Activities of Daily Living Are Improved by Inpatient Multimodal Complex Treatment for PD-a Real-World Cohort Study

BackgroundThe multimodal complex treatment for Parkinson's disease (MCT) provides inpatient care by a multi-disciplinary team for people with Parkinson's disease (PwP) in Germany. ObjectivesWe conducted a 5-year real-world mono-center cohort study to describe the effectiveness of MCT in the full cohort and various subgroups and outcome predictors. MethodsWe collected an anonymized dataset between Jan 2015 and Dec 2019, involving N = 1773. The self-reported MDS-UPDRS part II was used as primary outcome, and clinical routine data for explanatory variables. PwP were categorized as responders or non-responders according to a response of at least 3 points 4 weeks after discharge. ResultsN = 591 complete data records were available for statistical analyses. The full group improved by -2.4 points on the MDS-UPDRS II (P = <0.0001). 47.7% (n = 282) and 52.3% (n = 309) were coded as responders and non-responders, respectively. A clinically meaningful response was positively associated to age (chi(2) = 11.07, P = 0.018), as well as baseline-severity of the MDS-UPDRS II (chi(2) = 6.05, P = 0.048) and negatively associated to the presence of psychiatric disorder (chi(2) = 3.9, P = 0.048) and cognitive dysfunction (chi(2) = 7.29, P = 0.007). Logistic regression showed that baseline severity of the MDS-UPDRS II predicted therapy success. PwP with moderate baseline-severity had an about 2fold chance (OR 2.08; 95% CI 1.20-3.61; P = 0.009) and with severe an about 6fold chance (OR 5.92; 95% CI 2.76-12.68; P < 0.0001) to benefit clinically meaningful. DiscussionIn a naturalistic setting of a specialized Parkinson's center, MCT improved ADL disability of PwP at least 4 weeks after discharge. Moderately and severely impaired patients were more likely to achieve clinically meaningful responses.