A randomized controlled trial demonstrates improved outcomes if patients with Parkinson's disease (PD) are cared for by a multidisciplinary team.
Researchers compared quality of life and motor functioning in patients cared for by a general neurologist and those cared for by a multidisciplinary team comprising a movement disorders specialist, PD nurses, and a social worker.
"Because the multidisciplinary team included a movement disorders specialist, we cannot be certain whether the group difference in outcome was the result of the 'team' aspect or the 'specialist' aspect of the intervention," say study author Mark Guttman (University of Toronto, Ontario, Canada) and co-workers.
They suggest that the next step should be to compare outcomes for patients treated by a general neurologist with and without a team. "Studying a movement disorders specialist plus a team versus a movement disorders specialist risks the possibility of a ceiling effect," they note, also observing that movement disorder specialists are often in short supply and may be best reserved for the most challenging cases.
During the 8 months of the intervention, quality of life on the Parkinson's Disease Questionnaire (PDQ-39) worsened slightly among the 49 patients receiving usual care from a neurologist, by an average of 1.4 points. By contrast, scores improved by 2.5 points among the 51 patients assigned to multidisciplinary care, creating a significant 3.4-point difference between the groups.
"Such an improvement will be clinically meaningful to patients," the researchers write in Movement Disorders.
The patients were unavoidably aware of their group allocation, but were asked not to reveal it to any clinician, and the researchers who assessed the patients were not aware of which group they were in.
Multidisciplinary care was associated with significant improvements in the PDQ-39 subscales assessing mobility, activities of daily living, and emotional wellbeing, but not in those measuring stigma, social support, cognition, communication, and bodily discomfort.
The secondary outcome of change on the Unified Parkinson's Disease Rating Scale was also significantly influenced by group allocation, with patients in the multidisciplinary care group having a 2.7-point improvement compared with a 1.6-point deterioration in the control group.
"This improvement falls within the range of effect sizes reported in several clinical trials of dopaminergic medication," say Guttman et al. "Although direct comparisons with drug trials are difficult, the observed change in motor functioning appears clinically relevant for patients."
Tertiary outcomes covering depression and psychosocial functioning were also improved in patients assigned to multidisciplinary rather than usual care.
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