Difference [SMD] = - 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depressive symptoms (SMD = - 0.48; CI: -0.71, -0.25). We found large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. CONCLUSIONS Among people with chronic health conditions, case management has beneficial effects on symptoms of depressive symptoms and symptoms of anxiety. Currently, research on case management interventions are rare. Future studies should assess the utility of case management for potentially preventative and common complications, focusing on the optimal content, frequency, and intensity of case management.
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Affiliation(s)
- Angelika D Geerlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jules M Janssen Daalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan H L Ypinga
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
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Vlaanderen FP, de Man Y, Tanke MAC, Munneke M, Atsma F, Meinders MJ, Jeurissen PPT, Bloem BR, Krijthe JH, Groenewoud S. Density of Patient-Sharing Networks: Impact on the Value of Parkinson Care. Int J Health Policy Manag 2022; 11:1132-1139. [PMID: 33812348 PMCID: PMC9808175 DOI: 10.34172/ijhpm.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Optimal care for Parkinson's disease (PD) requires coordination and collaboration between providers within a complex care network. Individual patients have personalised networks of their own providers, creating a unique informal network of providers who treat ('share') the same patient. These 'patient-sharing networks' differ in density, ie, the number of identical patients they share. Denser patient-sharing networks might reflect better care provision, since providers who share many patients might have made efforts to improve their mutual care delivery. We evaluated whether the density of these patient-sharing networks affects patient outcomes and costs. METHODS We analysed medical claims data from all PD patients in the Netherlands between 2012 and 2016. We focused on seven professional disciplines that are commonly involved in Parkinson care. We calculated for each patient the density score: the average number of patients that each patient's providers shared. Density scores could range from 1.00 (which might reflect poor collaboration) to 83.00 (which might reflect better collaboration). This score was also calculated at the hospital level by averaging the scores for all patients belonging to a specific hospital. Using logistic and linear regression analyses we estimated the relationship between density scores and health outcomes, healthcare utilization, and healthcare costs. RESULTS The average density score varied considerably (average 6.7, SD 8.2). Adjusted for confounders, higher density scores were associated with a lower risk of PD-related complications (odds ratio [OR]: 0.901; P<.001) and with lower healthcare costs (coefficients: -0.018, P=.005). Higher density scores were associated with more frequent involvement of neurologists (coefficient 0.068), physiotherapists (coefficient 0.052) and occupational therapists (coefficient 0.048) (P values all <.001). CONCLUSION Patient sharing networks showed large variations in density, which appears unwanted as denser networks are associated with better outcomes and lower costs.
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Affiliation(s)
- Floris P. Vlaanderen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Yvonne de Man
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Marit A. C. Tanke
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Marjan J. Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Patrick P. T. Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Jesse H. Krijthe
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Stef Groenewoud
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
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7
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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. J Parkinsons Dis 2021; 10:S11-S20. [PMID: 32925110 PMCID: PMC7592650 DOI: 10.3233/jpd-202126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Lennaerts-Kats H, Ebenau A, van der Steen JT, Munneke M, Bloem BR, Vissers KCP, Meinders MJ, Groot MM. "No One Can Tell Me How Parkinson's Disease Will Unfold": A Mixed Methods Case Study on Palliative Care for People with Parkinson's Disease and Their Family Caregivers. J Parkinsons Dis 2021; 12:207-219. [PMID: 34542031 PMCID: PMC8842750 DOI: 10.3233/jpd-212742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Palliative care for persons with Parkinson’s disease (PD) is developing. However, little is known about the experiences of patients with PD in the palliative phase and of their family caregivers. Objective: To explore needs of patients with PD in the palliative phase and of their family caregivers. Methods: A mixed methods case study design. Health care professionals included patients for whom the answer on the question “Would you be surprised if this patient died in the next 12 months?” was negative. At baseline, and after six and twelve months, we conducted semi-structured interviews with patients and caregivers. Participants completed questionnaires on quality of life, disease burden, caregiver burden, grief, and positive aspects of caregiving. We analyzed quantitative data using descriptive statistics, while we used thematic analysis for qualitative data. Results: Ten patients and eight family caregivers participated, of whom five patients died during the study period. While the quantitative data reflected a moderate disease burden, the qualitative findings indicated a higher disease burden. Longitudinal results showed small differences and changes in time. Patients reported a diverse range of symptoms, such as fatigue, immobility, cognitive changes, and hallucinations, which had a tremendous impact on their lives. Nevertheless, they rated their overall quality of life as moderate to positive. Family caregivers gradually learned to cope with difficult situations such delirium, fluctuations in functioning and hallucinations. They had great expertise in caring for the person with PD but did not automatically share this with health care professionals. Patients sensed a lack of time to discuss their complex needs with clinicians. Furthermore, palliative care was rarely discussed, and none of these patients had been referred to specialist palliative care services. Conclusion: Patients with PD experienced many difficulties in daily living. Patients seems to adapt to living with PD as they rated their quality of life as moderate to positive. Family caregivers became experts in the care for their loved one, but often learned on their own. An early implementation of the palliative care approach can be beneficial in addressing the needs of patients with PD and their family caregivers.
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Affiliation(s)
- Herma Lennaerts-Kats
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
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9
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Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
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Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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10
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Rompen L, de Vries NM, Munneke M, Neff C, Sachs T, Cedrone S, Cheves J, Bloem BR. Introduction of Network-Based Healthcare at Kaiser Permanente. J Parkinsons Dis 2021; 10:207-212. [PMID: 31594246 PMCID: PMC7029370 DOI: 10.3233/jpd-191620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Early 2014, Kaiser Permanente decided to adopt an innovative model for network-based allied healthcare for persons with Parkinson’s disease (PD), based on the principles of the Dutch ParkinsonNet. Objective: We present the interventions that were performed to implement this method at Kaiser Permanente and we show the first outcomes based on these interventions. Methods: In this study, 57 physical therapists, 18 speech therapists and 20 occupational therapists, as well as 13 medical centers across the state of California were included. Nine interventions were performed more or less simultaneously, including training and education of healthcare providers and patients, a train the trainer curriculum, organizing IT, streamlining referral processes and building networks. Results: At the start, less than 30% of the patients within the Southern California Region received specialized allied health treatment (consisting of, i.e., gait training, voice training or guidance in activities of daily life). After one year, almost 55% of patients received specialized allied health treatment. In the second year, this number increased to just under 67%, suggesting a sustained concentration of care (the second core component of networked care). This can be seen as a first indicator for successful implementation of the ParkinsonNet network at Kaiser Permanente. Conclusions: The importance of these findings lies in the fact that a healthcare innovation that proved effective in one country can be transferred successfully to another country and to another healthcare system.
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Affiliation(s)
- Lonneke Rompen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Carolyn Neff
- Kaiser Permanente, Southern California Permanente Medical Group, CA, USA
| | - Todd Sachs
- Kaiser Permanente, Southern California Permanente Medical Group, CA, USA
| | - Steve Cedrone
- Kaiser Permanente, Southern California Permanente Medical Group, CA, USA
| | - Jason Cheves
- Kaiser Permanente, Southern California Permanente Medical Group, CA, USA
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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11
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van de Warrenburg BP, Tiemessen M, Munneke M, Bloem BR. The Architecture of Contemporary Care Networks for Rare Movement Disorders: Leveraging the ParkinsonNet Experience. Front Neurol 2021; 12:638853. [PMID: 33859608 PMCID: PMC8042326 DOI: 10.3389/fneur.2021.638853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
In this paper, we present a universal model for implementing network care for persons living with chronic diseases, specifically those with rare movement disorders. Building on our longstanding experience with ParkinsonNet, an integrated care network for persons living with Parkinson's disease or a form of atypical parkinsonism, we provide a series of generic, supportive building blocks to (re)design comparable care networks. We discuss the specific challenges related to rare movement disorders and how these challenges can inform a tailored implementation strategy, using the basic building blocks to offer practical guidance. Lastly, we identify three main priorities to facilitate network development for these rare diseases. These include the clustering of different types of rare movement disorders at the network level, the implementation of supportive technology, and the development of interdisciplinary guidelines.
