Abstract
Parkinson’s disease Multimodal Complex Treatment (PD-MCT) is a multidisciplinary inpatient treatment approach that has been demonstrated to improve motor function and quality of life in patients with Parkinson’s disease (PD). In this study, we assessed the efficacy of PD-MCT and calculated predictors for improvement. We performed a prospective analysis in a non-randomized, open-label observational patient cohort. Study examinations were done at baseline (BL), at discharge after two-weeks of inpatient treatment (DC) and at a six-week follow-up examination (FU). Besides Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III as a primary outcome, motor performance was measured by the Timed Up-and-Go (TUG), the Berg Balance Scale (BBS) and the Perdue Pegboard Test (PPT). Until DC, motor performance improved significantly in several parameters and was largely maintained until FU (MDS-UPDRS III BL-to-DC: −4.7 ± 1.2 (SE) p = 0.0012, BL-to-FU: −6.1 ± 1.3 p = 0.0001; TUG BL-to-DC: −2.5 ± 0.9 p = 0.015, BL-to-FU: 2.4 ± 0.9 p = 0.027; BBS BL-to-DC: 2.4 ± 0.7 p = 0.003, BL-to-FU: 1.3 ± 0.7 p = 0.176, PPT BL-to-DC: 3.0 ± 0.5 p = 0.000004, BL-to-FU: 1.7 ± 0.7 p = 0.059). Overall, nontremor items were more therapy responsive than tremor items. Motor complications evaluated with MDS-UPDRS IV occurred significantly less frequent at DC (−1.8 ± 0.5 p = 0.002). Predictor analyses revealed an influence of initial motor impairment and disease severity on the treatment response in different motor aspects. In summary, we demonstrate a significant positive treatment effect of PD-MCT on motor function of PD patients which can be maintained in several parameters for an extended time period of six weeks and identify predictors for an improvement of motor function.
Highlights
Parkinson’s disease (PD) is the second-most common neurodegenerative disorder, which is neuropathologically characterized by dopaminergic dysfunction because of dopaminergic neuronal cell and axonal loss [1,2]
We present a prospective observational study to analyze the effects of the two-week inpatient multimodal complex treatment (PD-MCT) on motor symptoms and motor complications
Almost half of the patient population presented with postural instability (Hoehn and Yahr ≥ 3) or had motor complications as documented in the Movement Disorder Society (MDS)-UPDRS part IV (55.3%)
Summary
Parkinson’s disease (PD) is the second-most common neurodegenerative disorder, which is neuropathologically characterized by dopaminergic dysfunction because of dopaminergic neuronal cell and axonal loss [1,2]. Since there is still no curative treatment among the various therapeutic strategies available, PD remains a progressive disorder that leads to severe disability [1]. A higher self-reported physical activity is shown to be associated with less severe disease progression [7,8]. This is why an increased level of physical activity is recommended for this patient population and why it is claimed to have a disease modifying effect with attenuation of the progression in motor scores [9,10]. Positive effects on motor performance have been described after completion of intense physical treatment that can persist for several months [11]
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