Patient-centered integrated healthcare improves quality of life in Parkinson’s disease patients: a randomized controlled trial
Improving quality of life (QoL) is a key issue when dealing with Parkinson’s disease (PD). Integrative care shows potential to achieve improvements in QoL. Here, we analyzed whether a community-based, open-label, integrated approach improves QoL in PD patients.
PD patients were screened for eligibility and evaluated by a university-based PD specialist, a PD nurse, and a general neurologist at a local practice. Patients were randomly assigned to a control group (CG), receiving standard German neurological treatment including a baseline assessment and follow-up visit at 6 months, or an interventional group (IG) who received an individually tailored therapy plan and additional home visits. Patients and investigators were not blinded for either intervention. Primary outcome analysis compared the differential change of PDQ-39 from baseline to 6-month follow-up between CG and IG. Between-group changes in mood, motor/non-motor functioning, and cognition were secondary outcomes.
300 patients were included and randomized equally to IG and CG. 132 IG and 125 CG patients had a valid PDQ-39 at follow-up and qualified for the modified ITT analysis. PDQ-39 improved more in IG compared to CG [2.2 points (95% CI − 4.4 to 0.1); p = 0.044]. Likewise, change scores between IG and CG favored IG for UPDRS III (p < 0.001, mean change 3.3, 95% CI − 4.9 to − 1.7) and PD-NMS (p < 0.001, mean change 11.3, 95% CI − 17.1 to − 5.5).
Data show that an integrated approach, compared to regular PD care, improves QoL as well as motor and nonmotor PD symptoms over 6 months. Future studies need to address the cost–benefit ratio and whether positive effects can be maintained beyond intervention.
KeywordsParkinson Integrated care Multidisciplinary Allied health Quality of life
The authors thank Dr. Christopher G. Goetz for helpful presubmission advice and comments. This study was supported by Abbott Pharma GmbH, Archimedes GmbH, Bayer Vital GmbH, Medtronic GmbH, Teva Pharma GmbH, UCB Pharma GmbH, and Zur Rose Pharma GmbH. Funding was transferred to the University Hospital Cologne, so that no direct sponsoring of any of the participating team members occurred. The sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the report. CE and LT had full access to all the data of the study and take final responsibility for the decision to submit this manuscript for publication.
The CPN study group
The CPN study group included the following community neurologists:
Susanne Adams, MD; Karl Assmann, MD; Angela Böhme, MD; Eckhard Bonmann, MD; Gisela Buchberger, MD; Birgit Cremer, MD; Christian Dortmann, MD; Johannes Faulhaber, MD; Marius Fischer, MD; Mehran Ghaemi, MD; Martin Hettmann, MD; Christine Hofmann, MD; Sabine Kersting, MD; Gereon Nelles, MD; Wei-Chi Liu, MD; Rainer Maelger, MD; Kyra Merzbach, MD; Oliver Scharwat, MD; Joachim Schläfer, MD; Christian Schmiegelt, MD; Dirk Schulze Zumloh, MD; Annette Semmroth, MD; David Svoboda, MD; Hans-Hermann Winter, MD; Sonja Wirtz, MD; Gilbert Wunderlich, MD.
CE: literature search, figures, study design, data collection, data analysis, data interpretation, and writing. RD: data collection and data analysis. JS: figures, data collection, data analysis, data interpretation, and review of the manuscript. GRF: data interpretation and review of the manuscript. MH: data analysis and data interpretation. LT: study design, data analysis, data interpretation, writing, and review of the manuscript.
Compliance with ethical standards
Conflicts of interest
C. Eggers has received honoraria for speaking engagements and consultancy from Abbvie Pharma, Bial Pharma, Medtronic, Zambon Pharma, TEVA Pharma, GE Healthcare, and UCB Pharma. The institution of C. Eggers, not C. Eggers himself, received funding by the German Research Foundation (DFG) via the Clinical Research Group 219, the medical faculty of the University of Cologne via the “Köln Fortune program”, Medtronic Inc. and the German Parkinson Foundation (Deutsche Parkinson Vereinigung). R. Dano has no conflicts of interest. J. Schill has no conflicts of interest. G.R. Fink receives royalties from the publication of the book Funktionelle MRT in Psychiatrie und Neurologie and Neurologische Differentialdiagnose; received honoraria for speaking engagements from Bayer, TEVA, GlaxoSmithKline, and Boehringer Ingelheim; and receives research support from the Bundesministerium für Bildung und Forschung, the Deutsche Forschungsgemeinschaft and the Marga- and Walter-Boll Foundation. M. Hellmich has no conflicts of interest. L. Timmermann is consultant for Medtronic Inc, Boston Scientific, Bayer Healthcare, UCB Schwarz Pharma, received honoraria in symposia sponsored by TEVA Pharma, Lundbeck Pharma, Bracco, Gianni PR, Medas Pharma, UCB Schwarz Pharma, Desitin Pharma, Boehringer Ingelheim, GlaxoSmithKline, Eumecom, Orion Pharma, Medtronic, Boston Scientific, Cephalon, Abbott, and GE Medical. The institution of Prof. Timmermann, not Prof. Timmermann himself, received funding by the German Research Foundation (DFG) via the Clinical Research Group 219, the German Ministry of Education and Research (BMBF), Manfred und Ursula Müller Stiftung, Klüh Stiftung, Hoffnungsbaum e. V., NBIA DISORDERS SOCIETY USA, the medical faculty of the University of Cologne via the “Köln Fortune program”, Medtronic Inc. and the German Parkinson Foundation (Deutsche Parkinson Vereinigung).
The study was approved by the local ethics committee of the medical faculty of the University of Cologne (No. 11-233).
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