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Affiliation(s)
- Bart P van de Warrenburg
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Mark Tiemessen
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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12
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Bloem BR, Eimers M, van Galen MS, Munneke M, Darweesh SKL. From trials to clinical practice: Temporal trends in the coverage of specialized allied health services for Parkinson's disease. Eur J Neurol 2020; 28:775-782. [PMID: 33141474 DOI: 10.1111/ene.14627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To determine how the coverage of specialized allied health services for patients with Parkinson's disease (PD) has developed in the Netherlands since the publication of trials that demonstrated cost-effectiveness. METHODS We used healthcare expenditure-based data on all insured individuals in the Netherlands to determine the annual proportion of patients with PD who received either specialized or generic allied health services (physiotherapy, occupational therapy, speech-language therapy) in 2 calendar years separated by a 5-year interval (2012 and 2017). Specialized allied health services were delivered through the ParkinsonNet approach, which encompassed professional training and concentration of care among specifically trained professionals. RESULTS Between 2012 and 2017, there was an increase in the number of patients with any physiotherapy (from 17,843 [62% of all patients with PD that year] to 22,282 [68%]), speech-language therapy (from 2171 [8%] to 3378 [10%]), and occupational therapy (from 2813 [10%] to 5939 [18%]). Among therapy-requiring patients, the percentage who were treated by a specialized therapist rose substantially for physiotherapy (from 36% in 2012 to 62% in 2017; χ2 = 2460.2; p < 0.001), speech-language therapy (from 59% to 85%; χ2 = 445.4; p < 0.001), and occupational therapy (from 61% to 77%; χ2 = 231.6; p < 0.001). By contrast, the number of patients with generic therapists did not change meaningfully. By 2017, specialized care delivery had extended to regions that had been poorly covered in 2012, essentially achieving nationwide coverage. CONCLUSIONS Following the publication of positive trials, specialized allied healthcare delivery was successfully scaled for patients with PD in the Netherlands, potentially serving as a template for other healthcare innovations for patients with PD elsewhere.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marietta Eimers
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Marten Munneke
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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13
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Bloem BR, Henderson EJ, Dorsey ER, Okun MS, Okubadejo N, Chan P, Andrejack J, Darweesh SKL, Munneke M. Patient-centred management of Parkinson's disease - Authors' reply. Lancet Neurol 2020; 19:889-890. [PMID: 33098792 PMCID: PMC7577709 DOI: 10.1016/s1474-4422(20)30360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Emily J Henderson
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Ray Dorsey
- Centre for Health and Technology, Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Piu Chan
- Department of Neurobiology, Neurology and Geriatrics, National Clinical Research Centre for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | - Sirwan K L Darweesh
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marten Munneke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands
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14
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Radder DLM, Nonnekes J, van Nimwegen M, Eggers C, Abbruzzese G, Alves G, Browner N, Chaudhuri KR, Ebersbach G, Ferreira JJ, Fleisher JE, Fletcher P, Frazzitta G, Giladi N, Guttman M, Iansek R, Khandhar S, Klucken J, Lafontaine AL, Marras C, Nutt J, Okun MS, Parashos SA, Munneke M, Bloem BR. Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease. J Parkinsons Dis 2020; 10:1087-1098. [PMID: 32444563 PMCID: PMC7415700 DOI: 10.3233/jpd-202078] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Optimal management in expert centers for Parkinson’s disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely. Objective: To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD. Methods: Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center’s multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed. Results: We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation. Conclusion: We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.
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Affiliation(s)
- Danique L M Radder
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Nijmegen, The Netherlands
| | - Marlies van Nimwegen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Alves
- The Norwegian Center for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Browner
- University of North Carolina, Movement Disorders Center, Chapel Hill, NC, USA
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation International Center of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Georg Ebersbach
- Movement Disorder Clinic Beelitz-Heilstaetten, Beelitz, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | | | | | | | - Nir Giladi
- Neurological Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Suketu Khandhar
- Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany.,Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill Movement Disorders Clinic, McGill University, Montreal, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Canada
| | - John Nutt
- Oregon & Health Science University Hospital, Portland, OR, USA
| | - Michael S Okun
- University of Florida Department of Neurology, Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
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15
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Lennaerts-Kats H, Ebenau A, Steppe M, van der Steen JT, Meinders MJ, Vissers K, Munneke M, Groot M, Bloem BR. "How Long Can I Carry On?" The Need for Palliative Care in Parkinson's Disease: A Qualitative Study from the Perspective of Bereaved Family Caregivers. J Parkinsons Dis 2020; 10:1631-1642. [PMID: 32651330 PMCID: PMC8764597 DOI: 10.3233/jpd-191884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Family caregivers provide the majority of care for people with Parkinson’s disease (PD) in the palliative care phase. For many this is a demanding experience, affecting their quality of life. Objective: We set out to map the experiences of bereaved family caregivers during the period of informal care in the palliative care phase as well as after the death of their loved one with PD. Methods: Ten bereaved family caregivers participated in this qualitative study. Semi-structured interviews were conducted and interpretative phenomenological analysis was used executed. Results: We identified four main themes. 1) Feeling like a professional caregiver: while caring for a person with PD, the family caregivers took over many roles and tasks of the person with PD. 2) Healthcare professionals do not always know what PD really means: most interviewees had negative experiences with knowledge and understanding of PD of, especially, (practice) nurses. 3) Being on your own: many respondents had felt highly responsible for their loved one’s care and lacked time and space for themselves. Grief and feelings of guilt were present during the caregiving period and after death. 4) Being behind the times: to provide palliative care in line with patients’ preferences and to feel prepared for the palliative care phase of PD, proactive palliative care planning was considered important. However, the interviewees told that this was most often not provided. Conclusion: These findings indicate that caring for a person with PD in the palliative care phase is a demanding experience for family caregivers. They experience psychological problems for many years before and after the death of the person with PD. Increasing healthcare professionals’ awareness of family and bereaved caregivers’ needs may mitigate these long-term detrimental effects.
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Affiliation(s)
- Herma Lennaerts-Kats
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.,Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Maxime Steppe
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Jenny T van der Steen
- Radboud University Medical Center (Radboudumc), Nijmegen, Department of Primary and Community Care, Nijmegen, The Netherlands; and Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center (Radboudumc), Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Kris Vissers
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Marieke Groot
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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16
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Proud E, Morris ME, Bilney B, Miller KJ, Nijkrake MJ, Munneke M, McGinley JL. Hand dexterity assessment in Parkinson's disease: construct validity of the 9-Hole peg test for the more affected hand. Disabil Rehabil 2020; 43:3834-3838. [PMID: 32343614 DOI: 10.1080/09638288.2020.1754474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There is limited understanding of the characteristics and evaluation of more affected hand dexterity loss in Parkinson's disease. We described 9-Hole Peg Test performance for the more affected hand and examined the construct validity of these pegboard scores in mild to severe Parkinson's disease. Methods: This observational study analysed baseline data from a cluster-randomised controlled trial.Participants (n = 582) completed the pegboard with their more affected hand, the Patient-Specific Index-Parkinson's Disease and Self-assessment Parkinson's Disease Disability Scale. Mean pegboard performance was summarised at each disease stage. To investigate known groups validity, we explored differences in pegboard scores between participants identifying upper limb problems in their 'top three' functional limitations, and those prioritising other limitations. Convergent validity investigated correlations between pegboard performance and self-reported hand function.Results: Pegboard performance was reduced compared with normative values, and problems with hand activities were reported at each disease stage. Significant differences in pegboard performance between the two functional limitation priority groups (p < 0.05), and moderate correlations between pegboard dexterity and hand function (Self-assessment Parkinson's Disease Disability Scale) provided evidence for construct validity.Conclusions: People with mild to severely disabling Parkinson's disease have reduced dexterity and problems with hand function. Evidence supported the construct validity of 9-Hole Peg Test more affected hand performance.IMPLICATIONS FOR REHABILITATIONPeople with mild to severely disabling PD experience dexterity loss and problems with hand function.It is important for clinicians to assess dexterity and hand function in people with this movement disorder.Evidence supports the construct validity of 9-Hole Peg Test for measuring more affected hand performance in Parkinson's disease.
