Tschentscher Vera, Oppermann Judith, Welzel Julius, Geritz Johanna, Gold Ralf, Muhlack Siegfried, Hansen Clint, Maetzler Walter, Tönges Lars, Scherbaum Raphael
Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany.
Department of Neurology, Kiel University, 24105, Kiel, Germany.
Neurol Res Pract. 2025 Jul 28;7(1):53. doi: 10.1186/s42466-025-00409-9.
BACKGROUND: In Germany, multidisciplinary care for people with Parkinson's disease (PwP, PD) is mainly provided in the inpatient setting. Differences in user groups between established and effective interventions like PD Multimodal Complex Therapy (PD-MCT) and Geriatric Complex Therapy (GCT) have not been investigated. METHODS: This real-world bicenter prospective observational study involved PwP undergoing 14-day inpatient multidisciplinary therapies at two German university hospitals providing either PD-MCT or GCT. Demographic and clinical variables were recorded before and device-based gait variables before and after therapy. Non-parametric and parametric tests including ANCOVA with age as covariate were conducted to compare groups at baseline, and an exploratory binomial logistic regression (LR) to identify predictors of 'therapy response' concerning gait speed. RESULTS: Between 09/2017 and 09/2022, 100 (41% female) and 102 (34.3% female) PwP received GCT or PD-MCT, with significant (p < 0.003) mean or median differences (GCT vs. PD-MCT) in age (74.7 vs. 65.6 years), disease duration (9.9 vs. 7.4 years), and HY stage (3 vs. 2.5). The GCT group showed significantly reduced lower extremity (SPPB), global cognitive (MoCA) and executive function (TMT), lower quality of life, and higher fear of falling (FES-I). There were significant (p < 0.004) between-group differences in gait parameters at both normal and fast pace, e.g., reduced gait speed and step length among GCT users. After age-adjustment, differences in gait speed, fast-pace step length, lower extremity and executive function, fear of falling and quality of life persisted. The exploratory LR model was statistically significant (p < 0.05, R = 0.312) and revealed lower fear of falling and gait speed as predictors of 'therapy response', independent of therapy type, age, sex, disease duration or stage. CONCLUSION: GCT users show higher age and severity, particularly concerning mobility impairments independent of age. It is unclear if, on a national level, actual PD-MCT/GCT user groups align with intended target groups. Health insurance data analyses could help refine clinical recommendations and public health policies for more targeted multidisciplinary PD care. TRIAL REGISTRATION: Park Move Study: DRKS, DRKS00020948. Registered 30 March 2020-retrospectively registered, https://drks.de/search/de/trial/DRKS00020948/details.
背景:在德国,帕金森病患者的多学科护理主要在住院环境中提供。对于已确立且有效的干预措施,如帕金森病多模式综合治疗(PD-MCT)和老年综合治疗(GCT),其用户群体之间的差异尚未得到研究。 方法:这项真实世界的双中心前瞻性观察性研究纳入了在两家德国大学医院接受为期14天住院多学科治疗的帕金森病患者,这两家医院分别提供PD-MCT或GCT。记录治疗前后的人口统计学和临床变量以及基于设备的步态变量。进行非参数和参数检验,包括以年龄为协变量的协方差分析,以比较基线时的组间差异,并进行探索性二项逻辑回归(LR)以确定与步态速度相关的“治疗反应”预测因素。 结果:在2017年9月至2022年9月期间,100名(41%为女性)和102名(34.3%为女性)帕金森病患者接受了GCT或PD-MCT,年龄(74.7岁对65.6岁)、病程(9.9年对7.4年)和Hoehn-Yahr分期(3期对2.5期)存在显著(p < 0.003)的均值或中位数差异(GCT组对PD-MCT组)。GCT组的下肢功能(SPPB)、整体认知功能(MoCA)和执行功能(TMT)显著降低,生活质量较低,跌倒恐惧(FES-I)较高。在正常和快速步速下,步态参数的组间差异均显著(p < 0.004),例如GCT使用者的步态速度和步长降低。年龄调整后,步态速度、快速步长、下肢和执行功能、跌倒恐惧和生活质量的差异仍然存在。探索性LR模型具有统计学意义(p < 0.05,R = 0.312),并显示较低的跌倒恐惧和步态速度是“治疗反应”的预测因素,与治疗类型、年龄、性别、病程或分期无关。 结论:GCT使用者年龄更大且病情更严重,尤其是在与年龄无关的运动障碍方面。在国家层面上,实际的PD-MCT/GCT用户群体是否与预期目标群体一致尚不清楚。医疗保险数据分析有助于完善临床建议和公共卫生政策,以提供更有针对性的帕金森病多学科护理。 试验注册:Park Move研究:DRKS,DRKS00020948。2020年3月30日注册——追溯注册,https://drks.de/search/de/trial/DRKS00020948/details。
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