Efficiency of Physiotherapeutic Care in Parkinson's Disease
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Interventional
Phase: Phase 3

Summary: 
      In the course of their disease, most patients with Parkinson's Disease (PD) face mounting
      mobility deficits, including difficulties with walking, balance, posture and transfers. This
      frequently leads to (fear of) falls, injuries, loss of independence, and inactivity which
      causes social isolation and increases the risk of osteoporosis or cardiovascular disease.
      These mobility deficits are difficult to treat with drugs and neurosurgery. However,
      physiotherapy is deemed effective in improving mobility deficits in PD. Physiotherapy is
      widely prescribed for this purpose in the Netherlands. Yet, the efficiency of current "usual
      care" physiotherapy can be questioned, for two reasons. First, the referral process seems
      inadequate because patients are mainly referred by neurologists who often lack insight into
      the (im-)possibilities of physiotherapy for PD. Consequently, patients with a real need for
      physiotherapy are not always referred (undertreatment), whereas others without a real need
      are (overtreatment). Furthermore, most therapists treating PD patients are not specifically
      trained in treating these patients. This is not surprising because average therapists rarely
      treat more than two patients per year in their practice. Therefore, patients who are being
      referred probably receive suboptimal treatment.

      The objective of this study is to evaluate whether the efficiency of physiotherapeutic care
      for patients with Parkinson's disease can be improved, at a reduced cost, by targeting two
      key elements of the current care system: a) inadequate referral by neurologists; b)
      suboptimal treatment by physiotherapists. We expect that optimal referral combined with
      expert treatment will increase the efficiency, as reflected by increased health benefits for
      patients at equal or reduced costs'.
    

Detailed description: 
      Design In a Cluster Randomised Trial, 16 clusters will be randomly allocated to either
      network care (8 clusters with an altered organisation of physiotherapeutic care) or usual
      care (8 clusters with unchanged organisation of physiotherapeutic care). Clusters are formed
      by all PD patients living in the communities connected to participating regional hospitals in
      the 16 clusters.

      The health care intervention in the experimental group has two elements: (a) an improved
      quality of referrals by neurologists; and (b) an improved quality of interventions by
      physiotherapists. Brief description Network Care: In each of the Network Care clusters, 5 to
      7 motivated therapists are selected to enroll in a regional ParkNet and consequently trained.
      Training is focused at correct use of the evidence-based guidelines for physiotherapy in PD
      (Keus et al, 2006). This training consists of a 5-day competence-oriented course, web-based
      continues education supported by seminars, and use of a PD specific electronic patient
      record. Neurologists are informed about indications for referral to physiotherapy. Improved
      communication between neurologist and ParkNet therapists is initiated and supported.

      Following implementation of the health care change, PD patients attending the neurological
      outpatient clinics of the individual hospitals within the clusters will be asked to
      participate. During a period of 6 months, PD patients will enrol in the study. Enrollees will
      be followed for 6 months to measure the use and quality of physiotherapy, patient health
      benefit and satisfaction, and costs.
    

Intervention name(s): ParkNet; Usual Care
Intervention type(s): Other; Other
Intervention description(s): Development of a network of dedicated physiotherapist with specific expertise in Parkinson's Disease and structured referrals to these ParkNet therapists by neurologists.; No altered organisation of physiotherapy care in Parkinson's Disease
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Physical Therapy; Organisation of care