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Affiliation(s)
- Elizabeth Proud
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Meg E Morris
- Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Healthscope Ltd, Melbourne, VIC, Australia
| | - Belinda Bilney
- School of Allied Health, Australian Catholic University-Ballarat Campus, Ballarat, VIC, Australia
| | - Kimberly J Miller
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Sunny Hill Health Centre for Children, Vancouver, BC, Canada
| | - Maarten J Nijkrake
- Cognition and Behaviour, Radboud University, Donders Institiute for Brain, Nijmegen, The Netherlands
| | - Marten Munneke
- Cognition and Behaviour, Radboud University, Donders Institiute for Brain, Nijmegen, The Netherlands
| | - Jennifer L McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
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17
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Radder DLM, Lennaerts HH, Vermeulen H, van Asseldonk T, Delnooz CCS, Hagen RH, Munneke M, Bloem BR, de Vries NM. The cost-effectiveness of specialized nursing interventions for people with Parkinson's disease: the NICE-PD study protocol for a randomized controlled clinical trial. Trials 2020; 21:88. [PMID: 31941538 PMCID: PMC6961317 DOI: 10.1186/s13063-019-3926-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Current guidelines recommend that every person with Parkinson’s disease (PD) should have access to Parkinson’s disease nurse specialist (PDNS) care. However, there is little scientific evidence of the cost-effectiveness of PDNS care. This hampers wider implementation, creates unequal access to care, and possibly leads to avoidable disability and costs. Therefore, we aim to study the (cost-)effectiveness of specialized nursing care provided by a PDNS compared with usual care (without PDNS) for people with PD in all disease stages. To gain more insight into the deployed interventions and their effects, a preplanned subgroup analysis will be performed on the basis of disease duration (diagnosis < 5, 5–10, or > 10 years ago). Methods We will perform an 18-month, single-blind, randomized controlled clinical trial in eight community hospitals in the Netherlands. A total of 240 people with PD who have not been treated by a PDNS over the past 2 years will be included, independent of disease severity or duration. In each hospital, 30 patients will randomly be allocated in a 1:1 ratio to receive either care by a PDNS (who works according to a recent guideline on PDNS care) or usual care. We will use two co-primary outcomes: quality of life (measured with the Parkinson’s Disease Questionnaire-39) and motor symptoms (measured with the Movement Disorders Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale part III). Secondary outcomes include nonmotor symptoms, health-related quality of life, experienced quality of care, self-management, medication adherence, caregiver burden, and coping skills. Data will be collected after 12 months and 18 months by a blinded researcher. A healthcare utilization and productivity loss questionnaire will be completed every 3 months. Discussion The results of this trial will have an immediate impact on the current care of people with PD. We hypothesize that by offering more patients access to PDNS care, quality of life will increase. We also expect healthcare costs to remain equal because increases in direct medical costs (funding additional nurses) will be offset by a reduced number of consultations with the general practitioner and neurologist. If these outcomes are reached, wide implementation of PDNS care will be warranted. Trial registration ClinicalTrials.gov, NCT03830190. Registered February 5, 2019 (retrospectively registered).
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Affiliation(s)
- Danique L M Radder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands.
| | - Herma H Lennaerts
- Department of Neurology, Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thies van Asseldonk
- Department of Neurology, Elisabeth-TweeSteden Center, Tilburg, The Netherlands
| | | | - Rob H Hagen
- Patient Expert at the Dutch Parkinson Association, Bunnik, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
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18
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Bloem BR, Ypinga JHL, Willis A, Canning CG, Barker RA, Munneke M, De Vries NM. Using Medical Claims Analyses to Understand Interventions for Parkinson Patients. J Parkinsons Dis 2019; 8:45-58. [PMID: 29254108 PMCID: PMC5836412 DOI: 10.3233/jpd-171277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson’s disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking “real world” analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Jan H L Ypinga
- Department Care Purchasing, CZ Groep, Goes, The Netherlands
| | - Allison Willis
- Departments of Neurology and of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, UK
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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19
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Vlaanderen FP, de Man Y, Krijthe JH, Tanke MAC, Groenewoud AS, Jeurissen PPT, Oertelt-Prigione S, Munneke M, Bloem BR, Meinders MJ. Sex-Specific Patient Journeys in Early Parkinson's Disease in the Netherlands. Front Neurol 2019; 10:794. [PMID: 31428033 PMCID: PMC6690007 DOI: 10.3389/fneur.2019.00794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To reconstruct a sex-specific patient journey for Dutch persons with Parkinson's disease (PD) during the first 5 years after diagnosis. Method: We analyzed a national administrative medical claims database containing data of all patients newly diagnosed with PD between 2012 and 2016 in the Netherlands. We performed time-to-event analysis to identify the moments when patients received care from neurologists, allied healthcare therapists or general practitioners. We also extracted relevant clinical milestones: unexpected hospitalization for PD, pneumonia, orthopedic injuries, nursing home admission, and death. Using these data, we constructed the patient journey stratified for sex. Results: We included claims data of 13,518 men and 8,775 women with newly diagnosed PD in the Netherlands. While we found little difference in neurologist consultations, women visited general practitioners and physiotherapists significantly earlier and more often (all p-values < 0.001). After 5 years, 37.9% (n = 3,326) of women had visited an occupational therapist and 18.5% (n = 1,623) a speech and language therapist at least once. This was 33.1% (n = 4,474) and 23.7% (n = 3,204) for men. Approximately 2 years after diagnosis, PD-related complications (pneumonia, orthopedic injuries, and PD-related hospitalization) occurred for the first time (women: 1.8 years; men: 2.3 years), and after 5 years, 72.9% (n = 6,397) of women, and 68.7% (n = 9,287) of men had experienced at least one. Discussion: Considering the strengths and limitations of our methods, our findings suggest that women experience complications and access most healthcare services sooner after diagnosis and more frequently than men. The identified sex differences extend the debate about phenotypical differences in PD between men and women.
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Affiliation(s)
- Floris Pieter Vlaanderen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
| | - Yvonne de Man
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
| | - Jesse H Krijthe
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - Marit A C Tanke
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
| | - A S Groenewoud
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
| | - Patrick P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
| | - Sabine Oertelt-Prigione
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands
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20
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Duits AA, Munneke M, Aalderink CJ, Kuijf ML, Bloem BR, Esselink RAJ. [Deep brain stimulation in Parkinson's disease: better balanced through consideration of the psychosocial consequences]. Ned Tijdschr Geneeskd 2019; 163:D3838. [PMID: 31386314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Deep Brain Stimulation (DBS) is an effective intervention for Parkinson's disease if drug therapy with dopaminergic medication has become insufficient. Current post-operative care focuses on optimizing the neurostimulator in combination with medication. We believe that the success rate of DBS surgery can be enhanced if more attention is paid to the (psychosocial) adjustment problems of patients and their families. Finding a new balance after surgery, in the relationship, family and work, is not easy and can be complicated by postoperative non-motor changes. Care for psychosocial adjustment may improve the quality of life and as such increase the overall outcome after surgery. We present two cases to illustrate these psychosocial adjustment problems. One case describes the impact of stimulation-related behavioural changes on relationships, while the other case describes difficulties in resuming work despite successful surgery. Psychosocial support appeared helpful for both cases to find their new balance in life.
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Affiliation(s)
- Annelien A Duits
- Maastricht Universitair Medisch Centrum (MUMC+), afd. Medische Psychologie, Maastricht
- Contact: A. Duits
| | - Marten Munneke
- Radboud Universitair Medisch Centrum, Donders Institutefor Brain, Cognition and Behaviour, afd. Neurologie, Nijmegen
| | | | - Mark L Kuijf
- Maastricht Universitair Medisch Centrum (MUMC+), afd. Neurologie, Maastricht
| | - Bastiaan R Bloem
- Radboud Universitair Medisch Centrum, Donders Institutefor Brain, Cognition and Behaviour, afd. Neurologie, Nijmegen
| | - Rianne A J Esselink
- Radboud Universitair Medisch Centrum, Donders Institutefor Brain, Cognition and Behaviour, afd. Neurologie, Nijmegen
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21
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Lennaerts H, Steppe M, Munneke M, Meinders MJ, van der Steen JT, Van den Brand M, van Amelsvoort D, Vissers K, Bloem BR, Groot M. Palliative care for persons with Parkinson's disease: a qualitative study on the experiences of health care professionals. BMC Palliat Care 2019; 18:53. [PMID: 31288821 PMCID: PMC6617627 DOI: 10.1186/s12904-019-0441-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
Background Parkinson’s disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals’ experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands. Methods This was a qualitative descriptive study. The data were collected from 10 individual in-depth interviews and three focus groups (n = 29) with health care professionals. Health care professionals were selected based on a positive answer to the question: “In the past 2 years, did you treat or support a person with PD who subsequently died?” The data were analyzed by thematic text analysis. Results Health care professionals supported the development of a palliative care system for PD but needed to better understand the essence of palliative care. In daily practice, they struggled to identify persons’ needs due to interfering PD-specific symptoms such as cognitive decline and communication deficits. Timely addressing the personal preferences for providing palliative care was identified as an important facilitator. Health care professionals acknowledged being aware of their lack of knowledge and of their little competence in managing complex PD. Findings indicate a perceived lack of care continuity, fragmentation of services, time pressure and information discontinuity. Conclusions Health care professionals experienced several facilitators and barriers to the provision of palliative care to people with PD. There is a need to improve the knowledge on complex PD and the continuity of information, as well as optimize coordination and deliver care based on a persons’ preferences. Additional training can help to become more knowledgeable and confident. Electronic supplementary material The online version of this article (10.1186/s12904-019-0441-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Herma Lennaerts
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands.
| | - Maxime Steppe
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Van den Brand
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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22
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Affiliation(s)
- Floris P. Vlaanderen
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Lonneke Rompen
- Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marije Stoffer
- Consultancy Group Process Improvement and Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marjan J. Faber
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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23
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Bloem BR, Rompen L, Vries NMD, Klink A, Munneke M, Jeurissen P. ParkinsonNet: A Low-Cost Health Care Innovation With A Systems Approach From The Netherlands. Health Aff (Millwood) 2018; 36:1987-1996. [PMID: 29137501 DOI: 10.1377/hlthaff.2017.0832] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ParkinsonNet, a low-cost innovation to optimize care for patients with Parkinson disease, was developed in 2004 as a network of physical therapists in several regions in the Netherlands. Since that time, the network has achieved full national reach, with 70 regional networks and around 3,000 specifically trained professionals from 12 disciplines. Key elements include the empowerment of professionals who are highly trained and specialized in Parkinson disease, the empowerment of patients by education and consultation, and the empowerment of integrated multidisciplinary teams to better address and manage the disease. Studies have found that the ParkinsonNet approach leads to outcomes that are at least as good as, if not better than, outcomes from usual care. One study found a 50 percent reduction in hip fractures and fewer inpatient admissions. Other studies suggest that ParkinsonNet leads to modest but important cost savings (at least US$439 per patient annually). These cost savings outweigh the costs of building and maintaining the network. Because of ParkinsonNet's success, the program has now spread to several other countries and serves as a model of a successful and scalable frugal innovation.
