Nijhuis Frouke A P, Esselink Rianne, de Bie Rob M A, Groenewoud Hans, Bloem Bastiaan R, Post Bart, Meinders Marjan J
Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands.
Mov Disord. 2021 Jun;36(6):1293-1307. doi: 10.1002/mds.28599. Epub 2021 Apr 2.
In the advanced stages of Parkinson's disease (PD), patients frequently experience disabling motor complications. Treatment options include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusion (CSAI). Choosing among these treatments is influenced by scientific evidence, clinical expertise, and patient preferences. To foster patient engagement in decision-making among the options, scientific evidence should be adjusted to their information needs. We conducted a systematic review from the patient perspective. First, patients selected outcomes for a treatment choice: quality of life, activities of daily living, ON and OFF time, and adverse events. Second, we conducted a systematic review and meta-analysis for each treatment versus best medical treatment using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Finally, the evidence was transformed into comprehensible and comparable information. We converted the meta-analysis results into the number of patients (per 100) who benefit clinically from an advanced treatment per outcome, based on the minimal clinically important difference and the cumulative distribution function. Although this approach allows for a comparison of outcomes across the three device-aided therapies, they have never been compared directly. The interpretation is hindered by the relatively short follow-up time in the included studies, usually less than 12 months. These limitations should be clarified to patients during the decision-making process. This review can help patients integrate the evidence with their own preferences, and with their clinician's expertise, to reach an informed decision. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
在帕金森病（PD）晚期，患者经常会出现致残性运动并发症。治疗选择包括脑深部电刺激（DBS）、左旋多巴 - 卡比多巴肠凝胶（LCIG）和皮下持续阿扑吗啡输注（CSAI）。在这些治疗方法中进行选择受到科学证据、临床专业知识和患者偏好的影响。为促进患者参与这些治疗方案的决策，科学证据应根据他们的信息需求进行调整。我们从患者的角度进行了一项系统评价。首先，患者选择治疗选择的结果指标：生活质量、日常生活活动能力、开期和关期时间以及不良事件。其次，我们使用推荐分级、评估、制定和评价（GRADE）系统，对每种治疗方法与最佳药物治疗进行了系统评价和荟萃分析。最后，将证据转化为易于理解和可比的信息。我们根据最小临床重要差异和累积分布函数，将荟萃分析结果转换为每个结果指标下从晚期治疗中临床获益的患者人数（每100人）。虽然这种方法允许对三种器械辅助治疗的结果进行比较，但它们从未被直接比较过。纳入研究中相对较短的随访时间（通常少于12个月）阻碍了对结果的解读。在决策过程中，应向患者阐明这些局限性。本综述可帮助患者将证据与自身偏好以及临床医生的专业知识相结合，从而做出明智的决策。© 2021作者。《运动障碍》由Wiley Periodicals LLC代表国际帕金森和运动障碍协会出版。
