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Disclosure:
Duffley reports that he received a grant from the National Institute of Nursing Research while conducting the study. Please refer to the study for all relevant financial information from the other authors.
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Postoperative home care after deep brain stimulation in Parkinson’s disease demonstrated efficacy, safety, and feasibility while reducing travel stress, according to the results of a single-center study published in JAMA Neurology.
“In combination with recent research results that prove the effectiveness of telemedicine-based preoperative screenings, effective at home [deep brain stimulation] post-operative management could create a future in which only travel is required to conceive [deep brain stimulation] is for the operation itself “, Gordon Duffley, PhD, from the Scientific Computing and Imaging Institute, University of Utah, and colleagues. “In order to develop a model of home health management that could be practically implemented in a community setting, we designed the experimental part of the study for home care workers who lacked years of experience in dealing with patients [deep brain stimulation] Treat PD. To address this problem, we developed the mobile application for PD [deep brain stimulation (MAP DBS)], a mobile decision support system for support [deep brain stimulation] Programming.”
Duffley and colleagues identified 75 patients to undergo deep brain stimulation for Parkinson’s at the University of Florida Health, 44 of whom were enrolled in the study. Investigators randomly assigned 21 patients to standard care and 23 patients postoperatively to home nursing Deep brain stimulation Treatment for 6 months after the operation. The researchers also enrolled primary caregivers, usually spouses, to study the caregiver’s exposure.
“Of the 44 patients included, 19 of 21 randomized patients received standard care (mean [standard deviation (SD)] Age, 64.1 [10] Years; 11 men) and 23 of 23 randomized home health care patients who underwent at least 1 postoperative management visit (mean [SD] Age, 65 [10.9] Years; 13 men) were included in the analysis, ”wrote Duffley and colleagues.
The primary endpoint was the frequency with which each patient traveled to the movement disorders clinic. Other endpoints included changes from baseline on the Unified Parkinson’s Disease Rating Scale Part 3.
Patients who have received Care at home compared to those who received standard care, had few clinic visits (mean [SD], 0.4 [0.8] Visits vs. 4.8 [0.4] Visits; P <.001), after Duffley and colleagues. With regard to the secondary endpoints, the researchers did not see any significant differences between the two groups. In addition, no adverse events related to the study procedure or devices were reported.
The researchers also assessed the development of the home nurses’ skills in programming deep brain stimulation. They found no significant correlation between the order of the first postoperative visits to deep brain stimulation, which demonstrated the “progressively increasing level” of programming experience for the nurse’s deep brain stimulation, and changes in no-drug, on-medication, and total scores according to the Unified Parkinson’s Disease Rating Scale Part 3 as well as other markers.
“This study showed that postoperative home nursing [deep brain stimulation] Care model was safe and feasible, and significantly reduced the need for traditional clinic management. Further evidence was gathered to demonstrate the effectiveness of the MAP. to demonstrate [deep brain stimulation] Technology to simplify the [deep brain stimulation] Programming process, ”wrote Duffley and colleagues. “The disruption of the traditional expert care model should lead to the thoughtful development of new care models that significantly reduce the burden on patients and caregivers and provide access to [deep brain stimulation] Therapy.”
perspective
Ethan Brown, MD
Even before the COVID-19 pandemic, getting deep brain stimulation in Parkinson’s disease could be a tedious process for patients. Reviews involve multiple visits, sometimes without medication, and can be time-consuming, expensive, and physically demanding. These barriers make deep brain stimulation inaccessible to many patients who live far from academic medical centers or who come from underserved populations. The pandemic has only exacerbated these problems and restricted people’s travel even further.
While the pandemic has led providers to conduct many of these assessments through telemedicine, programming deep brain stimulation has been an especially difficult activity that can be done remotely. Here, Duffley and colleagues demonstrate that these visits can be conducted effectively and safely at home. The authors randomized the patients to either normal personal follow-up visits or home follow-up visits. Follow-up examinations at home were carried out by a nurse, either by telephone with a patient’s programmer or at home with a programming device from the provider and the assistance of an app to visualize the location of the lead. The home health care group had fewer hospital visits and, more importantly, similar disease and quality of life outcomes at 6 months compared to the standard treatment group.
The ability to provide home follow-up care for programming deep brain stimulation would be a huge benefit for both patients and providers. Breaking down barriers to deep brain stimulation would widen the circle of patients who could receive this important and effective therapy and free up specialist clinics to treat the most urgent cases and evaluate new patients. Further study is needed to determine which patients are ideal candidates for home programming, what systematic changes are most needed, and to ensure that complications are not greater in this group. In this study, there were more adverse events in the home programming group, although the difference was not significant and the events were considered non-protocol related.
The rapidly changing nature of deep brain stimulation and the inevitable integration of wearable monitoring will only enhance our ability to treat these patients at home. This study is yet another example of how a clinical encounter believed to be needed in person can be made remotely and ultimately more inclusive and accessible to the challenges our patients face.
Ethan Brown, MD
Assistant Professor of Neurology
Classification of movement disorders and neuromodulation
Weill Institute for Neuroscience
University of California, San Francisco
Disclosure: Healio Neurology was unable to confirm any relevant financial information for Brown at the time of publication.
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