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Affiliation(s)
- Bas R Bloem
- Bas R. Bloem is a professor in the Department of Neurology, Radboud University Medical Centre, in Nijmegen, and medical director of ParkinsonNet, in the Netherlands
| | - Lonneke Rompen
- Lonneke Rompen is a policy adviser at the Department of Neurology, Radboud University Medical Centre
| | - Nienke M de Vries
- Nienke M. de Vries is a researcher in the Department of Neurology, Radboud University Medical Centre
| | - Ab Klink
- Ab Klink is on the Faculty of Social Sciences, Political Science, and Public Administration at Vrije Universiteit Amsterdam, in the Netherlands
| | - Marten Munneke
- Marten Munneke is an associate professor in the Department of Neurology and the Department of Rehabilitation and Allied Health, Radboud University Medical Centre
| | - Patrick Jeurissen
- Patrick Jeurissen ( ) is a professor in fiscal sustainable health care systems, Radboud University Medical School, and holds an affiliation with the Ministry of Health in the Netherlands
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24
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Lennaerts H, Groot M, Rood B, Gilissen K, Tulp H, van Wensen E, Munneke M, van Laar T, Bloem BR. A Guideline for Parkinson's Disease Nurse Specialists, with Recommendations for Clinical Practice. J Parkinsons Dis 2018; 7:749-754. [PMID: 28800338 DOI: 10.3233/jpd-171195] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Parkinson's Disease Nurse Specialists (PDNS) play an important role in the care for patients with Parkinson's disease (PD) and their caregivers. Until now, there were no nursing guidelines in PD, and interventions were based solely on daily clinical practice because there is no evidence to support the merits of nursing interventions. Consequently, there is little uniformity in current care delivery. OBJECTIVE Developing a guideline for PDNS. METHODS We developed a guideline based on a questionnaire among PDNS and a literature review, supplemented with expert opinion plus the input of patients and caregivers. The questionnaire was filled in by 97 PDNS and 51 generic nurses with knowledge of PD to identify barriers in PD nursing care. Subsequently, we did a systematic literature search and transformed these sources of information into practice recommendations, which were developed according to international standards for guideline development. RESULTS Based on the results of the questionnaire we identified seven specific core areas: defining the role of PDNS in terms of caseload, education, competences and care coordination; medication adherence; provision of information and education; coping; caregiver support; urogenital function and orthostatic hypotension. The systematic literature search identified 186 studies, of which 33 studies were finally analyzed. Furthermore, we developed practice recommendations based on good clinical practice for the following areas: self-care, mental functioning, mobility, nutrition, sexuality, work, sleep, palliative care and complementary (integrative) care. CONCLUSION This guideline provide ground to harmonize care delivery by PDNS in clinical practice, and offer a foundation for future research.
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Affiliation(s)
- Herma Lennaerts
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Berna Rood
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Koen Gilissen
- Department of Neurology, Medical centre Alkmaar, Alkmaar, The Netherlands
| | - Hella Tulp
- Department of Neurology, Elkerliek Hospital, Helmond, The Netherlands
| | - Erik van Wensen
- Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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25
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Ypinga JHL, de Vries NM, Boonen LHHM, Koolman X, Munneke M, Zwinderman AH, Bloem BR. Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: a retrospective analysis of medical claims data. Lancet Neurol 2017; 17:153-161. [PMID: 29246470 DOI: 10.1016/s1474-4422(17)30406-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parkinson's disease is a complex condition that is best managed by specialised professionals. Trials show that specialised allied health interventions are cost-effective, as compared with usual care. We aimed to study the long-term benefits of specialised physiotherapy using the ParkinsonNet approach in real-world practice. METHODS We did an observational study, retrospectively analysing a database of health insurance claims that included a representative population of Dutch patients with Parkinson's disease, who were followed for up to 3 years (Jan 1, 2013, to Dec 31, 2015). Eligibility criteria included having both a diagnosis of Parkinson's disease and having received physiotherapy for the disease. Allocation to specialised or usual care physiotherapy was based on the choices of patients and referring physicians. We used a mixed-effects model to compare health-care use and outcomes between patients treated by specialised or usual care physiotherapists. The primary outcome was the percentage of patients with a Parkinson's disease-related complication (ie, visit or admission to hospital because of fracture, other orthopaedic injuries, or pneumonia) adjusted for baseline variables. We compared physiotherapist caseload, the number of physiotherapy sessions, physiotherapy costs, and total health-care costs (including hospital care, but excluding community care, long-term care, and informal care) between the groups, and used a Cox's proportional hazard model for survival time to establish whether mortality was influenced by treatment by a specialised physiotherapist. FINDINGS We analysed 2129 patients (4649 observations) receiving specialised physiotherapy and 2252 patients (5353 observations) receiving usual care physiotherapy. Significantly fewer patients treated by a specialised physiotherapist had a Parkinson's disease-related complication (n=368 [17%]) than patients treated by a usual care physiotherapist (n=480 [21%]; odds ratio 0·67, 95% CI 0·56-0·81, p<0·0001). The annual caseload of patients per therapist was significantly higher for specialised physiotherapists (mean 3·89 patients per therapist [SD 3·91]) than usual care physiotherapists (1·48 [1·24]). Patients who saw specialised physiotherapists received fewer treatment sessions (mean 33·72 [SD 26·70]) than usual care physiotherapists (47·97 [32·11]). Consequently, expenditure was lower for specialised than usual care physiotherapists, both for direct costs (mean €933 [SD 843] vs €1329 [1021]; annual difference €395, 95% CI 358-432, p<0·0001) and total health-care expenditure (€2056 [3272] vs €2586 [3756]; €530, 391-669, p<0·0001). Mortality risk was lower for patients receiving specialised physiotherapy (134 [6%]) compared with patients receiving usual care physiotherapy (205 [9%], p=0·001) before correction for baseline variables, although Cox's survival model showed no significant difference between the two (hazard ratio 0·86, 95% CI 0·69-1·07, p=0·195). INTERPRETATION These results confirm the findings from controlled trials, and offer evidence that specialised physiotherapy as delivered through ParkinsonNet is associated with fewer Parkinson's disease-related complications and lower costs in real-world practice. Neurologists can facilitate specialised physiotherapy by specific referral to such experts. FUNDING None.
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Affiliation(s)
| | - Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lieke H H M Boonen
- Department Care Purchasing, CZ Group, Goes, Netherlands; Equalis, Den Haag, Netherlands
| | - Xander Koolman
- Department of Health Sciences, VU University, Amsterdam, Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
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Lennaerts H, Groot M, Steppe M, van der Steen JT, Van den Brand M, van Amelsvoort D, Vissers K, Munneke M, Bloem BR. Palliative care for patients with Parkinson's disease: study protocol for a mixed methods study. BMC Palliat Care 2017; 16:61. [PMID: 29178865 PMCID: PMC5702094 DOI: 10.1186/s12904-017-0248-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
Background Parkinson’s disease (PD) is a chronic, progressive neurological disorder with many intractable consequences for patients and their family caregivers. Little is known about the possibilities that palliative care could offer to patients and their proxies. Guidelines strongly recommend palliative care to improve the quality of life and – if needed – the quality of dying. However, providing palliative care to persons with PD involves specific challenges. For example, a timely initiation of palliative interventions is difficult because due to the gradually progressive nature of PD, there is often no clear marker for the transition from curative towards palliative care. Furthermore, there is little evidence to indicate which palliative care interventions are effective. Here, we describe the contours of a study that aims to examine the experiences of patients, (bereaved) family caregivers and professionals, with the aim of improving our knowledge about palliative care needs in PD. Methods/design We will perform a mixed methods study to evaluate the experiences of patients, (bereaved) family caregivers and palliative care professionals. In this study, we focus on Quality of Life, Quality of Care, perceived symptoms, caregiver burden and collaboration between professionals. In phase 1, we will retrospectively explore the views of bereaved family caregivers and professionals by conducting individual interviews and focus group interviews. In phase 2, 5–15 patients with PD and their family caregiver will be followed prospectively for 8–12 months. Data collection will involve semi-structured interviews and questionnaires at three consecutive contact moments. Qualitative data will be audio recorded, transcribed and analyzed using CAQDAS. If patients pass away during the study period, a bereavement interview will be done with the closest family caregiver. Discussion This study will offer a broad perspective on palliative care, and the results can be used to inform a palliative care protocol for patients with PD. By describing the experiences of patients, (bereaved) family caregivers and professionals with palliative care, this investigation will also establish an important ground for future intervention research.
