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Post of the Week: Time for Networks of PD Physiotherapists


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#1 Dr. Okun

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Posted 07 December 2009 - 07:39 AM

Dear Forum members,

There is a terrific new article available in the Lancet Neurology this week by Bas Bloem and colleagues at the NPF center of Excellence in the Netherlands. They present a partially NPF funded study where they set up networks of PD physiotherapists all over the Netherlands. This model of care delivery improved the quality of care in PD patients. Should we be setting up rational networks for PD care throughout the globe? This is an important question, and we believe the time may be coming, and NPF has been working hard on this front to set the stage for a paradigm shift in PD care.

See abstract below:


Lancet Neurol. 2009 Dec 1. [Epub ahead of print]
Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial.
Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang EM, Overeem S, Bloem BR; on behalf of the ParkinsonNet Trial Study Group.

Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Department of Rehabilitation Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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. FINDINGS: 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). INTERPRETATION: 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. FUNDING: ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#2 Guest__*

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Posted 07 December 2009 - 07:52 PM

This sounds very promising and something to aim for here. But, who is going to pay for the patients who are being treated? Many of us with pd who are on medicare, find that alot of this comes out of their pocket and many can't afford it.

#3 Dr. Okun

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Posted 08 December 2009 - 01:46 PM

We are hoping that by doing great studies through NPF we can make the case for the US based health care system to fork up the change for this....which should save money in the long-run.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

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Posted 20 December 2009 - 09:12 AM

Before my diagnosis in JUly 99, I was frantic trying to relieve my symptoms while being told 'there was nothing wrong with me.' I had a trusted massage therapist and I was amazed how I felt after a full body massage. I could use my body and turn my head instead of being rigid. It would only last for two days but it was real at the time. I went every week and paid for it which I realize is impossible for some people. But my point is with side effects of medication it is an area that needs exploring. JUst as there is a connection between exercise and PD symptoms,massage theraphy with someone that you trust might be worth the investment. I have had DBS and have not had a massage in years; however, I have a massage chair that I seldom use. Perhaps I should try it again!
Regards, Robin




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