Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
IC – 171.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2023, vol. 32, nr 6, June, p. 623–631

doi: 10.17219/acem/157241

Publication type: meta-analysis

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Cite as:


Li T, Zou X, Kang Y, Sun M, Huang X, Duan X. A meta-analysis of the effect of multidisciplinary comprehensive care on health-related quality of life and Unified Parkinson’s Disease Rating Scale in Parkinson’s disease. Adv Clin Exp Med. 2023;32(6):623–631. doi:10.17219/acem/157241

A meta-analysis of the effect of multidisciplinary comprehensive care on health-related quality of life and Unified Parkinson’s Disease Rating Scale in Parkinson’s disease

Ting Li1,B,C, Xiumei Zou2,C,D, Yujuan Kang3,B,D,E, Mingzhu Sun1,B,C, Xi Huang1,B,C, Xiaoyan Duan4,A,E,F

1 School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China

2 Emergency Department,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China

3 Nursing Department, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China

4 Outpatient Department, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China

Graphical abstract


Graphical abstracts

Abstract

Introduction. According to many reports, multidisciplinary comprehensive care alleviates Parkinson’s disease (PD) more frequently than any other standard care, though the results were found to vary greatly.

Materials and methods. A systematic literature search up to July 2022 was performed and 1234 related studies were evaluated. The chosen studies comprised 1115 subjects with PD who participated in baseline trials; 633 of them were under multidisciplinary comprehensive care, while 482 were under standard care. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CIs) were calculated to measure the results of multidisciplinary comprehensive care for PD by the contentious and dichotomous approaches with a random or fixed influence model employed.

Results. The use of multidisciplinary comprehensive care resulted in significantly better health-related quality of life (HRQL) (MD: −3.17; 95% CI: −5.98–−0.35, p = 0.03) and Unified Parkinson’s Disease Rating Scale (UPDRS) score (MD: −5.25; 95% CI: −10.14–−0.37, p = 0.04) compared to the standard care for subjects with PD. Nevertheless, no significant difference was found between multidisciplinary comprehensive care and standard care for subjects with PD regarding medication dosage (MD: 0.31; 95% CI: −0.72–1.34, p = 0.56) and caregiver strain (MD: −0.51; 95% CI: −1.69–0.67, p = 0.40).

Conclusions. Outpatient multidisciplinary comprehensive care models may improve patient-reported HRQL and UPDRS score; nevertheless, no significant difference was found in terms of medication dosage and caregiver strain compared to the standard care for subjects with PD. The small sample size of 2 out of 7 analyzed studies and the small number of studies in certain comparisons requires attention when analyzing the results.

Key words: Parkinson’s disease, integrated care, health-related quality of life, Unified Parkinson’s Disease Rating Scale

Background

Parkinson’s disease (PD) is a progressive neurological condition with bradykinesia, tremor, stiffness, and postural instability as its hallmarks. These clinical symptoms can be present in several illnesses, and the clinical syndrome is known as parkinsonism. Parkinsonian disorders are conditions where parkinsonism is a dominant feature. Parkinson’s disease has toxic, traumatic and degenerative vascular etiologies.1 In autopsy series, synucleinopathies (Lewy body disease and multiple system atrophy) and tauopathies (progressive supranuclear palsy and corticobasal degeneration) are the most prevalent neurological causes of PD.2 Because the above causes include additional symptoms, some of these are regarded as atypical PD.3, 4 Parkinson’s disease is characterized by irregularities of movement, including tremors, gait and balance issues, and slowness of movement.5 The abnormalities of neuronal and muscular activity that are associated with these symptoms are well understood.6 Motor symptoms can also be described in terms of motor control, a level of description that explains how movement variables, such as a limb’s position and speed, are controlled and coordinated.7 Understanding motor symptoms as motor control abnormalities means identifying how the disease disrupts normal control processes.8, 9, 10, 11, 12, 13, 14 In the case of PD, movement slowness, for example, would be explained by a disruption of the control processes that determine normal movement speed.15, 16, 17, 18, 19, 20, 21, 22, 23 The capacity to manage behaviors can be impacted by emotions.24 The valence of emotional cues may have a varied impact on certain motor skills; however, it is unclear whether emotions have a positive or negative impact on action control.25 The stop-signal task, which calculates the ability to completely cancel a response to the presentation of a stop signal using the stop signal reaction times, is a method for measuring reactive inhibitory control.26 When challenged with emotional stimuli, such as stop signals in stop-signal tasks, action control is both impaired and assisted, with conflicting outcomes for positive compared to negative stimuli.27