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Affiliation(s)
- Herma Lennaerts
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands. .,Department of Neurology, Nijmegen, 6500 AB, The Netherlands. .,Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, 6500 AB, The Netherlands.
| | - Marieke Groot
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, 6500 AB, The Netherlands
| | - Maxime Steppe
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Neurology, Nijmegen, 6500 AB, The Netherlands.,Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, 6500 AB, The Netherlands
| | - Jenny T van der Steen
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Primary and Community Care, Nijmegen, 6500 AB, The Netherlands.,Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
| | - Marieke Van den Brand
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, 6500 AB, The Netherlands
| | | | - Kris Vissers
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, 6500 AB, The Netherlands
| | - Marten Munneke
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Neurology, Nijmegen, 6500 AB, The Netherlands
| | - Bastiaan R Bloem
- Radboud university medical center, Nijmegen, 6500 AB, The Netherlands.,Department of Neurology, Nijmegen, 6500 AB, The Netherlands
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van der Eijk M, Bloem BR, Nijhuis FAP, Koetsenruijter J, Vrijhoef HJM, Munneke M, Wensing M, Faber MJ. Multidisciplinary Collaboration in Professional Networks for PD A Mixed-Method Analysis. J Parkinsons Dis 2016; 5:937-45. [PMID: 26444096 DOI: 10.3233/jpd-150673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND ParkinsonNet, a nationwide organization with regionally oriented professional health networks in TheNetherlands, aims to improve the quality of Parkinson care. Facilitation of multidisciplinary collaboration is a key objective of ParkinsonNet. OBJECTIVES This study examined whether the concept enhances multidisciplinary collaboration between healthcare professionals involved in Parkinson care. METHODS A regional network involving 101 healthcare professionals was newly established. Participants received two questionnaires. One aimed at documenting direct working relationships ('connections') between professionals and the other aimed at evaluating multidisciplinary team performance. Additionally, thirteen healthcare professionals were interviewed to identify barriers and facilitators for multidisciplinary collaboration. 'Social network analysis' focused on sub-networks around three community hospitals at baseline and one year after the implementation. RESULTS The number of 'knowing each other' connections increased from 1431 to 2175 (52% , p < 0.001) and 'professional contact' connections increased from 664 to 891 (34% , p < 0.001). Large differences between sub-networks were found, positive changes being associated with a central role of neurologists and nurse specialists committed to multidisciplinary care. The perceived team performance did not change. Participants experienced problems with information exchange and interdisciplinary communication. Generally, participants were unaware of other healthcare professionals involved in individual patients and what treatments they provide simultaneously. CONCLUSIONS ParkinsonNet partially enhanced multidisciplinary collaboration between healthcare professionals involved in Parkinson care. Crucial facilitators of this were a central role of nurse specialists and the commitment to collaborate with and refer to expert therapists among neurologists. Additional measures are needed to further improve multidisciplinary care across different institutions and around individual patients.
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Affiliation(s)
- Martijn van der Eijk
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frouke A P Nijhuis
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Koetsenruijter
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus J M Vrijhoef
- Tilburg School of Social and Behavioral Sciences, Tranzo, Scientific center for care and welfare, The Netherlands.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Faber
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Van De Ven-Stevens L, Munneke M, Spauwen PH, Van Der Linde H. Assessment of Activities in Patients with Hand Injury: A Review of Instruments in Use. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175899830701200101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical impairments are not necessarily coupled with functional limitations. For this reason, it is important to assess not only body functions and structures, but also activities and/or participation to decide which intervention is indicated and to evaluate the effect of the intervention in a valid way. The purpose of this review was to examine available instruments for assessing the limitations in activity and their application within the clinical reasoning process in patients with hand injuries. A literature search identified instruments that met four selection criteria: quality of information, target population, percentage items related to hand function, and a focus on activities. The selected instruments were categorised according to three items: the specific components, the aspects of activity that could be assessed with it and how activity was assessed (questionnaire or otherwise). Seventy two instruments were identified, of which 23 met the selection criteria. These selected instruments showed important differences in the constructs they assessed and in the manner of assessment. Instruments to assess limitations of activity as a result of hand injury should be evaluated further in terms of reliability and validity, before their use within the clinical reasoning process can be standardised.
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Affiliation(s)
- Lucelle Van De Ven-Stevens
- Department of Occupational Therapy, Research Centre for Allied Health Care, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Marten Munneke
- Department of Neurology and Research Centre for Allied Health Care, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Paul Hm Spauwen
- Department of Plastic and Reconstructive Surgery, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Harmen Van Der Linde
- Department of Rehabilitation Medicine, Radboud University Nijmegen Medical Centre, The Netherlands
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Canoy M, Faber MJ, Munneke M, Oortwijn W, Nijkrake MJ, Bloem BR. Hidden Treasures and Secret Pitfalls: Application of the Capability Approach to ParkinsonNet. JPD 2015; 5:575-80. [DOI: 10.3233/jpd-150612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Marcel Canoy
- Erasmus School of Accounting and Assurance, Rotterdam, the Netherlands
| | - Marjan J. Faber
- Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marten Munneke
- Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Maarten J. Nijkrake
- Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
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van der Eijk M, Faber MJ, Post B, Okun MS, Schmidt P, Munneke M, Bloem BR. Capturing patients' experiences to change Parkinson's disease care delivery: a multicenter study. J Neurol 2015; 262:2528-38. [PMID: 26292793 PMCID: PMC4639577 DOI: 10.1007/s00415-015-7877-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 11/30/2022]
Abstract
Capturing patients’ perspectives has become an essential part of a quality of care assessment. The patient centeredness questionnaire for PD (PCQ-PD) has been validated in The Netherlands as an instrument to measure patients’ experiences. This study aims to assess the level of patient centeredness in North American Parkinson centers and to demonstrate the PCQ-PD’s potential as a quality improvement instrument. 20 Parkinson Centers of Excellence participated in a multicenter study. Each center asked 50 consecutive patients to complete the questionnaire. Data analyses included calculating case mix-adjusted scores for overall patient centeredness (scoring range 0–3), six subscales (0–3), and quality improvement (0–9). Each center received a feedback report on their performance. The PCQ-PD was completed by 972 PD patients (median 50 per center, range 37–58). Significant differences between centers were found for all subscales, except for emotional support (p < 0.05). The information subscale (mean 1.62 SD 0.62) and collaboration subscale (mean 2.03 SD 0.58) received the lowest experience ratings. 14 centers (88 %) who returned the evaluation survey claimed that patient experience scores could help to improve the quality of care. Nine centers (56 %) utilized the feedback to change specific elements of their care delivery process. PD patients are under-informed about critical care issues and experience a lack of collaboration between healthcare professionals. Feedback on patients’ experiences facilitated Parkinson centers to improve their delivery of care. These findings create a basis for collecting patients’ experiences in a repetitive fashion, intertwined with existing quality of care registries.
