scholarly journals Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson’s disease. Protocol for a longitudinal, randomized clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260889
Author(s):  
Esther Cubo ◽  
Alvaro Garcia-Bustillo ◽  
Alvar Arnaiz-Gonzalez ◽  
Jose Miguel Ramirez-Sanz ◽  
Jose Luis Garrido-Labrador ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Cost Effectiveness ◽  
Medical Care ◽  
Fall Prevention ◽  
Intervention Program ◽  
Multidisciplinary Care ◽  
Standard Medical Care

Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.

Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial (ISRCTN 64716113)

2008 ◽  
Vol 24 (02) ◽  
pp. 193-202 ◽  
Author(s):  
Marike R. C. Hendriks ◽  
Silvia M. A. A. Evers ◽  
Michel H. C. Bleijlevens ◽  
Jolanda C. M. van Haastregt ◽  
Harry F. J. M. Crebolder ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Fall Prevention ◽  
Prevention Program ◽  
Intervention Program ◽  
Community Dwelling ◽  
Daily Functioning ◽  
Economic Evaluations ◽  
Fall Prevention Program

Objectives:Multidisciplinary and multifactorial interventions seem to be effective in preventing falls. We aimed to assess the cost-effectiveness of a multidisciplinary fall prevention program compared with usual Dutch healthcare in community-dwelling people 65 years of age or older who experienced a fall.Methods:Cost-effectiveness and cost-utility analysis were performed from a societal perspective. Falls and healthcare utilization were continuously measured for 12 months. Daily functioning and quality of life were measured at baseline, after 4 and 12 months. Bootstrap analyses were performed to estimate uncertainty of the findings and sensitivity analysis to assess the generalizability of assumptions made.Results:One hundred sixty-six participants were randomly allocated to the experimental group and 167 to the control group. The overall response rate was 74 percent. Healthcare and patient and family costs of both groups were comparable. Our analyses showed no effect of the intervention program on falls, daily functioning, or quality of life measures.Conclusions:The multidisciplinary intervention program to prevent falls was not cost-effective compared with usual care in the Netherlands. Notwithstanding our findings, however, falls still have an important impact on society and individuals in terms of costs and effects. Economic evaluations studying promising interventions to prevent falls, therefore, remain necessary.

Home-based dance exercise for adults with moderate Parkinson’s disease: Protocol with a pilot study for a non-randomized clinical trial using video-dances in a DVD format (Preprint)

2022 ◽  
Author(s):  
Manoela de Paula Ferreira ◽  
Adriano Zanardi da Silva ◽  
Bruna Yamaguchi ◽  
Sunita Mathur ◽  
Taina Ribas Melo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Parkinson's Disease ◽  
Cognitive Function ◽  
Pilot Study ◽  
Functional Mobility ◽  
Contemporary Dance ◽  
Home Based

BACKGROUND Many people with Parkinson’s disease (PD) have never received rehabilitation care due to lack of accessibility and transportation and high therapy costs for in-person rehabilitation. Home-based dance exercise is an innovative, low-cost therapy that may reduce accessibility barriers to exercise. Especially since the COVID-19 pandemic, home-exercise programs are a highly relevant, alternative approach for people with PD OBJECTIVE This clinical trial protocol aims to explore the effects of a Home-Based contemporary dance exercise program for people with moderate Parkinson’s Disease (PD), focusing on balance, functional mobility, quality of life (QOL), cognitive function, and depression. METHODS This protocol is for a non-randomized clinical trial for adults with moderate PD divided into control group (CG) and Experimental Group (EG). Participants from the EG will perform video-dances of the contemporary dance, delivered in a DVD format. The video-dances will be executed 16 weeks, three times per week, 30 minutes each day at home, with exercise intensity controlled by the BORG scale. Participants from the CG will not receive any new exercise therapy. As primary outcomes, the signs and symptoms of the PD assessed by the Unified Parkinson’s Disease Rating Scale – UPDRS II and III, Hoehn and Yahr for the PD severity, and health-related quality of life (HRQL), measured by the Parkinson’s Disease Questionnaire – PDQ-39) will be tested. Secondary outcomes include cognitive function by the Montreal Cognitive Assessment – MoCA, balance by the Mini-BESTest, functional mobility by the Timed “Up and Go” test – TUG and depression by the Geriatric Depression Scale – GDS. All outcomes will be assessed in an in-person evaluation by a blinded assessor before and after the 16 weeks of the program. RESULTS This protocol has a pilot study that included 10 participants (5 in each group). It was observed positive results favoring the EG over cognitive function (p = 0.034). In addition, HRQL, balance, and depression were improved after the pilot program in the EG, however, without significant difference. CONCLUSIONS This clinical trial has the potential to be a safe alternative exercise approach under COVID restrictions and travel-free therapy with effects on PD symptoms. CLINICALTRIAL RBR-58T68W (Brazilian Clinical Trials Registry)

