5 research outputs found
Efficacy of community-based physiotherapy networks for patients with Parkinson's disease:a cluster-randomised trial
\u3cp\u3eBACKGROUND: Many patients with Parkinson's disease are treated with physiotherapy. We have developed a community-based professional network (ParkinsonNet) that involves training of a selected number of expert physiotherapists to work according to evidence-based recommendations, and structured referrals to these trained physiotherapists to increase the numbers of patients they treat. We aimed to assess the efficacy of this approach for improving health-care outcomes.\u3c/p\u3e\u3cp\u3eMETHODS: Between February, 2005, and August, 2007, we did a cluster-randomised trial with 16 clusters (defined as community hospitals and their catchment area). Clusters were randomly allocated by use of a variance minimisation algorithm to ParkinsonNet care (n=8) or usual care (n=8). Patients were assessed at baseline and at 8, 16, and 24 weeks of follow-up. The primary outcome was a patient preference disability score, the patient-specific index score, at 16 weeks. Health secondary outcomes were functional mobility, mobility-related quality of life, and total societal costs over 24 weeks. Analysis was by intention to treat. This trial is registered, number NCT00330694.\u3c/p\u3e\u3cp\u3eFINDINGS: We included 699 patients. Baseline characteristics of the patients were comparable between the ParkinsonNet clusters (n=358) and usual-care clusters (n=341). The primary endpoint was similar for patients within the ParkinsonNet clusters (mean 47.7, SD 21.9) and control clusters (48.3, 22.4). Health secondary endpoints were also similar for patients in both study groups. Total costs over 24 weeks were lower in ParkinsonNet clusters compared with usual-care clusters (difference euro727; 95% CI 56-1399).\u3c/p\u3e\u3cp\u3eINTERPRETATION: Implementation of ParkinsonNet networks did not change health outcomes for patients living in ParkinsonNet clusters. However, health-care costs were reduced in ParkinsonNet clusters compared with usual-care clusters.\u3c/p\u3e\u3cp\u3eFUNDING: ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust.\u3c/p\u3
Suicidal ideation in a European Huntington's disease population
Previous studies indicate increased prevalences of suicidal ideation,
suicide attempts, and completed suicide in Huntington's disease (HD) compared
with the general population. This study investigates correlates and predictors of
suicidal ideation in HD.
METHODS: The study cohort consisted of 2106 HD mutation carriers, all
participating in the REGISTRY study of the European Huntington's Disease Network.
Of the 1937 participants without suicidal ideation at baseline, 945 had one or
more follow-up measurements. Participants were assessed for suicidal ideation by
the behavioural subscale of the Unified Huntington's Disease Rating Scale
(UHDRS). Correlates of suicidal ideation were analyzed using logistic regression
analysis and predictors were analyzed using Cox regression analysis.
RESULTS: At baseline, 169 (8.0%) mutation carriers endorsed suicidal ideation.
Disease duration (odds ratio [OR]=0.96; 95% confidence interval [CI]: 0.9-1.0),
anxiety (OR=2.14; 95%CI: 1.4-3.3), aggression (OR=2.41; 95%CI: 1.5-3.8), a
previous suicide attempt (OR=3.95; 95%CI: 2.4-6.6), and a depressed mood
(OR=13.71; 95%CI: 6.7-28.0) were independently correlated to suicidal ideation at
baseline. The 4-year cumulative incidence of suicidal ideation was 9.9%.
Longitudinally, the presence of a depressed mood (hazard ratio [HR]=2.05; 95%CI:
1.1-4.0) and use of benzodiazepines (HR=2.44; 95%CI: 1.2-5.0) at baseline were
independent predictors of incident suicidal ideation, whereas a previous suicide
attempt was not predictive.
LIMITATIONS: As suicidal ideation was assessed by only one item, and participants
were a selection of all HD mutation carriers, the prevalence of suicidal ideation
was likely underestimated.
CONCLUSIONS: Suicidal ideation in HD frequently occurs. Assessment of suicidal
ideation is a priority in mutation carriers with a depressed mood and in those
using benzodiazepines