Objective: To study the long-term benefits of specialised physiotherapy using the ParkinsonNet approach in real-world practice.

Background: Trials show that specialised allied health interventions are cost-effective, as compared with usual care, but there is a need for further insight into the long-term effects in real-world clinical practice (1,2).

Methods: We did an observational study, retrospectively analysing a database of health insurance claims including a representative population of Dutch patients with Parkinson’s disease (PD), who were followed for up to 3 years. Eligibility criteria included having a diagnosis of PD and having received PT for PD (figure 1). Allocation was based on the choices of patients and physicians. We used a mixed-effects model to compare healthcare use and outcomes between patients treated by specialised or usual care PT (table 1). The primary outcome was the percentage of patients with a PD-related complication adjusted for baseline variables. We compared PT caseload, number of sessions and costs between groups, and used a Cox’s model to establish whether mortality was influenced by treatment allocation.

Results: We analysed 2129 patients receiving specialised PT and 2252 patients receiving usual care PT. Significantly fewer patients treated by a specialised PT had a PD-related complication (n=368 [17%]) than in the usual care PT group (n=480 [21%]; odds ratio 0·67 (table 4). The annual caseload of patients per therapist was significantly higher for specialised PT (mean 3·89) [SD 3·91]) than usual care PT (1·48 [1·24]). Patients who saw specialised PT received fewer treatment sessions (mean 33·72 [SD 26·70]) than usual care PT (47·97 [32·11]). Consequently, expenditure was significantly lower for specialised than usual care PT, both for direct costs (mean €933 [SD 843] vs €1329 [1021]; annual difference €395 and total health-care expenditure (€2056 [3272] vs €2586 [3756]; €530 (table 2). Mortality risk was lower for patients receiving specialised PT(134 [6%]) compared with patients receiving usual care PT (205 [9%], p=0·001), although Cox’s survival model showed no significant difference between the two (hazard ratio 0·86 (table 3).

Conclusions: These results confirm the findings from controlled trials that specialised PT as delivered through ParkinsonNet is associated with fewer PD related complications and lower costs in real-world practice.

References: 1) Munneke M, Nijkrake MJ, Keus SH, et al. Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a cluster-randomised trial. Lancet Neurol 2010; 9: 46–54. 2) Bloem BR, de Vries NM, Ebersbach G. Nonpharmacological treatments for patients with Parkinson’s disease. Mov Disord 2015; 30: 1504–20.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-and-costs-of-specialised-physiotherapy-given-via-parkinsonnet-a-retrospective-analysis-of-medical-claims-data/