Since the beginning of cognitive neuroscience, it has been known that emotions have an impact on several executive functions, including the inhibition of action; however, the intricate interplay between emotional stimuli and action regulation is still not fully comprehended.28 The stop-signal task is a method of assessing inhibitory control.29 Regarding internal emotional stimuli such as stop signals in stop-signal tasks, it has been discovered that action control is both aided and impaired.30

Currently, the most effective medical care available for patients with PD entails a medical professional applying cutting-edge diagnostic and therapeutic knowledge acquired from cohort studies and clinical trials.31 The ability, experience and intuition of medical professionals to translate knowledge based on collective decision-making to individual decision-making is crucial to the much-needed customization of medicine.32 Within 20 years, such individual therapeutic decisions will be substantially backed by digital technologies, creating a new healthcare ecosystem that is frequently referred to as “digital medicine.”33 New “digital health pathways” or data-driven personalized decision support, which is based on a combination of multimodal data sources, including evidence-based medical knowledge, is anticipated to be part of the next phase of digitalization (e.g., clinical guidelines).34 Currently, PD can only be treated with symptomatic medications.35 Both motor and a wide range of nonmotor symptoms in PD contribute to the general disease problem.36 This complexity calls for a personalized, all-encompassing therapeutic strategy. Given the variety of symptoms of the disease, PD nurses or care coordinators who specialize in the condition can support patients in achieving their unique therapeutic objectives.37 Better self-management information, adequate interdisciplinary collaboration amongst various healthcare professionals, appropriate amount of time to discuss potential future scenarios, and a specific healthcare professional guiding and support are among the reported core needs from the patient’s point of view.38 With widely differing degrees and intensities, several distinct multidisciplinary comprehensive care models have been formed globally to meet these needs.39 All of these models strive to provide PD patients with structured, individually tailored treatment programs. Until now, programs’ venues, team makeup or degree of clinical integration have not been consistent. The majority of programs do, nevertheless, adhere to some common disciplines. Additionally, the outcomes of published data vary in terms of study design and findings (including improvement in HRQL). The nomenclature employed is also not uniform, with care models most frequently being referred to as “multidisciplinary”, “interprofessional”, “interdisciplinary”, or “integrated”. The phrase “multidisciplinary comprehensive care” is consistently used. The delivery of multidisciplinary comprehensive care involves at least 1 patient and numerous healthcare workers from various specialties. The accessible data and evidence on present multidisciplinary comprehensive care models and their results concerning the improvements in the HRQL of PD patients are synthesized in the current meta-analysis and systematic review, along with Unified Parkinson’s Disease Rating Scale (UPDRS), medication dosage and caregiver strain. The most often used rating tool for PD is the UPDRS.40, 41 Three subscales, namely (I) Mentation, Behavior, and Mood; (II) Activities of Daily Living; and (III) Motor Examination, make up the total UPDRS score, which consists of 31 items.40 Although this information might provide help in clinical decision-making, the UPDRS does not evaluate general cardiovascular fitness and offers only scant details on functional performance relevant to daily activities. Therefore, it is important to assess the UPDRS’s ability to predict outcomes for time- and resource-intensive tests, such as ambulatory function.

Objectives

The objective of the study was to determine the outcomes of multidisciplinary comprehensive care for PD, e.g., HRQL, UPDRS, medication dosage, and caregiver strain.

Materials and methods

Information sources

All studies included in the analysis involved humans as research participants. Language or study scope were not among the inclusion or exclusion criteria. The list of publications did not include commentaries, review papers and papers that did not present any relationship between the studied phenomenons. The complete course of the study is shown in Figure 1. The studies were chosen for the meta-analysis when the following inclusion criteria were met:

1. The study was either a controlled trial, observational, prospective, or retrospective study.

2. The selected subjects were subjects with PD.

3. The intervention program included multidisciplinary comprehensive care.

4. The study was the consequence of multidisciplinary comprehensive care for PD.

The studies which did not present any comparison of outcomes within its protocol, studies that did not examine multidisciplinary comprehensive care in subjects with PD, and research papers on subjects with no PD or without multidisciplinary comprehensive care were excluded from the study.

Search strategy

A protocol regarding search strategy was developed following the PICOS concept, and was characterized as follows: population (P) – subjects with PD; intervention (I) – multidisciplinary comprehensive care technique; comparison (C) – multidisciplinary comprehensive care compared to standard care; outcomes (O) – HRQL, UPDRS, medication dosages, and caregiver strain; study design (S) – no restrictions.42, 43

A thorough search of the OVID, Embase, Cochrane Library, PubMed, and Google Scholar databases up to June 2022 was conducted, using an arrangement of key words and correlated terms regarding multidisciplinary comprehensive care, HRQL, PD, and UPDRS (as shown in Figure 1 and Table 1). To single out studies that did not examine the relationship between multidisciplinary comprehensive care and standard care in subjects with PD, all included papers were listed in an EndNote file, duplicates were eliminated, and the titles and abstracts were assessed.

Data collection process

The data collected for the purpose of the study included the last name of the first author, country, quantitative and qualitative assessment technique, the information source, the results of the assessment, and statistical analysis results.44

Study risk of bias assessment

Two authors individually evaluated the methodology of the 7 chosen papers to ascertain the possibility of bias in each study. The procedural quality was assessed using the “risk of bias instrument” from the Cochrane Handbook for Systematic Reviews of Interventions v. 5.1.0.45 Each study was assessed according to the evaluation criteria and assigned one of 3 levels of bias risk. A study was rated as having a low risk of bias if all the quality standards were met. If one or more requirements were not met, a study was rated as having a moderate risk of bias. High risk of bias occurred if one or more quality criteria were not met at all or were only partially met. The original article was revised to remove any inconsistencies.

Effect measures

Only the studies that reported and assessed the influence of multidisciplinary comprehensive care in comparison to standard care underwent sensitivity assessment. Sensitivity and subclass analyses were utilized to compare the consequences of multidisciplinary comprehensive care for PD.

Statistical analyses

The current meta-analysis used a fixed- or random-effects model with dichotomous and continuous techniques to compute the odds ratio (OR) and mean difference (MD) with a 95% confidence interval (95% CI). The heterogeneity (I2) index was calculated using a range of 0–100%. The values were around 0%, 25%, 50%, and 75%, respectively, and showed no, low, moderate, and high heterogeneity.46 Additional characteristics that show a high degree of similarity between the included studies were analyzed to confirm the employment of the correct model. The random-effects model was considered if I2 was 50% or above; if I2 was less than 50%, the likelihood of employing the fixed-effects model increased.46 By stratifying the initial evaluation according to the previously mentioned outcome categories, the subclass analysis was finished. The value of p = 0.05 indicated statistical significance for differences between the subcategories.

Reporting bias assessment

Publication bias was measured both qualitatively and statistically using the funnel plots and the Egger’s regression test, which display the logarithm of ORs or MDs compared to their standard errors (publication bias was considered for p = 0.05).47

Certainty assessment

Two-tailed tests were used to analyze all p-values. The graphs were created and the statistical analysis was conducted using Reviewer Manager v. 5.3 (The Cochrane Collaboration, Copenhagen, Denmark).

Results

From a total of 1234 examined studies, 7 articles published between 2003 and 2021 that met the requirements and were included in the meta-analysis were selected.48, 49, 50, 51, 52, 53, 54 Table 2 presents the findings from these studies. A total of 1115 subjects with PD participated in the selected studies’ baseline trials; 633 of them underwent multidisciplinary comprehensive care, while 482 were provided with standard care. Sample size of the analyzed studies was between 79 and 269. Six studies presented data organized according to the HRQL, 4 studies presented data organized according to UPDRS, 3 studies presented data organized according to the medication dosage, and ٢ studies presented data organized according to caregiver strain.

The use of multidisciplinary comprehensive care resulted in significantly better HRQL (MD: −3.17; 95% CI: −5.98–−0.35, p = 0.03, Z = 2.21, degrees of freedom (df) = 5) with moderate heterogeneity (I2 = 55%), and UPDRS (MD: −5.25; 95% CI: −10.14–−0.37, p = 0.04, Z = 2.11, df = 3) with moderate heterogeneity (I2 = 71%) compared to the standard care for subjects with PD (Figure 2, Figure 3). Nevertheless, no significant difference was found between multidisciplinary comprehensive care and standard care for subjects with PD in terms of medication dosage (MD: 0.31; 95% CI: −0.72–١.34, p = 0.56, Z = 0.59, df = 2) with no heterogeneity (I2 = 0%), and caregiver strain (MD: −0.51; 95% CI: −1.69–0.67, p = 0.40, Z = 0.85, df = 1) with low heterogeneity (I2 = 28%) (Figure 4, Figure 5).

Stratified models could not be utilized to examine the influence of some factors on comparison outcomes, such as gender, age and ethnicity, due to scarcity of data on these parameters. After performing quantitative evaluations using the Egger’s regression test and visual inspection of the funnel plot, there was no evidence of publication bias (p = 0.85, p = 0.83, p = 0.89, and p = 0.91, respectively, for HRQL, UPDRS, medication dosage, and caregiver strain) (Figure 6, Figure 7, Figure 8, Figure 9). Nevertheless, the bulk of the included randomized controlled trials were found to have subpar methodological quality, no bias in selective reporting, and scant outcome data.

Discussion

In the trials included in this meta-analysis, 1115 subjects with PD participated in baseline trials; 633 of them received multidisciplinary comprehensive care, while 482 were provided with standard care.48, 49, 50, 51, 52, 53, 54 The use of multidisciplinary comprehensive care resulted in significantly better HRQL and UPDRS compared to the standard care for subjects with PD. Nevertheless, no significant difference was found between multidisciplinary comprehensive care and standard care for subjects with PD in terms of medication dosage and caregiver strain. Caution should be taken when evaluating the results due to the modest sample size of 2 studies (n = 100) and the small number of studies including the comparisons, e.g., medication dosage and caregiver strain.

This systematic review identified several healthcare delivery models that provide PD patients with multidisciplinary comprehensive care. For a better understanding of the advantages and disadvantages of the various individual models, further information from head-to-head comparisons could be needed. Nevertheless, despite individual variations in the models, earlier studies on other topics, such as chronic lung illness, cancer treatment and chronic renal disease, have effectively analyzed the impact of multidisciplinary comprehensive care.55, 56, 57, 58 Although many concerns are still not answered, there are some important discoveries that might be taken into account for the application of present or future multidisciplinary comprehensive care models in PD.59 Some significant endorsements for the organization of integrated clinical care teams in PD have recently been made using a practice-based evidence approach.60 Additionally, some team members, such as the vascular medicine specialist,61 gastroenterologists,62 pulmonologist, neuro-ophthalmologist, urologist, geriatrician, palliative care specialist, and dentist, have not been recognized as “classic” candidates of a multidisciplinary comprehensive care model for PD.63 The inclusion of these specialties may raise awareness of the complexity of nonmotor symptoms linked to PD and encourage the commencement of more effective referrals to the appropriate healthcare providers.64, 65 According to a recent randomized controlled trial, extended multidisciplinary care is superior to conventional multidisciplinary rehabilitation in PD.66 Multidisciplinary comprehensive care models offer a probability to harmonize healthcare pathways, personalize healthcare utilization based on individual requirements, and improve patient–provider communication as digital infrastructures continue to develop.65 Nevertheless, there are few comprehensive statistics on these novel methods and their use. It is crucial to note that the fundamental objectives of multidisciplinary comprehensive care models might change in the future as researchers continue to look for disease-modifying treatments to slow down, halt or even reverse the neurodegenerative process linked to PD. The team makeup and overall design of multidisciplinary comprehensive care programs may need to be reviewed whenever major advancements in this area are made and some method of disease modification is truly available.

This meta-analysis assessed the results of multidisciplinary comprehensive care for PD. More homogeneous and larger study samples are necessary in such investigation. This was likewise emphasized in a previous work that employed a similar meta-analysis technique and yielded advantageous outcomes for multidisciplinary comprehensive care and standard care for subjects with PD.66, 67 Since in the present meta-analysis it was impossible to define whether the differences in gender, age and ethnicity are related to the outcomes, future randomized controlled trials are needed to evaluate these factors.

Limitations

Since several studies identified during the search were not included in the systemic review, there might have been a selection bias. However, the removed publications did not meet the necessary inclusion criteria. The sample size for 2 of the 7 chosen papers was less than 100. Furthermore, we were incapable to determine whether factors such as age, gender or ethnicity affected the outcomes of the study. The meta-analysis aimed to compare the outcomes of the standard care group with the multidisciplinary comprehensive care group for subjects with PD. The incorporation of data from earlier studies could have added bias due to incomplete or inaccurate data. Potential sources of bias included the nutritional status of the participants as well as their age and gender characteristics. Regrettably, some unpublished papers and missing data can bias the studied results.

Conclusions

The use of multidisciplinary comprehensive care resulted in significantly better HRQL and UPDRS compared to the standard care for subjects with PD. Nevertheless, no significant difference was found between multidisciplinary comprehensive care and standard care for subjects with PD in terms of medication dosage and caregiver strain. Thus, we encourage the use of multidisciplinary comprehensive care for PD subjects. Communication between team members is an important constituent of multidisciplinary comprehensive care and might need tailored solutions. Above all, maintaining the subject-centered approach in any care model requires constant feedback and availability of modification mechanism in which the subjects and caregiver play equally vital roles.

Availability of data

The corresponding author agrees to make the meta-analysis database available upon reasonable request.

Tables


Table 1. Search strategy for each database

Database

Search strategy

PubMed

#1 “multidisciplinary comprehensive care” [MeSH terms] OR “subjects with Parkinson’s disease” [all fields] OR “standard care” [all fields]

#2 “Unified Parkinson’s Disease Rating Scale” [MeSH terms] OR “Health Related Quality of Life new” [all fields]

#3 #1 AND #2

Embase

#1 “multidisciplinary comprehensive care”/exp OR “subjects with Parkinson’s disease”/exp OR “standard care”

#2 “Unified Parkinson’s Disease Rating Scale”/exp OR “Health Related Quality of Life”

#3 #1 AND #2

Cochrane Library

#1 “multidisciplinary comprehensive care”: ti,ab,kw OR “subjects with Parkinson’s disease”: ti,ab,kw OR “standard care”: ti,ab,kw (word variations have been searched)

#2 “Unified Parkinson’s Disease Rating Scale”: ti,ab,kw OR “Health Related Quality of Life”: ti,ab,kw (word variations have been searched)

#3 #1 AND #2
MeSH – medical subject headings; ti,ab,kw – terms in either title or abstract or keyword fields; exp – exploded indexing term.
Table 2. Characteristics of the studies selected for the meta-analysis

Study, year

Country

Total

Multidisciplinary comprehensive care

Standard care

Intervention application

Setting

Time

Control

Wade et al., 200348

UK

94

53

41

PD nurse

physical therapist

occupational therapist

social worker (program coordinator)

specialist center and general neurology clinic

baseline, 24 weeks

standard care

Tickle-Degnen et al., 201049

USA

116

76

40

movement disorder specialist

outpatient specialist center and home visits

post-treatment, 2 months, 4 months

standard care

van der Marck et al., 201350

Netherlands

100

51

49

movement disorder specialist

PD nurse

general neurologist

social worker (program coordinator)

outpatient specialist center and general neurology clinic

baseline, 4 months, 8 months

standard care with general neurology

Gage et al., 201451

UK

269

181

88

general neurologist

PD nurse

gerontologist

physical therapist

occupational therapist

speech therapist

non-nurse coordinator

community

baseline, 6 weeks, 24 weeks, 36 weeks

standard care

Eggers et al., 201852

Germany

257

132

125

movement disorders specialist

general neurologist

PD nurse

outpatient neurology clinic and home visits

baseline, 3 months, 6 months

standard care

Lo Buono et al., 202153

Italy

200

100

100

60 days of hospitalization rehabilitative program

neurorehabilitation unit

baseline, 2 months

standard care

Mitsui et al., 202154

Japan

79

40

39

physical therapist

occupational therapist

speech-language-hearing therapist;

2 categories of training: multidisciplinary rehabilitation consisting of conventional training of passive and active movements

Tokushima National Hospital, Japan

post-treatment, 32 months, 6 months

standard care

Total

1115

633

482

–
PD – Parkinson’s disease.

Figures


Fig. 1. Flowchart of the study
Fig. 2. The forest plot of multidisciplinary comprehensive care compared to standard care regarding the health-related quality of life (HRQL) outcomes in subjects with Parkinson’s disease (PD)
df – degrees of freedom; 95% CI – 95% confidence interval; SD – standard deviation.
Fig. 3. The forest plot of multidisciplinary comprehensive care compared to standard care regarding the Unified Parkinson’s Disease Rating Scale (UPDRS) results in subjects with Parkinson’s disease (PD)
df – degrees of freedom; 95% CI – 95% confidence interval; SD – standard deviation.
Fig. 4. The forest plot of multidisciplinary comprehensive care compared to standard care regarding the medication dosage outcomes in subjects with Parkinson’s disease (PD)
df – degrees of freedom; 95% CI – 95% confidence interval; SD – standard deviation.
Fig. 5. The forest plot of multidisciplinary comprehensive care compared to standard care regarding the caregiver strain outcomes in subjects with Parkinson’s disease (PD)
df – degrees of freedom; 95% CI – 95% confidence interval; SD – standard deviation.
Fig. 6. Health-related quality of life (HRQL) outcomes funnel plot
SE – standard error; MD – mean difference.
Fig. 7. Unified Parkinson’s Disease Rating Scale (UPDRS) outcomes funnel plot
SE – standard error; MD – mean difference.
Fig. 8. Medication dosage outcomes funnel plot
SE – standard error; MD – mean difference.
Fig. 9. Caregiver strain outcomes funnel plot
SE – standard error; MD – mean difference.

References (67)

