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A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease

Moro, Elena; Allert, Niels; Eleopra, Roberto; Houeto, Jean-Luc; Phan, Tra-Mi; Stoevelaar, Herman and , (2009) In Journal of Neurology 256(1). p.8-83
Abstract

BACKGROUND AND OBJECTIVE: Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration.

METHODS: Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion... (More)

BACKGROUND AND OBJECTIVE: Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration.

METHODS: Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile.

RESULTS: Referral was considered appropriate for 33% of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age >or= 70 years and presence of cognitive impairment showed the strongest negative impact.

CONCLUSIONS: The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Age Factors, Aged, Cognition Disorders, Deep Brain Stimulation, Female, Humans, Levodopa, Logistic Models, Male, Middle Aged, Parkinson Disease, Referral and Consultation, Journal Article, Research Support, Non-U.S. Gov't
in
Journal of Neurology
volume
256
issue
1
pages
6 pages
publisher
Steinkopff
external identifiers
  • scopus:62149096484
ISSN
1432-1459
DOI
10.1007/s00415-009-0069-1
language
English
LU publication?
no
id
31f7716a-a6d0-47c2-99ac-06acb82cfc80
date added to LUP
2017-04-19 18:33:39
date last changed
2017-09-24 05:09:51
@article{31f7716a-a6d0-47c2-99ac-06acb82cfc80,
  abstract     = {<p>BACKGROUND AND OBJECTIVE: Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration.</p><p>METHODS: Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile.</p><p>RESULTS: Referral was considered appropriate for 33% of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age &gt;or= 70 years and presence of cognitive impairment showed the strongest negative impact.</p><p>CONCLUSIONS: The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.</p>},
  author       = {Moro, Elena and Allert, Niels and Eleopra, Roberto and Houeto, Jean-Luc and Phan, Tra-Mi and Stoevelaar, Herman and , },
  issn         = {1432-1459},
  keyword      = {Age Factors,Aged,Cognition Disorders,Deep Brain Stimulation,Female,Humans,Levodopa,Logistic Models,Male,Middle Aged,Parkinson Disease,Referral and Consultation,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {1},
  pages        = {8--83},
  publisher    = {Steinkopff},
  series       = {Journal of Neurology},
  title        = {A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease},
  url          = {http://dx.doi.org/10.1007/s00415-009-0069-1},
  volume       = {256},
  year         = {2009},
}