Objective: To determine the feasibility in the US of a multimodal intensive inpatient Parkinson’s Rehabilitation program for patients with moderately advanced Parkinson’s disease (PD)

Background: Rehabilitation interventions, including Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST), are essential to preserve functional abilities in PD patients [1]. While dosing of rehabilitation intervention is not well established in PD, multimodal rehabilitation has been shown to be effective at all stages of the disease and can be especially effective in restoring functional activities in patients with moderately advanced stages of the disease [2]. Despite evidence of efficacy Multimodal Intensive Inpatient Parkinson’s Rehabilitation Program (MIIPRP) have not been established in the US, mostly because of reimbursement difficulties.

Method: We established a MIIPRP that included PT, OT, ST, recreational and art therapy, neuropsychology, dietary, social worker, pharmacists, nursing, and neurological care. All therapists and staff completed specific Parkinson’s training. Admission criteria included: loss of independence in activity of daily living; mobility and gait impairment with recent falls; speech and swallow impairment; preserved cognitive abilities; failure to achieve meaningful improvement with outpatient therapy. The intervention was pre-approved by public or private insurance. Functional metrics were measured at admission and discharge and included PDQ39, Beck’s scale, Parkinson’s Disease Sleep Scale, Vocal Volume and Voice Handicap, TUG, and Timed Sit to Stand.

Results: Although the program was suspended at peak times of COVID-19 infection, 145 patients were approved for elective admission by Medicare or commercial payors between May 2019 and February 2022. 131 patients completed the program; 5 patients ended prematurely for perceived lack of benefit or logistic reasons, including perceived risk for COVID-19 infection. 121 patients (82.7%) reported subjective benefit and enhanced independence. 10 patients showed no evidence of improvement at the end of the program.

Conclusion: Multidisciplinary intensive inpatient Parkinson’s Rehabilitation program is a feasible and reimbursable intervention in the US for patients with moderately advanced PD. Benefits are both subjective and objective in nature and can be measured and replicated. Specific outcome data is available for review.

References: [1] CMS. (2021). Medicare Benefit Policy Manual. CMS. Retrieved March 7, 2022, from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673

[2] Ekker, M. S., Janssen, S., Nonnekes, J., Bloem, B. R., & De Vries, N. M. (2016). Neurorehabilitation for Parkinson’s disease: future perspectives for behavioural adaptation. Parkinsonism & related disorders, 22, S73-S77.

[3] Lang AE. The evidence for multidisciplinary care in Parkinson’s disease. Expert Rev Neurother. 2020 Jun;20(6):539-549. doi: 10.1080/14737175.2020.1771184. Epub 2020 Jun 1. PMID: 32479209.

[4] Meloni, M., Saibene, F. L., Di Tella, S., Di Cesare, M., Borgnis, F., Nemni, R., & Baglio, F. (2021). Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson’s Disease: A Retrospective and Observational Study. Frontiers in neurology, 12, 626041. https://doi.org/10.3389/fneur.2021.626041

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MDS Abstracts - https://www.mdsabstracts.org/abstract/feasibility-of-an-intensive-inpatient-parkinsons-rehabilitation-program-for-moderately-advanced-parkinsons-disease/