Effectiveness of multidisciplinary care for Parkinson's disease: A randomized, controlled trial
Effectiveness of multidisciplinary care for Parkinson's disease: A randomized, controlled trial
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DOI：
10.1002/mds.25194
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发表时间：
2013-04-01
影响因子：
8.6
通讯作者：
Guttman, Mark
中科院分区：
文献类型：
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作者：
van der Marck, Marjolein A.;Bloem, Bastiaan R.;Guttman, Mark
多学科护理被认为是治疗帕金森病 (PD) 的最佳模式，但支持证据有限。我们进行了一项随机对照试验 (RCT)，以确定与普通神经科医生的独立护理相比，多学科/专家团队是否能提供更好的结果。 PD 患者被随机分配到干预组（由运动障碍专家、PD 护士和社会工作者护理）或对照组（由普通神经科医生护理）。两次干预持续了8个月。临床医生和研究人员对分组分配不知情。主要结局是生活质量（帕金森病问卷；PDQ-39）从基线到 8 个月的变化。其他结果包括 UPDRS、抑郁症（蒙哥马利-阿斯伯格抑郁量表；MADRS）、心理社会功能（帕金森病结果量表 - 心理社会；SCOPA-PS）和看护者压力（看护者压力指数；CSI）。使用针对基线值和响应波动的存在进行调整的协方差分析来分析组差异。共有 122 名患者被随机分组，其中 100 名患者完成了研究（干预组，n = 51；对照组，n = 49）。与对照组相比，干预组的 PDQ-39（差异，3.4；95% 置信区间 [CI]：0.56.2）和 UPDRS 运动评分（4.1；95% CI：0.87.3）显着改善。 UPDRS 总分（5.6；95% CI：0.910.3）、MADRS（3.7；95% CI：1.45.9）和 SCOPA-PS（2.1；95% CI：0.53.7）也显着改善。该随机对照试验证实了多学科/专家团队的方法。由于研究设计的局限性，我们谨慎地解释这些积极的发现。需要进一步的研究来评估涉及其他学科的团队并评估综合方法的成本效益。 (c) 2012 年运动障碍协会
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]: 0.56.2) and UPDRS motor scores (4.1; 95% CI: 0.87.3). UPDRS total score (5.6; 95% CI: 0.910.3), MADRS (3.7; 95% CI: 1.45.9), and SCOPA-PS (2.1; 95% CI: 0.53.7) 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. (c) 2012 Movement Disorder Society