Referral of patients with neuromuscular disease to occupational therapy, physical therapy and speech therapy: usual practice versus multidisciplinary advice.
PURPOSE To compare the volume of occupational therapy (OT), physical therapy (PT) and speech therapy (ST) as currently received by patients with neuromuscular diseases with the volume of OT, PT and ST recommended by a multidisciplinary team.


METHODS
The use of OT, PT and ST was studied retrospectively and prospectively in a reference group (n = 106) receiving usual care and in an intervention group (n = 102) receiving advice based on multidisciplinary assessments. A cost analysis was made and the implementation of the advice was evaluated at 6 months.


METHODS
Multidisciplinary assessments consisted of a single consultation by OT, PT and ST each, followed by a multidisciplinary meeting and integrated advice.


METHODS
Volume (frequency times duration) of therapy, relative over- and underuse of therapy and costs of therapy and intervention.


RESULTS
Compared to the multidisciplinary advice, there was 40% underuse of OT among patients with neuromuscular disease. For PT, there was 32% overuse and 22% underuse; for ST, there was neither over- nor underuse. Some 40% of patients received once-only advice regarding ST compared to 27% regarding OT and 19% regarding PT. The costs of the multidisciplinary advice were estimated at euro245 per patient. If fully implemented, our multidisciplinary approach would result in a mean cost savings of euro85.20 per patient. The recommended therapy had, however, been implemented only partially at 6 months follow-up.


CONCLUSIONS
Some patients with a neuromuscular disease do not receive any form of allied healthcare, whereas they should. Among patients with neuromuscular disease who do receive some form of allied healthcare, quite a few receive these treatments for too long periods of time. Ways need to be developed to improve implementation of the multidisciplinary advice and to obtain a more favourable balance between its costs and benefits.
Cup
Edith H C
EH
Research Centre of Allied Health Care, Occupational Therapy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. e.cup@pmd.umcn.nl
Pieterse
Allan J
AJ
Knuijt
Simone
S
Hendricks
Henk T
HT
van Engelen
Baziel G M
BG
Oostendorp
Rob A B
RA
van der Wilt
Gert-Jan
GJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009468:Neuromuscular Diseases / Q000191:economics / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000191:economics / Q000706:statistics & numerical data*; D010348:Patient Care Team; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013070:Speech Therapy / Q000191:economics / Q000706:statistics & numerical data*