Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
Lancet Neurol. 2010 Jan;9(1):46-54. doi: 10.1016/S1474-4422(09)70327-8. Epub 2009 Dec 1.
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.
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.
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).
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.
ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust.
许多帕金森病患者接受物理治疗。我们开发了一个基于社区的专业网络（ParkinsonNet），该网络涉及培训一定数量的专家理疗师，根据循证建议开展工作，并对这些经过培训的理疗师进行结构化转诊，以增加他们治疗的患者人数。我们旨在评估这种方法在改善医疗保健结果方面的效果。
在 2005 年 2 月至 2007 年 8 月期间，我们进行了一项以 16 个集群（定义为社区医院及其覆盖区域）为单位的集群随机试验。使用方差最小化算法对集群进行随机分组，分配到 ParkinsonNet 护理组（n=8）或常规护理组（n=8）。患者在基线和随访的 8、16 和 24 周时进行评估。主要结局是 16 周时的患者偏好残疾评分，即患者特异性指数评分。次要健康结局是功能性移动能力、与移动相关的生活质量以及 24 周内的总社会成本。分析采用意向治疗。该试验已注册，编号为 NCT00330694。
我们纳入了 699 名患者。ParkinsonNet 集群（n=358）和常规护理集群（n=341）患者的基线特征相似。ParkinsonNet 集群（平均 47.7，标准差 21.9）和对照组（48.3，22.4）的患者主要终点相似。两组患者的次要健康结局也相似。与常规护理集群相比，ParkinsonNet 集群的 24 周总费用更低（差值为 727 欧元；95%置信区间为 56-1399）。
实施 ParkinsonNet 网络并未改变生活在 ParkinsonNet 集群中的患者的健康结果。然而，与常规护理集群相比，ParkinsonNet 集群的医疗保健成本降低了。
ZonMw；荷兰科学研究组织；荷兰帕金森氏症协会；国家帕金森基金会；Stichting Robuust。
