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- Title
Objective measurement in routine care of people with Parkinson's disease improves outcomes.
- Authors
Farzanehfar, Parisa; Woodrow, Holly; Braybrook, Michelle; McGregor, Sarah; Evans, Andrew; Nicklason, Frank; Horne, Malcolm
- Abstract
It is common in medicine to titrate therapy according to target ranges of objectively measured parameters. Objective measurement of motor function is available for Parkinson's Disease (PD), making it possible to optimise therapy and clinical outcomes. In this study, an accelerometry based measurement and predefined target ranges were used to assess motor function in a Northern Tasmania PD cohort managed by a Movement Disorder clinic. Approximately 40% (n = 103) of the total PD population participated in this study and motor scores were within target in 22%. In the 78% above target, changes in oral therapy were recommended in 74%, Advanced Therapy in 12% and treatment was contraindicated in 9%. Following changes in oral therapy, there was a further objective measurement and clinical consultation to establish whether scores had reached target range: if so subjects left the study, otherwise further changes of therapy were recommended (unless contraindications were present). Seventy-seven cases completed the study, with 48% achieving target (including 22% at outset), Advanced Therapy recommended in 19% and contraindications preventing any change in therapy in 17%. In the 43% of cases in whom oral therapy was changed, total UPDRS improved significantly (effect size = 8) as did the PDQ39 in cases reaching target. NMS Quest and MOCA scores also improved significantly. This study shows that many people in a representative cohort of PD would benefit from objective assessment and treatment of their PD features against a target. Motor symptoms: benefits of treating to a target Measuring motor features of patients with Parkinson's disease (PD) against a target range can guide medication adjustments and improve disease management. An Australian study led by Malcolm Horne at The University of Melbourne used a movement recording system, the Parkinson's KinetiGraph (PKG), in 103 patients with PD to determine whether their bradykinesia and dyskinesia were within a predefined target range. They showed that adjustments to the oral medication of 14 patients whose PKG scores were outside the target range at the start of the study significantly improved their motor symptoms and brought them within the target range. These findings highlight how objective measurement of motor features can benefit a proportion of patients with PD and contribute to improve the current standard of care based on clinical judgement and patient history.
- Publication
NPJ Parkinson's Disease, 2018, Vol 4, Issue 1, pN.PAG
- ISSN
2373-8057
- Publication type
Article
- DOI
10.1038/s41531-018-0046-4