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Effectiveness of multidisciplinary care for Parkinson's disease: A randomized, controlled trial

Authors

  • Marjolein A. van der Marck MSc,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands
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  • Bastiaan R. Bloem MD, PhD,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands
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  • George F. Borm PhD,

    1. Radboud University Nijmegen Medical Centre, Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands
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  • Sebastiaan Overeem MD, PhD,

    1. Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands
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  • Marten Munneke PhD,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands
    2. Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
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  • Mark Guttman MD, FRCPC

    Corresponding author
    1. University of Toronto, Division of Neurology, Department of Medicine, Toronto, Ontario, Canada
    • Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands
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  • Funding agencies: This study was financially supported by funding from the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, and the National Parkinson Foundation (NPF). The funding sources had no role in the design, data collection, analysis, interpretation of data, writing of the report or the decision to submit the article. M.A.v.d.M. is sponsored by the NutsOhra Foundation, Stichting Porticus, and the National Parkinson Foundation. S.O. was supported by a VIDI research grant (grant no.: 016.116.371) from the Netherlands Organisation for Scientific Research.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

Correspondence to: Dr. Mark Guttman, Division of Neurology, Department of Medicine, University of Toronto, 2780 Bur Oak Avenue, Markham, Ontario L6B 1C9, Canada; mguttman@movementdisorders.ca

Abstract

Multidisciplinary care is considered an optimal model to manage Parkinson's disease (PD), but supporting evidence is limited. We performed a randomized, controlled trial (RCT) to establish whether a multidisciplinary/specialist team offers better outcomes, compared to stand-alone care from a general neurologist. Patients with PD were randomly allocated to an intervention group (care from a movement disorders specialist, PD nurses, and social worker) or a control group (care from general neurologists). Both interventions lasted 8 months. Clinicians and researchers were blinded for group allocation. The primary outcome was the change in quality of life (Parkinson's Disease Questionnaire; PDQ-39) from baseline to 8 months. Other outcomes were the UPDRS, depression (Montgomery-Asberg Depression Scale; MADRS), psychosocial functioning (Scales for Outcomes in Parkinson's disease-Psychosocial; SCOPA-PS), and caregiver strain (Caregiver Strain Index; CSI). Group differences were analyzed using analysis of covariance adjusted for baseline values and presence of response fluctuations. A total of 122 patients were randomized and 100 completed the study (intervention, n = 51; control, n = 49). Compared to controls, the intervention group improved significantly on PDQ-39 (difference, 3.4; 95% confidence interval [CI]: 0.5–6.2) and UPDRS motor scores (4.1; 95% CI: 0.8–7.3). UPDRS total score (5.6; 95% CI: 0.9–10.3), MADRS (3.7; 95% CI: 1.4–5.9), and SCOPA-PS (2.1; 95% CI: 0.5–3.7) also improved significantly. This RCT gives credence to a multidisciplinary/specialist team approach. We interpret these positive findings cautiously because of the limitations in study design. Further research is required to assess teams involving additional disciplines and to evaluate cost-effectiveness of integrated approaches. © 2012 Movement Disorder Society

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