MANAGE-PD: A clinician-reported tool to identify patients with Parkinson's disease inadequately controlled on oral medications – results from vignette-based validation

Abstract

To evaluate the reliability and validity of MANAGE-PD tool. Timely identification of advancing symptoms of people living with Parkinson’s Disease for clinical practice improvement. MANAGE-PD is a simple clinician-reported screening tool developed to address this practice gap. Through timely evaluation of PD symptoms. Hypothetical vignettes (n = 10) were developed to represent a wide spectrum of disease severity. this tool was conducted via a web-based survey of selected panelists. Steering Committee classified each vignette into 3 categories: adequately controlled on oral therapy; inadequately controlled on oral therapy and recommend oral optimization only; inadequately controlled on oral therapy and recommend evaluation for device-aided therapies along with oral optimization. Each panelist evaluated one anchor vignette and four randomly assigned vignettes using the MANAGE-PD tool. Concordance between clinical judgment for management of patient versus MANAGE-PD recommendation was assessed. The panel included MDS (n = 19) from 15 countries, with extensive experience in treating PD [Mean: 24.4 ± 7.6 years; Mean patients treated/month: 73.2 ± 45.4]. In open-ended feedback, panelists reported no issues with usage of the tool. The determination of inadequate symptom control and possible eligibility of device-aided therapies was made based on frequency and severity of motor symptoms, non-motor symptoms and functional limitations. A high concordance between clinical judgement and MANAGE-PD recommendation was observed (Intra-class co-efficient: 0.82; weighted kappa statistic:0.71; unweighted kappa statistic:0.78; concordance for the categories ranged from 82.35 to 88.24%). MANAGE-PD demonstrated high reliability and validity. Future steps include validation with a large global survey of general neurologists and optimizing scoring algorithm based on patient-level data.