Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial

Adrianus L.A.J. Hommel, Marjan J. Meinders, Nico J. Weerkamp, Carmen Richinger, Christian Schmotz, Stefan Lorenzl, Richard Dodel, Miguel Coelho, Joaquim J. Ferreira, Francois Tison, Thomas Boraud, Wassilios G. Meissner, Kristina Rosqvist, Jonathan Timpka, Per Odin, Michael Wittenberg, Bas R. Bloem, Raymond T. Koopmans, Anette Schragand, Care of Late Stage Parkinsonism (CLaSP) Consortium

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review

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Sammanfattning

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.

Originalspråkengelska
Sidor (från-till)1171-1184
Antal sidor14
TidskriftJournal of Parkinson's Disease
Volym10
Utgåva3
DOI
StatusPublished - 2020

Ämnesklassifikation (UKÄ)

  • Neurologi

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