Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial.
BACKGROUND
Many patients with Parkinson's disease are treated with physiotherapy. We have developed a community-based professional network (ParkinsonNet) that involves training of a selected number of expert physiotherapists to work according to evidence-based recommendations, and structured referrals to these trained physiotherapists to increase the numbers of patients they treat. We aimed to assess the efficacy of this approach for improving health-care outcomes.


METHODS
Between February, 2005, and August, 2007, we did a cluster-randomised trial with 16 clusters (defined as community hospitals and their catchment area). Clusters were randomly allocated by use of a variance minimisation algorithm to ParkinsonNet care (n=8) or usual care (n=8). Patients were assessed at baseline and at 8, 16, and 24 weeks of follow-up. The primary outcome was a patient preference disability score, the patient-specific index score, at 16 weeks. Health secondary outcomes were functional mobility, mobility-related quality of life, and total societal costs over 24 weeks. Analysis was by intention to treat. This trial is registered, number NCT00330694.


RESULTS
We included 699 patients. Baseline characteristics of the patients were comparable between the ParkinsonNet clusters (n=358) and usual-care clusters (n=341). The primary endpoint was similar for patients within the ParkinsonNet clusters (mean 47.7, SD 21.9) and control clusters (48.3, 22.4). Health secondary endpoints were also similar for patients in both study groups. Total costs over 24 weeks were lower in ParkinsonNet clusters compared with usual-care clusters (difference euro727; 95% CI 56-1399).


CONCLUSIONS
Implementation of ParkinsonNet networks did not change health outcomes for patients living in ParkinsonNet clusters. However, health-care costs were reduced in ParkinsonNet clusters compared with usual-care clusters.


BACKGROUND
ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust.
Munneke
Marten
M
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
Nijkrake
Maarten J
MJ
Keus
Samyra Hj
SH
Kwakkel
Gert
G
Berendse
Henk W
HW
Roos
Raymund Ac
RA
Borm
George F
GF
Adang
Eddy M
EM
Overeem
Sebastiaan
S
Bloem
Bastiaan R
BR
D000368:Aged; D000465:Algorithms; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands; D010300:Parkinson Disease / Q000628:therapy*; D026741:Physical Therapy Modalities; D026761:Physical Therapy Specialty / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome