Perspective from Ethan Brown, MD
Disclosures: Duffley reports receiving a grant from the National Institute of Nursing Research during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
July 02, 2021
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Home health care after deep brain stimulation safe, effective in Parkinson’s disease

Perspective from Ethan Brown, MD
Disclosures: Duffley reports receiving a grant from the National Institute of Nursing Research during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
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Postoperative home care after deep brain stimulation for Parkinson’s disease demonstrated efficacy, safety and feasibility while also decreasing travel burden, according to results from a single-center study published in JAMA Neurology.

“Combined with recent research that demonstrates the efficacy of telemedicine-based preoperative screening, effective in-home [deep brain stimulation] post-operative management could create a future where the only travel required to receive [deep brain stimulation] is for the surgery itself,” Gordon Duffley, PhD, of the Scientific Computing and Imaging Institute, University of Utah, and colleagues wrote. “To create a home health management model that could be feasibly implemented in a community setting, we designed the experimental arm of the study for home health nurses who lacked the years of experience thought to be needed to manage patients with [deep brain stimulation] to treat PD. To address this issue, we developed the Mobile Application for PD [deep brain stimulation (MAP DBS)], a mobile decision support system to aid in [deep brain stimulation] programming.”

Duffley and colleagues identified 75 patients who were to undergo deep brain stimulation for PD at the University of Florida Health, of which 44 were enrolled in the study. Investigators randomly assigned 21 patients to receive standard of care and 23 to home health postoperative deep brain stimulation management for 6 months after surgery. The researchers also enrolled primary caregivers, who were usually spouses, to examine caregiver strain.

“Of the 44 patients enrolled, 19 of 21 randomized patients receiving the standard of care (mean [standard deviation (SD)] age, 64.1 [10] years; 11 men) and 23 of 23 randomized patients receiving home health who underwent a minimum of 1 postoperative management visit (mean [SD] age, 65 [10.9] years; 13 men) were included in analysis,” Duffley and colleagues wrote.

The number of times each patient traveled to the movement disorders clinic served as the primary outcome. Other outcomes included changes from baseline on the Unified Parkinson’s Disease Rating Scale Part 3.

Patients who received home health care compared with those who received the standard of care had few clinic visits (mean [SD], 0.4 [0.8] visits vs. 4.8 [0.4] visits; P < .001), according to Duffley and colleagues. The researchers observed no significant differences between the two groups with regard to secondary outcomes. In addition, no adverse events related to the study procedure or the devices were reported.

The researchers also evaluated the evolution of the home health nurses’ capabilities in deep brain stimulation programming. They found no significant correlation between the order of the initial deep brain stimulation postoperative visits, which demonstrated the “progressively increasing level” of deep brain stimulation programming experience for the nurse, and changes in off-medication, on-medication and total scores according to the Unified Parkinson’s Disease Rating Scale Part 3, as well as other markers.

“This study demonstrated that a home health postoperative [deep brain stimulation] care model was safe and feasible and significantly reduced the need for traditional clinic management. Further evidence was collected to demonstrate the capability of the MAP [deep brain stimulation] technology to simplify the [deep brain stimulation] programming process,” Duffley and colleagues wrote. “Disruption of the traditional expert-based care model should lead to the thoughtful development of new care models designed to substantially reduce the burden on patients and caregivers and improve access to [deep brain stimulation] therapy.”