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Does the clinical practice guideline on Parkinson’s disease change health outcomes? A cluster randomized controlled trial

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Abstract

The successful transfer of clinical practice guidelines (CPGs) into patient care depends on the appropriateness of the implementation method. This study strived for a better understanding of which intervention strategy is effective in implementing the CPG on Parkinson’s disease (CPG-PD). In a cluster randomized controlled trial, we compared the impact of two different implementation strategies of the CPG-PD on health outcomes of PD patients. The primary outcome of health-related quality of life was measured by PDQ-39. The neurologists of the intervention group (IG) versus a control group (CG) received the CPG-PD with special instructions, a 4-h training and were offered personal feedback. Patients were followed over three assessment times: baseline, post-test (6 months) and follow-up (9 months). Lack of time and remuneration resulted in low study participation (32 out of 619 contacted neurologists). Multilevel modelling revealed that primary (PDQ-39) and secondary efficacy variables (EQ-5D, CGI, HADS-D, ZUF-8) of 386 patients were not affected significantly by the intervention and failed to show any significant difference between the two groups. The EQ-5D VAS scale (p = 0.0288) and the CGI-P severity scale (p = 0.0072) showed a significant worsening over time. A significant decrease of hours of dyskinesias in the IG (p = 0.007) was observed, whereas Parkinson symptoms did not change significantly between the groups. Lacking awareness of the CPG-PD seems to be no longer a barrier for its use, but it is still a major challenge to find effective implementation methods to optimise clinical outcome. Further studies are needed for a more comprehensive understanding of successful implementation strategies.

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Acknowledgments

The authors thank all those neurologists and their patients who participated in the study. We are indebted to research assistant Heiko Löwer, statistical advisor Nicole Burchardi, secu trial operator Gisela Anthony and the Hessian State Board of Physicians (Landesärztekammer Hessen). The study was supported by the Willy Robert Pitzer Foundation Grant No. 35/06 and the BMBF (CNP Grant No. 01 GI 0401).

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Authors and Affiliations

  1. Department of Neurology, Philipps-University of Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany

    Astrid Larisch, Wolfgang H. Oertel & Karla Eggert

  2. Center for Clinical Trials, Philipps-University of Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany

    Alexander Reuss

Authors
  1. Astrid Larisch
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  2. Alexander Reuss
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  3. Wolfgang H. Oertel
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  4. Karla Eggert
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Correspondence to Karla Eggert.

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Larisch, A., Reuss, A., Oertel, W.H. et al. Does the clinical practice guideline on Parkinson’s disease change health outcomes? A cluster randomized controlled trial. J Neurol 258, 826–834 (2011). https://doi.org/10.1007/s00415-010-5848-1

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  • DOI: https://doi.org/10.1007/s00415-010-5848-1

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