Our Parkinson's Place: Specialized Physiotherapy for Parkinson's Reduces Costs, Disease-Related Complications

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Thursday, January 18, 2018

Specialized Physiotherapy for Parkinson's Reduces Costs, Disease-Related Complications

Brandon May

January 17, 2018

Specialized physiotherapists treated more patients than traditional physiotherapists.

Treatment of Parkinson disease (PD) through ParkinsonNet, a network of multidisciplinary, specialized allied health professionals, is associated with fewer disease-related complications, reduced healthcare costs, and fewer treatment sessions compared with usual physiotherapy PD care, according to study findings published in the Lancet Neurology.

In this observational study, investigators reviewed a database of health insurance claims consisting of patients in The Netherlands with PD who participated in physiotherapy. All patients were followed for approximately 3 years. A mixed-effects model was created to compare disease-related outcomes and healthcare costs associated with specialized PD care (ParkinsonNet, n=2129) vs usual physiotherapy (n=2252).

Specialized physiotherapy with ParkinsonNet was associated with significantly fewer disease-related complications compared with usual care physiotherapy (17% vs 21%, respectively; odds ratio 0.67; 95% CI, 0.56-0.81; P <.0001). In addition, specialized physiotherapists treated a greater number of patients on an annual basis compared with usual care physiotherapists (mean 3.89 patients per therapist [SD 3.91] vs 1.48 [1.24], respectively). Investigators observed fewer treatment sessions in patients treated by specialized physiotherapists vs patients treated by usual care physiotherapists (mean 33.72 [SD 26.70] vs 47.97 [32.11], respectively).

Also, healthcare costs were lower in patients receiving care from specialized vs usual care physiotherapists, including direct costs (mean €933 [SD 843] vs €1329 [1021]; annual difference €395; 95% CI, 358-432; P <.0001) and total healthcare costs (€2056 [3272] vs €2586 [3756]; €530; 95% CI, 391-669; P <.0001). The risk for mortality was also lower in patients receiving care through ParkinsonNet vs usual care (6% vs 9%, respectively; P =.001); however, a Cox survival model demonstrated no difference between the two care strategies (hazard ratio 0.86; 95% CI, 0.69-1.07; P =.195).

The observational nature as well as potential referral bias are 2 limitations associated with this study. Further, the small percentage of PD-related complications in analyzed patients reduced the overall power of the findings.

Based on the results, the investigators of this study recommend that ParkinsonNet “should become usual care, and their use [should] be promoted by inclusion in guidelines for management of PD and by incentives for organizations that pay for PD care.”