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Affiliation(s)
- Martijn van der Eijk
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marjan J Faber
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael S Okun
- McKnight Brain Institute, UF Health College of Medicine, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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31
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Sturkenboom IH, Hendriks JC, Graff MJ, Adang EM, Munneke M, Nijhuis-van der Sanden MW, Bloem BR. Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial. Mov Disord 2015; 30:1059-67. [DOI: 10.1002/mds.26217] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/29/2014] [Accepted: 02/23/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ingrid H.W.M. Sturkenboom
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
| | - Jan C.M. Hendriks
- Radboud university medical center, Department of Health Evidence; Nijmegen The Netherlands
| | - Maud J.L. Graff
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare; Nijmegen The Netherlands
| | - Eddy M.M. Adang
- Radboud university medical center, Department of Health Evidence; Nijmegen The Netherlands
| | - Marten Munneke
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Neurology; Nijmegen The Netherlands
| | - Maria W.G. Nijhuis-van der Sanden
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare; Nijmegen The Netherlands
| | - Bastiaan R. Bloem
- Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology; Nijmegen The Netherlands
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Canning CG, Allen NE, Bloem BR, Keus SHJ, Munneke M, Nieuwboer A, Sherrington C, Verheyden GSAF. Interventions for preventing falls in Parkinson's disease. Cochrane Database of Systematic Reviews 2015. [DOI: 10.1002/14651858.cd011574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colleen G Canning
- University of Sydney; Clinical and Rehabilitation Sciences Research Group - Faculty of Health Sciences; PO Box 170 Lidcombe NSW Australia 1825
| | - Natalie E Allen
- University of Sydney; Clinical and Rehabilitation Sciences Research Group - Faculty of Health Sciences; PO Box 170 Lidcombe NSW Australia 1825
| | - Bastiaan R Bloem
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Samyra HJ Keus
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Marten Munneke
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Alice Nieuwboer
- KU Leuven; Department of Rehabilitation Sciences; Tervuursevest 101, Postbus 1501 Leuven Belgium 3001
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, University of Sydney; Musculoskeletal Division; PO Box M201 Missenden Road Sydney NSW Australia 2050
| | - Geert SAF Verheyden
- KU Leuven; Department of Rehabilitation Sciences; Tervuursevest 101, Postbus 1501 Leuven Belgium 3001
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van der Kolk NM, Speelman AD, van Nimwegen M, Kessels RP, IntHout J, Hakobjan M, Munneke M, Bloem BR, van de Warrenburg BP. BDNF polymorphism associates with decline in set shifting in Parkinson's disease. Neurobiol Aging 2015; 36:1605.e1-6. [DOI: 10.1016/j.neurobiolaging.2014.08.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 12/17/2022]
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van der Kolk N, van Nimwegen M, Speelman A, Munneke M, Backx F, Donders R, Post B, Overeem S, Bloem B. A personalized coaching program increases outdoor activities and physical fitness in sedentary Parkinson patients; a post-hoc analysis of the ParkFit trial. Parkinsonism Relat Disord 2014; 20:1442-4. [DOI: 10.1016/j.parkreldis.2014.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/25/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
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Weerkamp N, Tissingh G, Poels P, Zuidema S, Munneke M, Koopmans R, Bloem B. Applause sign in advanced Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1268-9. [DOI: 10.1016/j.parkreldis.2014.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 11/17/2022]
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36
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Weerkamp NJ, Tissingh G, Poels PJE, Zuidema SU, Munneke M, Koopmans RTCM, Bloem BR. Diagnostic accuracy of Parkinson's disease and atypical parkinsonism in nursing homes. Parkinsonism Relat Disord 2014; 20:1157-60. [PMID: 25258327 DOI: 10.1016/j.parkreldis.2014.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/21/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents. METHODS Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism. RESULTS In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum. CONCLUSIONS In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis.
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Affiliation(s)
- N J Weerkamp
- Bronovo Hospital, Department of Neurology, The Hague, The Netherlands; Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - G Tissingh
- Bronovo Hospital, Department of Neurology, The Hague, The Netherlands
| | - P J E Poels
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - S U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, The Netherlands
| | - M Munneke
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands
| | - R T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, The Netherlands
| | - B R Bloem
- Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, The Netherlands.
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38
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Sturkenboom IHWM, Graff MJL, Hendriks JCM, Veenhuizen Y, Munneke M, Bloem BR, Nijhuis-van der Sanden MW. Efficacy of occupational therapy for patients with Parkinson's disease: a randomised controlled trial. Lancet Neurol 2014; 13:557-66. [PMID: 24726066 DOI: 10.1016/s1474-4422(14)70055-9] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is insufficient evidence to support use of occupational therapy interventions for patients with Parkinson's disease. We aimed to assess the efficacy of occupational therapy in improving daily activities of patients with Parkinson's disease. METHODS We did a multicentre, assessor-masked, randomised controlled clinical trial in ten hospitals in nine Dutch regional networks of specialised health-care professionals (ParkinsonNet), with assessment at 3 months and 6 months. Patients with Parkinson's disease with self-reported difficulties in daily activities were included, along with their primary caregivers. Patients were randomly assigned (2:1) to the intervention or control group by a computer-generated minimisation algorithm. The intervention consisted of 10 weeks of home-based occupational therapy according to national practice guidelines; control individuals received usual care with no occupational therapy. The primary outcome was self-perceived performance in daily activities at 3 months, assessed with the Canadian Occupational Performance Measure (score 1-10). Data were analysed using linear mixed models for repeated measures (intention-to-treat principle). Assessors monitored safety by asking patients about any unusual health events during the preceding 3 months. This trial is registered with ClinicalTrials.gov, NCT01336127. FINDINGS Between April 14, 2011, and Nov 2, 2012, 191 patients were randomly assigned to the intervention group (n=124) or the control group (n=67). 117 (94%) of 124 patients in the intervention group and 63 (94%) of 67 in the control group had a participating caregiver. At baseline, the median score on the Canadian Occupational Performance Measure was 4·3 (IQR 3·5-5·0) in the intervention group and 4·4 (3·8-5·0) in the control group. At 3 months, these scores were 5·8 (5·0-6·4) and 4·6 (4·6-6·6), respectively. The adjusted mean difference in score between groups at 3 months was in favour of the intervention group (1·2; 95% CI 0·8-1·6; p<0·0001). There were no adverse events associated with the study. INTERPRETATION Home-based, individualised occupational therapy led to an improvement in self-perceived performance in daily activities in patients with Parkinson's disease. Further work should identify which factors related to the patient, environmental context, or therapist might predict which patients are most likely to benefit from occupational therapy. FUNDING Prinses Beatrix Spierfonds and Parkinson Vereniging.
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Affiliation(s)
| | - Maud J L Graff
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan C M Hendriks
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvonne Veenhuizen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Maria W Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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van der Marck MA, Klok MP, Okun MS, Giladi N, Munneke M, Bloem BR. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism Relat Disord 2014; 20:360-9. [DOI: 10.1016/j.parkreldis.2013.10.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 09/13/2013] [Accepted: 10/02/2013] [Indexed: 11/27/2022]
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40
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Strouwen C, Molenaar EALM, Keus SHJ, Münks L, Munneke M, Vandenberghe W, Bloem BR, Nieuwboer A. Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson's disease: the DUALITY trial. BMC Neurol 2014; 14:61. [PMID: 24674594 PMCID: PMC3974198 DOI: 10.1186/1471-2377-14-61] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/24/2014] [Indexed: 02/02/2023] Open
Abstract
Background Multiple tasking is an integral part of daily mobility. Patients with Parkinson’s disease have dual tasking difficulties due to their combined motor and cognitive deficits. Two contrasting physiotherapy interventions have been proposed to alleviate dual tasking difficulties: either to discourage simultaneous execution of dual tasks (consecutive training); or to practice their concurrent use (integrated training). It is currently unclear which of these training methods should be adopted to achieve safe and consolidated dual task performance in daily life. Therefore, the proposed randomized controlled trial will compare the effects of integrated versus consecutive training of dual tasking (tested by combining walking with cognitive exercises). Methods and design Hundred and twenty patients with Parkinson’s disease will be recruited to participate in this multi-centered, single blind, randomized controlled trial. Patients in Hoehn & Yahr stage II-III, with or without freezing of gait, and who report dual task difficulties will be included. All patients will undergo a six-week control period without intervention after which they will be randomized to integrated or consecutive task practice. Training will consist of standardized walking and cognitive exercises delivered at home four times a week during six weeks. Treatment is guided by a physiotherapist twice a week and consists of two sessions of self-practice using an MP3 player. Blinded testers will assess patients before and after the control period, after the intervention period and after a 12-week follow-up period. The primary outcome measure is dual task gait velocity, i.e. walking combined with a novel untrained cognitive task to evaluate the consolidation of learning. Secondary outcomes include several single and dual task gait and cognitive measures, functional outcomes and a quality of life scale. Falling will be recorded as a possible adverse event using a weekly phone call for the entire study period. Discussion This randomized study will evaluate the effectiveness and safety of integrated versus consecutive task training in patients with Parkinson’s disease. The study will also highlight whether dual task gait training leads to robust motor learning effects, and whether these can be retained and carried-over to untrained dual tasks and functional mobility. Trial registration Clinicaltrials.gov NCT01375413.
