Hommel, ALAJ;
Meinders, MJ;
Weerkamp, NJ;
Richinger, C;
Schmotz, C;
Lorenzl, S;
Dodel, R;
... Schrag, A; + view all
(2020)
Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial.
Journal of Parkinson's Disease
, 10
(3)
pp. 1171-1184.
10.3233/JPD-202033.
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Abstract
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.
| Type: | Article |
|---|---|
| Title: | Optimizing Treatment in Undertreated Late-Stage Parkinsonism: A Pragmatic Randomized Trial |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3233/JPD-202033 |
| Publisher version: | https://doi.org/10.3233/JPD-202033 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Parkinsonian disorders, randomized controlled trial, treatment, activities of daily living, quality of life |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10112127 |
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