This is a poster presented at the 3rd World Parkinson Congress, 1st-4th October 2013

Guppy, Helen

Lovegrove, Chris

Peace, Bridget

RD&E Research Repository

Royal Devon and ExeterNHS Foundation TrustAn acute Parkinson’s Therapy Pathway; bridging the gap between hospital and home.Chris Lovegrove, Senior Occupational Therapist; Helen Guppy, Senior Physiotherapist; Bridget Peace, Clinical Lead PhysiotherapistThe Royal Devon & Exeter (RD&E) NHS Foundation Trust, Exeter, Devon, United KingdomBackgroundn People with Parkinson’s can often experience long hospital  admissions, and frequently not discharged to their own homes  to continue rehabilitation. n Reports from people living with Parkinson’s show that the  hospital environment does not replicate their own home set-upn Home-based rehabilitation programmes shown to be effective  (Ashburn et al 2007, Antonini et al 2008). n Home-based therapy shown to have positive advantages over  day hospital based rehabilitation (Parker et al 2009). AimTo develop a Parkinson’s Therapy Pathway for the acute hospital setting, integrating early home-based assessment and therapy sessions, with seamless transition to community services.Methodologyn Pilot study.n Developed on PD ward (see poster #1033.00).n Intervention group= patients on therapy pathway,  control group= standard care.n Initial data collected; length of stay, readmitted within 14 days,  Lindop score on discharge, patient comments, Modified Barthel  Index score on d/c and number of home visits.n Not enough UPDRS data available to provide accurate analysis.n Raw data then calculated to give mean average or percentage  score.ResultsMeasure Control Group Interventional GroupSample Size – There were  5 patients in both the control and intervention groupsLength of Stay (LoS) – The mean average length of stay for patients in the interventional group was  7.2 days lower. Therefore the interventional group had an average length of stay 32.1% lower than the control group.  Readmissions – Following discharge the patients in both groups were monitored for readmissions to an acute healthcare provider within 14 days. Despite the interventional group having a lower acute length of stay their readmission rate matched the control group  Modified Barthel on Discharge – All patients had their performance in activities of daily living and mobility assessed on discharge using the modified Barthel index. The results indicate that despite the significantly lower hospital LoS the intervention patients had equivalent Barthel scores to the control group.  Lindop Score on Discharge – All patients had their mobility assessed on discharge using the Lindop Parkinson’s Assessment Scale. The scale runs between 0-30 with the mean average of the intervention group being  5.2 points (39.4%) higher.Discussionn Decrease in length of stay for intervention groupn On outcome measures,  improved performance of patients  through pathway increased compared to control groupn Intervention group= draw on resourcesn Positive response from patients and carersn Readmission rates remained stable in both groupsLimitationsn Small patient population analysed; would need 178 to achieve  80% power on length of stay outcome measure.n All patients were in the complex stage of Parkinson’s- only  analysing a subset of the population. Increasing the size of the  group would allow greater inclusion.n Patient population analysed from a short period of time, may  be beneficial to extend the length of future studies.n Incomplete data sets e.g. UPDRSImplicationsn This pilot’s findings suggest that a Parkinson’s Therapy Pathway  could reduce the length of time patient is in hospital.n Suggests an improvement in outcome measure scores.n This pilot has identified a future need for research into this  area, analysing a larger patient population over a longer period  of time.Abstract #1055.00ReferencesAshburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C. (2007) A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry 78(7), 678-685Antonini A, Miro L, Castiglioni C, Pezzoli G. (2008) The rationale for improved integration between home care and neurology hospital services in patients with advanced Parkinson’s disease. Neurological Sciences 29(5), S392-S396Parker SG, Oliver P, Pennington M, Bond J, Jagger C, Enderby PM (2009) Rehabilitation of older patients: Day hospital compared with rehabilitation at home. A randomised controlled trial. Health Technology Assessment 13(39)22.4Days15.2Days40% 40%49.813.250.618.4Presented at the 3rd World Parkinson Congress, Palais des Congrès, Montréal

An acute Parkinson's Therapy Pathway; bridging the gap between hospital and home

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An acute Parkinson's Therapy Pathway; bridging the gap between hospital and home

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