Objective: To explore documentation in medical records (EMRs) of the 5 (5 oral levodopa doses taken/day) -2 (2hours of OFF time/day) -1 (1 hour of troublesome dyskinesia/day) criteria.

Background: Identification of persons with PD who would benefit from device-aided therapy (DAT), i.e. deep brain stimulation, levodopa- or apomorphine infusion, can be challenging. The 5-2-1 criteria were proposed in 2015 as an aid to detect persons where DAT should be considered.[1] This project explores whether we identified and documented the 5-2-1 criteria in clinical routine.

Method: We reviewed the EMRs of a convenience sample of PD patients, visiting movement disorder specialists, other neurologists, or residents, at the outpatient clinic of the Karolinska University Hospital, Sweden, between January 1st 2017 and January 1st 2018. Sociodemographic variables, motor- and non-motor assessments, and documentation of 5-2-1 criteria were recorded. Descriptive statistics were used. Parametric and non-parametric analysis was used to describe group differences.

Results: DAT was used for 146 of 1000 patients. The other 854 patients were older (75.5 [SD=8.0] vs 67.1 [SD=8.1]yrs, p=<.001) and had shorter disease duration (8.1[SD=6.0] vs 14.4[SD=6.7]yrs, p=<.001). Hoehn & Yahr scores were 3 (IQR=2) with no difference between the groups. The patients without DAT took 4.7 (mean, SD=2.0, range 0-15) oral levodopa doses daily. In the EMRs of the 854 patients without DAT, OFF fluctuations were noted, with or without specified time, in 318 (37.2%). A specified time of daily OFF was recorded in 67 (7.8%). OFF fluctuations were negated in 223 (26.2%) EMRs. Information regarding OFF was lacking in 313 (36.7%) EMRs. Dyskinesia was documented in 226 (26.5%) EMRs. A specified time of daily dyskinesia was recorded in 28 (3.3%) EMRs. Dyskinesia was negated in 209 (24.5%) EMRs. Information regarding dyskinesia was lacking in 419 (49.1%) of EMRs.

Conclusion: The mean number of daily levodopa doses of the patients without DAT was 4.7, >1/3 of patients had off fluctuations, and at least ¼ of patients had dyskinesia, indicating that the 5-2-1 criteria are sensitive. Too many EMRs lacked information about motor fluctuations and dyskinesia. This project provides a basis for data-driven quality improvement.

References: 1. Odin, P., et al. Parkinsonism Relat Disord, 2015. 21(10): p. 1133-44.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/retrospective-exploration-of-the-5-2-1-criteria-in-clinical-practice/