The evidence for multidisciplinary care in Parkinson’s disease

ABSTRACT

Introduction

Parkinson’s Disease (PD) is a chronic and slowly progressive neurodegenerative disease. Team-based care is required to address and manage the diverse array of motor and non-motor symptoms in PD and related conditions. As the evidence base for the efficacy of non-pharmacological treatment of PD is expanding, many different centers are implementing interdisciplinary models of care with allied health professionals trained in PD.

Areas covered

In this review, the authors outline these various models and review the evidence for multidisciplinary approaches to care in PD. They begin by defining the terms used to describe the spectrum of multidisciplinary and integrated care models, followed by synthesizing the evidence for these models in PD. The authors then highlight some representative models to illustrate the variety of multidisciplinary care interventions: a community network-based model, a day-hospital model, an academic clinic-based model, and an intensive inpatient rehabilitation model. The authors synthesize these results and suggest directions for team-based PD care for the future.

Expert opinion

The future of medicine is team-based care that is decentralized and integrated vertically and horizontally across health systems. Building an evidence base for these complex interventions will require alternative models of evaluation other than randomized controlled trials.

KEYWORDS:

• Parkinson’s disease
• multidisciplinary
• interdisciplinary care
• integrated care
• rehabilitation
• care models
• community network
• non-motor symptoms
• holistic care
• patient-centered care

Article highlights

• There is general agreement that multidisciplinary care is essential for the treatment of Parkinson’s disease, however widespread implementation is limited for a number of reasons.

• More innovative models for evaluating the efficacy of multidisciplinary care models is needed as the randomized controlled trial is not ideal.

• Models should be restructured to reflect the new reality that people live longer with more chronic disease.

• Call to action: We need to engage patients in codesigning this new system and set up common data elements to measure outcomes

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported in part by an anonymous donation to the Movement Disorders program at the University Health Network, University of Toronto.