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Optimizing Treatmen...
Optimizing Treatment in Undertreated Late-Stage Parkinsonism : A Pragmatic Randomized Trial
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- Hommel, Adrianus L.A.J. (author)
- Radboud University Medical Center
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- Meinders, Marjan J. (author)
- Radboud University Medical Center
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- Weerkamp, Nico J. (author)
- HMC Bronovo
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- Richinger, Carmen (author)
- University Hospital Munich,Paracelsus Private Medical University of Salzburg
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- Schmotz, Christian (author)
- Paracelsus Private Medical University of Salzburg,University Hospital Munich
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- Lorenzl, Stefan (author)
- University Hospital Munich,Paracelsus Private Medical University of Salzburg
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- Dodel, Richard (author)
- University Hospital Essen
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- Coelho, Miguel (author)
- University of Lisbon
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- Ferreira, Joaquim J. (author)
- University of Lisbon
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- Tison, Francois (author)
- University of Bordeaux,Centre Hospitalier Universitaire de Bordeaux
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- Boraud, Thomas (author)
- Centre Hospitalier Universitaire de Bordeaux,University of Bordeaux
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- Meissner, Wassilios G. (author)
- University of Otago,University of Bordeaux,New Zealand Brain Research Institute,Centre Hospitalier Universitaire de Bordeaux
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- Rosqvist, Kristina (author)
- Lund University,Lunds universitet,Restorative Parkinson Unit,Forskargrupper vid Lunds universitet,Lund University Research Groups
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- Timpka, Jonathan (author)
- Lund University,Lunds universitet,Restorative Parkinson Unit,Forskargrupper vid Lunds universitet,Lund University Research Groups
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- Odin, Per (author)
- Lund University,Lunds universitet,Restorative Parkinson Unit,Forskargrupper vid Lunds universitet,Lund University Research Groups
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- Wittenberg, Michael (author)
- Philipp University of Marburg
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- Bloem, Bas R. (author)
- Radboud University Medical Center
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- Koopmans, Raymond T. (author)
- Radboud University Medical Center
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- Schragand, Anette (author)
- University College London
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(creator_code:org_t)
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- 2020
- 2020
- English 14 s.
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In: Journal of Parkinson's Disease. - 1877-7171. ; 10:3, s. 1171-1184
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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Abstract
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- Background: Treatment of patients with late-stage parkinsonism is often sub-optimal. Objective: To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. Methods: Ninety-one patients with late-stage parkinsonism considered undertreated were included in apragmatic a pragmatic multi-center randomized-controlled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS)part-II (Activities of Daily Living). Other outcomes included quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted. Results: Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations fully in 16 (28%) and partially in 21 (36%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference=-1.2, p=0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference=-3.7, p=0.02). The per-protocol analysis confirmed these findings, and showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. Conclusions: The findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize that specialist recommendations need to be accompanied by better strategies to implement these to further improve outcomes.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Keyword
- activities of daily living
- Parkinsonian disorders
- quality of life
- randomized controlled trial
- treatment
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Hommel, Adrianus ...
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Meinders, Marjan ...
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Weerkamp, Nico J ...
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Richinger, Carme ...
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Schmotz, Christi ...
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Lorenzl, Stefan
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Dodel, Richard
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Coelho, Miguel
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Ferreira, Joaqui ...
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Tison, Francois
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Boraud, Thomas
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Meissner, Wassil ...
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Rosqvist, Kristi ...
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Timpka, Jonathan
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Odin, Per
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Wittenberg, Mich ...
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Bloem, Bas R.
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Koopmans, Raymon ...
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Schragand, Anett ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
- Articles in the publication
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Journal of Parki ...
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Lund University