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Affiliation(s)
| | | | | | | | | | | | | | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Faculty of Kinesiology and Rehabilitation, Tervuursevest 101 bus 1501, Leuven 3001, Belgium.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands
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Weerkamp NJ, Tissingh G, Poels PJE, Zuidema SU, Munneke M, Koopmans RTCM, Bloem BR. Parkinson disease in long term care facilities: a review of the literature. J Am Med Dir Assoc 2013; 15:90-4. [PMID: 24314699 DOI: 10.1016/j.jamda.2013.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/14/2013] [Accepted: 10/04/2013] [Indexed: 10/25/2022]
Abstract
Parkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities. Even fewer studies have addressed the treatment strategies used to support these institutionalized patients, who are mostly in advanced stages of the disease. The available evidence suggests that current management of patients with PD in LTC facilities is less than optimal. In the Netherlands, and we suspect in many other countries, there are no formal guidelines for treating patients with PD who have been admitted to a LTC facility. In this review, we describe the epidemiology, clinical characteristics, and clinical management of patients with PD in LTC settings. We also address potentially modifiable elements of care and provide several recommendations to improve the management of PD in these facilities. We conclude by suggesting a possible guide for future research in this area.
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Affiliation(s)
- Nico J Weerkamp
- Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands; Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gerrit Tissingh
- Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands
| | - Petra J E Poels
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Syste U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Ketelaar NABM, Munneke M, Bloem BR, Westert GP, Faber MJ. Recognition of physiotherapists' expertise in Parkinson's disease. BMC Health Serv Res 2013; 13:430. [PMID: 24152942 PMCID: PMC4016478 DOI: 10.1186/1472-6963-13-430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 10/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Publicly available information comparing performance across quality and costs has proliferated in recent years, both about individual healthcare professionals and hospitals. This type of information is now becoming increasingly available for physiotherapists with expertise in Parkinson's disease (PD). Our study aimed to explore the ability of people with Parkinson's disease to recognise expertise, and to what extent respondents selectively choose such expert physiotherapists. METHODS We used claim data from the period 2009-2010 to select customers with PD who claimed physiotherapy. A random sample of 500 eligible respondents received a paper-based survey. We used descriptive statistics to compare the respondent characteristics, a qualitative programme to analyse the qualitative items, and univariate and multivariate regression. RESULTS Most respondents (89%) took their referring physician's advice when selecting a physiotherapist, although this advice rarely was supported with arguments. The remaining respondents (11%) searched for comparative performance information about physiotherapists. Respondents who recognised the added value of PD expertise among physiotherapists were 3.28 times as likely to search for comparative performance information as those who did not understand. Respondents were willing to switch to an expert physiotherapist (68%), and this willingness increased if they recognised the value of PD expertise (p < .001). CONCLUSION The participants were able to recognise certain aspects of expertise. Though they showed relatively few signs of selectively choice behaviour for expert physiotherapists. Both respondents and referring professionals need more understanding about the added value of an expert physiotherapist, to foster selective provider choice.
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Affiliation(s)
- Nicole ABM Ketelaar
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, IQ healthcare 137, 6500 HB, Nijmegen, The Netherlands
| | - Marten Munneke
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, IQ healthcare 137, 6500 HB, Nijmegen, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert P Westert
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, IQ healthcare 137, 6500 HB, Nijmegen, The Netherlands
| | - Marjan J Faber
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, IQ healthcare 137, 6500 HB, Nijmegen, The Netherlands
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Weerkamp NJ, Tissingh G, Poels PJ, Zuidema SU, Munneke M, Koopmans RT, Bloem BR. Nonmotor Symptoms in Nursing Home Residents with Parkinson's Disease: Prevalence and Effect on Quality of Life. J Am Geriatr Soc 2013; 61:1714-21. [DOI: 10.1111/jgs.12458] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nico J. Weerkamp
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Gerrit Tissingh
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
| | - Petra J.E. Poels
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Systse U. Zuidema
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
| | - Marten Munneke
- Department of Neurology; Nijmegen Center for Evidence Based Practice; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care; Center for Family Medicine, Geriatric Care and Public Health; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology; Donders Institute for Brain, Cognition and Behavior; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
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van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, Bloem BR. Integrated multidisciplinary care in Parkinson's disease: a non-randomised, controlled trial (IMPACT). Lancet Neurol 2013; 12:947-56. [PMID: 23988337 DOI: 10.1016/s1474-4422(13)70196-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A multidisciplinary approach is thought to be the best way to manage the motor and non-motor symptoms of Parkinson's disease, but how such care should be delivered is unknown. To address this gap in knowledge, we assessed the effectiveness of an integrated multidisciplinary approach compared with usual care. METHODS We recruited patients for our non-randomised controlled trial from six community hospitals in the Netherlands (two in regions where the integrated care intervention was available and four in control regions that administered usual care). Eligible patients were those with Parkinson's disease, aged 20-80 years, and without severe cognitive impairment or comorbidity. Patients in the intervention group were offered an individually tailored comprehensive assessment in an expert tertiary referral centre and subsequent referrals to a regional network of allied health professionals specialised in Parkinson's disease. Primary outcomes were activities of daily living (Academic Medical Center linear disability score [ALDS]) and quality of life (Parkinson's disease quality of life questionnaire [PDQL]) measured at 4, 6, and 8 months. Secondary outcomes included motor functioning (unified Parkinson's disease rating scale, part III [UPDRS III], at 4 months), caregiver burden (belastungsfragebogen Parkinson angehörigen-kurzversion [BELA-A-k] at 4 and 8 months), and costs (during whole study period). Primary analysis was by intention to treat and included scores over 4, 6, and 8 months, with correction for baseline score. The trial is registered at Clinicaltrials.gov, number NCT00518791. FINDINGS We recruited 301 patients (150 patients in the intervention group and 151 in the control group) between August, 2007, and December, 2009, of whom 285 completed follow-up (last follow-up was July, 2010). 101 (67%) patients in the intervention group visited the expert centre; 49 (33%) opted not to visit the expert centre. The average ALDS score from months 4, 6, and 8, with correction for baseline score, was greater in the intervention group than in the control group (difference 1·3 points, 95% CI -2·1 to 2·8; corresponding raw logit score difference 0·1, 95% CI 0·003 to 0·2) as was the average PDQL score (difference 3·0 points, 0·4 to 5·6). Secondary analysis with correction for baseline disease severity showed no differences between groups for ALDS (difference 0·9 points, 95% CI -0·6 to 2·4; corresponding raw logit score difference 0·1, -0·02 to 0·3) or PDQL (difference 1·7 points, -1·2 to 4·6). Secondary outcomes did not differ between groups (UPDRS III score difference 0·6 points, 95% CI -1·4 to 2·6; BELA-A-k score difference 0·8 points, -0·2 to 1·8; cost difference €742, -€489 to €1950). INTERPRETATION This integrated care approach offered only small benefits to patients with Parkinson's disease, and these disappeared after correction for baseline disease severity. These results suggest that different approaches are needed to achieve more substantial health benefits. FUNDING NutsOhra Foundation, Stichting Parkinson Nederland, National Parkinson Foundation.
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Affiliation(s)
- Marjolein A van der Marck
- Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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van der Eijk M, Faber MJ, Aarts JWM, Kremer JAM, Munneke M, Bloem BR. Using online health communities to deliver patient-centered care to people with chronic conditions. J Med Internet Res 2013; 15:e115. [PMID: 23803284 PMCID: PMC3713879 DOI: 10.2196/jmir.2476] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 11/13/2022] Open
Abstract
Background Our health care system faces major threats as the number of people with multiple chronic conditions rises dramatically. Objective To study the use of Online Health Communities (OHCs) as a tool to facilitate high-quality and affordable health care for future generations. Methods OHCs are Internet-based platforms that unite either a group of patients, a group of professionals, or a mixture of both. Members interact using modern communication technologies such as blogs, chats, forums, and wikis. We illustrate the use of OHCs for ParkinsonNet, a professional network for Parkinson disease whose participants—both patients and professionals—use various types of OHCs to deliver patient-centered care. Results We discuss several potential applications in clinical practice. First, due to rapid advances in medical knowledge, many health professionals lack sufficient expertise to address the complex health care needs of chronic patients. OHCs can be used to share experiences, exchange knowledge, and increase disease-specific expertise. Second, current health care delivery is fragmented, as many patients acquire relationships with multiple professionals and institutions. OHCs can bridge geographical distances and enable interdisciplinary collaboration across institutions and traditional echelons. Third, chronic patients lack adequate tools to self-manage their disease. OHCs can be used to actively engage and empower patients in their health care process and to tailor care to their individual needs. Personal health communities of individual patients offer unique opportunities to store all medical information in one central place, while allowing transparent communication across all members of each patient’s health care team. Conclusions OHCs are a powerful tool to address some of the challenges chronic care faces today. OHCs help to facilitate communication among professionals and patients and support coordination of care across traditional echelons, which does not happen spontaneously in busy practice.
