Activities of Daily Living Are Improved by Inpatient Multimodal Complex Treatment for PD-a Real-World Cohort Study

Kerstin Ziegler; Michael Messner; Mario Paulig; Klaus Starrost; Bernd Reuschenbach; Urban M Fietzek; Andres O Ceballos-Baumann

doi:10.1002/mdc3.13578

Activities of Daily Living Are Improved by Inpatient Multimodal Complex Treatment for PD-a Real-World Cohort Study

Mov Disord Clin Pract. 2022 Dec 7;10(1):42-54. doi: 10.1002/mdc3.13578. eCollection 2023 Jan.

Authors

Kerstin Ziegler^{1

2}, Michael Messner¹, Mario Paulig¹, Klaus Starrost¹, Bernd Reuschenbach², Urban M Fietzek^{1

3}, Andres O Ceballos-Baumann^{1

4}

Affiliations

¹ Department of Neurology and Clinical Neurophysiology Schön Klinik München Schwabing Munich Germany.
² Katholische Stiftungshochschule München University of Applied Science Munich Germany.
³ Department of Neurology University of Munich Munich Germany.
⁴ Department of Neurology Technische Universität München Munich Germany.

Abstract

Background: The multimodal complex treatment for Parkinson's disease (MCT) provides inpatient care by a multi-disciplinary team for people with Parkinson's disease (PwP) in Germany.

Objectives: We conducted a 5-year real-world mono-center cohort study to describe the effectiveness of MCT in the full cohort and various subgroups and outcome predictors.

Methods: We collected an anonymized dataset between Jan 2015 and Dec 2019, involving N = 1773. The self-reported MDS-UPDRS part II was used as primary outcome, and clinical routine data for explanatory variables. PwP were categorized as responders or non-responders according to a response of at least 3 points 4 weeks after discharge.

Results: N = 591 complete data records were available for statistical analyses. The full group improved by -2.4 points on the MDS-UPDRS II (P = <0.0001). 47.7% (n = 282) and 52.3% (n = 309) were coded as responders and non-responders, respectively. A clinically meaningful response was positively associated to age (χ² = 11.07, P = 0.018), as well as baseline-severity of the MDS-UPDRS II (χ² = 6.05, P = 0.048) and negatively associated to the presence of psychiatric disorder (χ² = 3.9, P = 0.048) and cognitive dysfunction (χ² = 7.29, P = 0.007). Logistic regression showed that baseline severity of the MDS-UPDRS II predicted therapy success. PwP with moderate baseline-severity had an about 2fold chance (OR 2.08; 95% CI 1.20-3.61; P = 0.009) and with severe an about 6fold chance (OR 5.92; 95% CI 2.76-12.68; P < 0.0001) to benefit clinically meaningful.

Discussion: In a naturalistic setting of a specialized Parkinson's center, MCT improved ADL disability of PwP at least 4 weeks after discharge. Moderately and severely impaired patients were more likely to achieve clinically meaningful responses.

Keywords: Parkinson's disease; inpatient multimodal complex treatment; multidisciplinary.