Effects of treadmill training on the balance, functional capacity and quality of life in Parkinson’s disease: A randomized clinical trial

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Paria Arfa-Fatollahkhani ◽  
Afsaneh Safar Cherati ◽  
Seyed Amir Hasan Habibi ◽  
Gholam Ali Shahidi ◽  
Ahmad Sohrabi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Functional Capacity ◽  
Treadmill Training ◽  
Moderate Intensity ◽  
P Value ◽  
Short Term

AbstractBackgroundThere is growing evidence that exercise modalities have considerable effects on Parkinson’s disease (PD). This trial aimed to provide a more detailed viewpoint of short-term and long-term treadmill training (TT) effects on some motor and non-motor features of PD.MethodsIn this prospective, randomized, single-blind clinical trial, 20 mild to moderate PD patients, admitted in Rasoul-e-Akram hospital in Tehran, Iran, were randomly allocated in case (11) and control (9) groups. Treadmill intervention was performed at moderate intensity with 60% of heart rate reserved (HRR) in two 30-min sessions/week for a duration of 10 weeks. Both the groups were evaluated for three times; at the baseline, 2 months later and then 2 months after the second evaluation. We assigned the Timed Up and Go test (TUG), 6-min walk test (6MW), and the SF-8 healthy questionnaire, for assessment of balance, functional capacity, and Quality of life (QoL), respectively.ResultsBalance and functional capacity were significantly improved in the case group after the intervention (TUG p-value: 0.003, 6MW p-value: 0.003). Moreover, the long-term analysis revealed significant results as well (TUG p-value: 0.001, 6MW p-value: 0.004). Mental condition’s scores of SF-8 in cases were not statistically different in short-term follow-up (F/U). However, analysis illustrated p-value: 0.016 for long-term assessment. The intervention induced significant changes in physical condition’s scores in both of the F/Us (PC p-value: 0.013).ConclusionsThis study provides evidence that a TT of mild to moderate intensity has significant and persistent benefits for the balance, functional capacity, and QoL in PD.

Benefits and Costs of Recombinant Human Erythropoietin for End-Stage Renal Failure: A Review: Benefits and Costs of Erythropoietin

1993 ◽  
Vol 9 (4) ◽  
pp. 490-504 ◽  
Author(s):  
Paul McNamee ◽  
Eddy van Doorslaer ◽  
Rob Segaar
Keyword(s):  
Quality Of Life ◽  
Renal Failure ◽  
Cost Effectiveness ◽  
Medical Care ◽  
Recombinant Human Erythropoietin ◽  
End Stage Renal Failure ◽  
Human Erythropoietin ◽  
End Stage ◽  
Benefits And Costs

AbstractRecombinant human erythropoietin is an efficacious therapy in treatment of the anemia of end-stage renal failure. However, the scale of impact on quality of life and medical care resources remains uncertain. By reviewing the literature we evaluate cost-effectiveness of recombinant human erythropoietin and show how previous studies may have implicitly overestimated cost-effectiveness.

scholarly journals Health-related Quality of Life of Macedonian Families Experiencing Cystic Fibrosis in Pediatric Practice

Folia Medica ◽  
2019 ◽  
Vol 61 (2) ◽  
pp. 213-222 ◽  
Author(s):  
Zoran Nikola Nakov ◽  
Stojka Naceva Fushtikj ◽  
Jasmina Tonikj-Ribarska ◽  
Suzana Trajkovikj Jolevska
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Medical Care ◽  
Social Activity ◽  
Social Aspect ◽  
Health Related Quality ◽  
Standard Medical Care ◽  
Related Quality ◽  
Health Related

Abstract Background: : Health-related quality of life (HRQoL) is a parameter that is examined in the area of clinical effectiveness. Like other chronic health conditions, paediatric cystic fibrosis (CF) impacts not only children but also their families. Aim: The present study investigates for the first time the HRQoL of children and parents in the Republic of North Macedonia. Materials and methods: The survey included 22 children (6 to 13 years of age) and their parents and 7 parents of children under 6 years of age by using the CFQ Revised and questions for current medical treatment. Results: Children (6-13 years) reported the highest score for the digestive condition (84.85), while the lowest score was given for social activity (59.74). The highest score for digestive condition was also obtained from the parents of children from 6-13 years and under age of 6. The parents of children (6-13 years) reported the lowest score (60.56) for treatment burden activity, while the lowest score (50.0) for eating condition was obtained from the parents of children under 6 years. Conclusion: Nationality and gender have no significant impact on the HRQoL parameters. The highest scores for the digestive condition, respiratory function and physical condition are in a positive correlation with the fact that enzyme, antibiotic and physical therapy are given as a standard medical care. The lowest scores of the social aspect of the CF patients indicate the need for including a psychological support and support of social workers as a part of the standard medical care of these patients.