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Affiliation(s)
- Martijn van der Eijk
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology (935), Nijmegen, Netherlands
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Dontje ML, de Greef MHG, Speelman AD, van Nimwegen M, Krijnen WP, Stolk RP, Kamsma YPT, Bloem BR, Munneke M, van der Schans CP. Quantifying daily physical activity and determinants in sedentary patients with Parkinson's disease. Parkinsonism Relat Disord 2013; 19:878-82. [PMID: 23769178 DOI: 10.1016/j.parkreldis.2013.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/11/2013] [Accepted: 05/20/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although physical activity is beneficial for Parkinson's disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical activity in self-identified sedentary PD patients; (2) compare this with criteria of a daily physical activity guideline; and (3) identify determinants of daily physical activity. METHODS Daily physical activity of 586 self-identified sedentary PD patients was measured with a tri-axial accelerometer for seven consecutive days. Physical fitness and demographic, disease-specific, and psychological characteristics were assessed. Daily physical activity was compared with the 30-min activity guideline. A linear mixed-effects model was estimated to identify determinants of daily physical activity. RESULTS Accelerometer data of 467 patients who fulfilled all criteria revealed that >98% of their day was spent on sedentary to light-intensity activities. Eighty-two percent of the participants were 'physically inactive' (0 days/week of 30-min activity); 17% were 'semi-active' (1-4 days/week of 30-min activity). Age, gender, physical fitness, and scores on the Unified Parkinson's Disease Rating Scale explained 69% of the variability in daily physical activity. CONCLUSIONS Performance-based measurements confirmed that most self-identified sedentary PD patients are 'physically inactive'. However, the variance in daily physical activity across subjects was considerable. Higher age, being female, and lower physical capacity were the most important determinants of reduced daily physical activity. Future therapeutic interventions should aim to improve daily physical activity in these high-risk patients, focusing specifically on modifiable risk factors.
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Affiliation(s)
- M L Dontje
- Hanze University of Applied Sciences, Professorship in Health Care and Nursing, Groningen, The Netherlands.
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van Nimwegen M, Speelman AD, Overeem S, van de Warrenburg BP, Smulders K, Dontje ML, Borm GF, Backx FJG, Bloem BR, Munneke M. Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial. BMJ 2013; 346:f576. [PMID: 23457213 PMCID: PMC3585777 DOI: 10.1136/bmj.f576] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson's disease. DESIGN Multicentre randomised controlled trial. SETTING 32 community hospitals in the Netherlands, collaborating in a nationwide network (ParkinsonNet). PARTICIPANTS 586 sedentary patients with idiopathic Parkinson's disease aged between 40 and 75 years with mild to moderate disease severity (Hoehn and Yahr stage ≤ 3). INTERVENTION Patients were randomly assigned to the ParkFit programme or a matched general physiotherapy intervention. ParkFit is a multifaceted behavioural change programme, designed specifically to achieve an enduring increase in the level of physical activity (coaches using motivational strategies; ambulatory feedback). MAIN OUTCOME MEASURES The primary endpoint was the level of physical activity, measured every six months with a standardised seven day recall (LASA physical activity questionnaire-LAPAQ). Secondary endpoints included two other measures of physical activity (activity diary and ambulatory activity monitor), quality of life (Parkinson's disease questionnaire-PDQ-39), and fitness (six minute walk test). RESULTS 540 (92.2%) patients completed the primary outcome. During follow-up, overall time spent on physical activities (LAPAQ) was comparable between the groups (adjusted group difference 7%, 95% confidence interval -3 to 17%; P=0.19). Analyses of three secondary outcomes indicated increased physical activity in ParkFit patients, as suggested by the activity diary (difference 30%; P<0.001), the activity monitor (difference 12%; P<0.001), and the six minute walk test (difference 4.8 m; P=0.05). PDQ-39 did not differ between ParkFit patients and controls (difference -0.9 points; P=0.14). The number of fallers was comparable between ParkFit patients (184/299; 62%) and controls (191/287; 67%). CONCLUSIONS The ParkFit behavioural change programme did not increase overall physical activity, as measured with the LAPAQ. The analysis of the secondary endpoints justifies further work into the possible merits of behavioural change programmes to increase physical activities in daily life in Parkinson's disease. TRIAL REGISTRATION Clinical trials NCT00748488.
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Affiliation(s)
- Marlies van Nimwegen
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Nijmegen, Netherlands
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Abstract
BACKGROUND patients with Parkinson's disease (PD) have a high risk of sustaining osteoporotic fractures as a result of falls and reduced bone mass. OBJECTIVE to summarise the underlying pathophysiological mechanisms of bone loss in PD by reviewing the available literature. METHODS a Medline search was performed for articles published between January 1975 and January 2011, using the keywords 'bone mineral density', 'bone loss', 'bone metabolism', 'osteoporosis', 'osteopenia', 'Parkinson's disease' and 'Parkinsonism'. RESULTS PD patients have a lower bone mineral density (BMD) than age-matched controls. Bone loss in PD is multifactorial, resulting from immobility, decreased muscle strength, and low body weight. Vitamin D deficiency is also important, not only because it reduces BMD, but also because cell function in the substantia nigra depends on vitamin D. Lastly, hyperhomocysteinaemia, an independent risk factor for osteoporosis, is common in PD, due to levodopa use, as well as vitamin B12 and folic acid deficiency. A few studies have demonstrated that treatment with bisphosphonates, vitamin D and calcium can increase BMD and reduce fractures in PD patients. CONCLUSION bone loss in PD is multifactorial. It is clinically important because of the concomitant risk of fractures. Screening for osteoporosis should be considered more often, and therapeutic interventions should be initiated.
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Sturkenboom IHWM, Graff MJ, Borm GF, Adang EMM, Nijhuis-van der Sanden MWG, Bloem BR, Munneke M. Effectiveness of occupational therapy in Parkinson's disease: study protocol for a randomized controlled trial. Trials 2013; 14:34. [PMID: 23374761 PMCID: PMC3599260 DOI: 10.1186/1745-6215-14-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/11/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Occupational therapists may have an added value in the care of patients with Parkinson's disease whose daily functioning is compromised, as well as for their immediate caregivers. Evidence for this added value is inconclusive due to a lack of rigorous studies. The aim of this trial is to evaluate the (cost) effectiveness of occupational therapy in improving daily functioning of patients with Parkinson's disease. METHODS/DESIGN A multicenter, assessor-blinded, two-armed randomized controlled clinical trial will be conducted, with evaluations at three and six months. One hundred ninety-two home-dwelling patients with Parkinson's disease and with an occupational therapy indication will be assigned to the experimental group or to the control group (2:1). Patients and their caregivers in the experimental group will receive ten weeks of home-based occupational therapy according to recent Dutch guidelines. The intervention will be delivered by occupational therapists who have been specifically trained to treat patients according to these guidelines. Participants in the control group will not receive occupational therapy during the study period. The primary outcome for the patient is self-perceived daily functioning at three months, assessed with the Canadian Occupational Performance Measure. Secondary patient-related outcomes include: objective performance of daily activities, self-perceived satisfaction with performance in daily activities, participation, impact of fatigue, proactive coping skills, health-related quality of life, overall quality of life, health-related costs, and effectiveness at six months. All outcomes at the caregiver level will be secondary and will include self-perceived burden of care, objective burden of care, proactive coping skills, overall quality of life, and care-related costs. Effectiveness will be evaluated using a covariance analysis of the difference in outcome at three months. An economic evaluation from a societal perspective will be conducted, as well as a process evaluation. DISCUSSION This is the first large-scale trial specifically evaluating occupational therapy in Parkinson's disease. It is expected to generate important new information about the possible added value of occupational therapy on daily functioning of patients with Parkinson's disease. TRIAL REGISTRATION Clinicaltrials.gov: NCT01336127.
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Affiliation(s)
- Ingrid HWM Sturkenboom
- Nijmegen Centre of Evidence Based Practice, Department of Rehabilitation-Occupational Therapy (898), Radboud University Nijmegen Medical Centre, Reinier Postlaan 2, 6525GC, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Maud J Graff
- Nijmegen Centre of Evidence Based Practice, Department of Rehabilitation-Occupational Therapy (898), Radboud University Nijmegen Medical Centre, Reinier Postlaan 2, 6525GC, PO Box 9101, 6500HB, Nijmegen, The Netherlands
- Nijmegen Centre of Evidence Based Practice, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - George F Borm
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Eddy MM Adang
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maria WG Nijhuis-van der Sanden
- Nijmegen Centre of Evidence Based Practice, Department of Rehabilitation-Occupational Therapy (898), Radboud University Nijmegen Medical Centre, Reinier Postlaan 2, 6525GC, PO Box 9101, 6500HB, Nijmegen, The Netherlands
- Nijmegen Centre of Evidence Based Practice, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behavior; Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marten Munneke
- Nijmegen Centre of Evidence Based Practice, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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