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To examine how regular and specialized physical therapy for Parkinson disease (PD) compare in the real-world setting, investigators conducted an observational study using 3 years of data from a Dutch health insurance claims database. A mixed effects model compared usage and outcomes between the two therapy groups. The primary outcome was defined as the proportion of patients with PD-related complications, including hospitalization for fracture, other orthopedic injuries, or pneumonia.
There were 2129 patients (4649 observations) in the specialized physiotherapy group and 2252 patients (5353 observations) in the usual-therapy groups. PD-related complications were significantly less common in the specialized care group (17%) than in the usual care group (21%). The caseload was more than twice as large in the specialized therapy group (3.89 vs. 1.48); patients seen by specialized therapists had fewer treatment sessions (33.7 vs. 48.0). Direct costs and total healthcare expenditure favored the specialized physiotherapy group.
Ypinga JHL et al. Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: A retrospective analysis of medical claims data. Lancet Neurol 2018 Feb; 17:153. (http://dx.doi.org/10.1016/S1474-4422(17)30406-4)
Comment
The notion that specialized physiotherapy for a disease such as PD is better seems intuitive but until this study lacked strong evidence. The generalizability of these findings will be a challenge because of lack of agreement on training standardization and limited availability of specialized therapists across international regions. This study did not show a difference in mortality between groups. The global healthcare system could benefit from similar studies focusing on specialized networks of care.