Does Pharmacological Adjustment Influence the Outcomes of In-Patient Multimodal Intensive Care? A Study in Patients with Moderately Advanced Parkinson's Disease.

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Background/Objectives: We have previously shown that motor and non-motor symptoms of patients with Parkinson's disease (PD) improved after a two-week in-patient multimodal intensive neurorehabilitation and care (iMINC). This program includes five hours/day for five days/week of multimodal neurorehabilitation and drug adjustments, taking advantage of extensive patient observation. In this study, we ascertained whether the improvements observed after iMINC similarly occurred in patients with and without drug adjustments. Methods: With a retrospective approach, the scores of UPDRS Total and Part III, Beck's Depression Inventory (BDI), PDQ-39, Parkinson's Disease Sleep Scale (PDSS), and Vocal Volume before and after two weeks of iMINC were compared in two groups of patients with moderate to advanced PD (H&Y Stage 3-4). In one group, drug adjustment was not necessary (PD no drug adjustment, PDnda, 38 patients), and another group underwent drug changes (PD with drug adjustment, PDda, 93 patients). Scores of all tests were compared using ANOVAs (within subject: before iMINC, after iMINC; between subject: PDda, PDnda). Results: Following iMINC, all outcome measures improved in both groups. Conclusions: Pharmacological adjustment is not the major factor that drives the improvement of motor and non-motor outcome scores following iMINC. These findings suggest that this comprehensive in-patient approach addresses most parkinsonian symptoms and that proper medication status may enhance the positive effects of iMINC.

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