scholarly journals Effects and Implementation of a Mindfulness and Relaxation App for Cancer Patients: Mixed-Methods Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Michael Mikolasek ◽  
Claudia Margitta Witt ◽  
Jürgen Barth
Keyword(s):  
Quality Of Life ◽  
Mixed Methods ◽  
Medical Care ◽  
Cancer Patients ◽  
Feasibility Study ◽  
Health Professionals ◽  
Controlled Trial ◽  
Standard Medical Care ◽  
Related Quality

BACKGROUND A cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive non-pharmacological treatments have been suggested to reduce cancer patients’ distress. However, not all patients use those interventions because of limited access or being unaware. To overcome these barriers, mHealth might be a promising way to deliver respective supportive treatments. OBJECTIVE The aim of this study was to evaluate effects and the implementation of a mindfulness and relaxation app intervention for cancer patients as well as patients’ adherence to such an intervention. METHODS In this observational feasibility study with a mixed-methods approach, cancer patients were recruited online and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline, week 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app in order to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention into standard medical care. We analyzed patients’ self-reported outcomes with linear mixed models (LMM) and qualitative data with content analysis. RESULTS A total of 100 cancer patients (74 female) with a mean age of 53.2 (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed an improvement in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement of distress (P<.001), a moderate improvement of anxiety (P=.001), and depression (P=.03) in patients with high symptom levels at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation and adherence to such an app. CONCLUSIONS This study indicates that a mindfulness and relaxation app for cancer patients can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content and the effectiveness of such an intervention needs to be tested in a randomized controlled trial. CLINICALTRIAL

scholarly journals The Cost-Effectiveness of specialized Nursing Interventions for people with Parkinson’s Disease: the NICE-PD study protocol for a randomized controlled clinical trial

2019 ◽  
Author(s):  
Danique LM Radder ◽  
Herma H Lennaerts ◽  
Hester Vermeulen ◽  
Thies van Asseldonk ◽  
Cathérine CS Delnooz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Controlled Clinical Trial ◽  
Motor Symptoms ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
The Cost

Abstract Background Current guidelines recommend that every person with Parkinson’s disease (PD) should have access to Parkinson’s Disease Nurse Specialist (PDNS) care. However, there is little scientific evidence on the cost-effectiveness of PDNS care. This hampers wider implementation, creates unequal access to care and possibly leads to avoidable disability and costs. Therefore, we aim to study the (cost-)effectiveness of specialized nursing care provided by a PDNS compared to usual care (without PDNS) for people with PD in all disease stages. To gain more insight into the deployed interventions and their effects, a pre-planned subgroup analysis will be performed based on disease duration (diagnosis <5, 5-10, or >10 years ago). Methods We will perform an 18-month, single-blind, randomized controlled clinical trial in eight community hospitals in the Netherlands. A total of 240 people with PD that have not been treated by a PDNS over the past two years will be included, independent of disease severity or duration. In each hospital, 30 patients will randomly be allocated in a 1:1 ratio to either care by a PDNS (who works according to a recent guideline on PDNS care) or usual care. We will use two co-primary outcomes: quality of life (measured with the Parkinson’s Disease Questionnaire-39) and motor symptoms (measured with the MDS-UPDRS part III). Secondary outcomes include non-motor symptoms, health-related quality of life, experienced quality of care, self-management, medication adherence, caregiver burden and coping skills. Data will be collected after 12 months and 18 months by a blinded researcher. A healthcare utilization and productivity loss questionnaire will be completed every 3 months. Discussion The results of this trial will have an immediate impact on the current care of people with PD. We hypothesize that, by offering more patients access to PDNS care, quality of life will increase. We also expect healthcare costs to remain equal, as increases in direct medical costs (funding additional nurses) will be offset by a reduced number of consultations with the general practitioner and neurologist. If these outcomes are reached, wide implementation of PDNS care is warranted. Trial registration ClinicalTrials.gov: NCT03830190. Registered February 5, 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03830190.

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