  1. Litvan I. What is the accuracy of the clinical diagnosis of multiple system atrophy? A clinicopathologic study. Arch Neurol. 1997;54(8):937–944. doi:10.1001/archneur.1997.00550200007003
  2. Espay AJ. What the VaP? The meaning of “vascular parkinsonism.” Parkinsonism Relat Disord. 2022;94:132–134. doi:10.1016/j.parkreldis.2021.12.008
  3. Caproni S, Colosimo C. Diagnosis and differential diagnosis of Parkinson disease. Clinics Geriatr Med. 2020;36(1):13–24. doi:10.1016/j.cger.2019.09.014
  4. Zijlmans JCM, Daniel SE, Hughes AJ, Révész T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord. 2004;19(6):630–640. doi:10.1002/mds.20083
  5. Liaqat H, Parveen A, Kim SY. Neuroprotective natural products’ regulatory effects on depression via gut–brain axis targeting tryptophan. Nutrients. 2022;14(16):3270. doi:10.3390/nu14163270
  6. Wang Z, Pi YL, Wu Y, et al. Selective effects of exercise on reactive and proactive inhibition in Parkinson’s disease. PeerJ. 2022;10:e13628. doi:10.7717/peerj.13628
  7. Wang C, Chen L, Zhang M, Yang Y, Wong G. PDmethDB: A curated Parkinson’s disease associated methylation information database. Comput Struct Biotechnol J. 2020;18:3745–3749. doi:10.1016/j.csbj.2020.11.015
  8. Török N, Maszlag-Török R, Molnár K, et al. Single nucleotide polymorphisms of indoleamine 2,3-dioxygenase 1 influenced the age onset of Parkinson’s disease. Front Biosci (Landmark Ed). 2022;27(9):265. doi:10.31083/j.fbl2709265
  9. Holland C, Garner I, Simpson J, et al. Impacts of COVID-19 lockdowns on frailty and wellbeing in older people and those living with long-term conditions. Adv Clin Exp Med. 2021;30(11):1111–1114. doi:10.17219/acem/144135
  10. Tanaka M, Szabó Á, Spekker E, Polyák H, Tóth F, Vécsei L. Mitochondrial impairment: A common motif in neuropsychiatric presentation? The link to the tryptophan–kynurenine metabolic system. Cells. 2022;11(16):2607. doi:10.3390/cells11162607
  11. Tanaka M, Toldi J, Vécsei L. Exploring the etiological links behind neurodegenerative diseases: Inflammatory cytokines and bioactive kynurenines. Int J Mol Sci. 2020;21(7):2431. doi:10.3390/ijms21072431
  12. Zhang YJ, Zhu WK, Qi FY, Che FY. CircHIPK3 promotes neuroinflammation through regulation of the miR-124-3p/STAT3/NLRP3 signaling pathway in Parkinson’s disease [published online ahead of print on October 28, 2022]. Adv Clin Exp Med. 2022. doi:10.17219/acem/154658
  13. Sini P, Dang TBC, Fais M, et al. Cyanobacteria, cyanotoxins, and neurodegenerative diseases: Dangerous liaisons. Int J Mol Sci. 2021;22(16):8726. doi:10.3390/ijms22168726
  14. Tanaka M, Spekker E, Szabó Á, Polyák H, Vécsei L. Modelling the neurodevelopmental pathogenesis in neuropsychiatric disorders: Bioactive kynurenines and their analogues as neuroprotective agents. In celebration of 80th birthday of Professor Peter Riederer. J Neural Transm. 2022;129(5–6):627–642. doi:10.1007/s00702-022-02513-5
  15. Nyatega CO, Qiang L, Adamu MJ, Kawuwa HB. Gray matter, white matter and cerebrospinal fluid abnormalities in Parkinson’s disease: A voxel-based morphometry study. Front Psychiatry. 2022;13:1027907. doi:10.3389/fpsyt.2022.1027907
  16. Battaglia S. Neurobiological advances of learned fear in humans. Adv Clin Exp Med. 2022;31(3):217–221. doi:10.17219/acem/146756
  17. Carrera-González M del P, Cantón-Habas V, Rich-Ruiz M. Aging, depression and dementia: The inflammatory process. Adv Clin Exp Med. 2022;31(5):469–473. doi:10.17219/acem/149897
  18. Hsu YL, Hung HS, Tsai CW, et al. Peiminine reduces ARTS-mediated degradation of XIAP by modulating the PINK1/parkin pathway to ameliorate 6-hydroxydopamine toxicity and α-synuclein accumulation in Parkinson’s disease models in vivo and in vitro. Int J Mol Sci. 2021;22(19):10240. doi:10.3390/ijms221910240
  19. Tanaka M, Vécsei L. Editorial of Special Issue ‘Dissecting Neurological and Neuropsychiatric Diseases: Neurodegeneration and Neuroprotection.’ Int J Mol Sci. 2022;23(13):6991. doi:10.3390/ijms23136991
  20. Török N, Tanaka M, Vécsei L. Searching for peripheral biomarkers in neurodegenerative diseases: The tryptophan–kynurenine metabolic pathway. Int J Mol Sci. 2020;21(24):9338. doi:10.3390/ijms21249338
  21. Chen C. Recent advances in the study of the comorbidity of depressive and anxiety disorders. Adv Clin Exp Med. 2022;31(4):355–358. doi:10.17219/acem/147441
  22. Cao X, Yang F, Zheng J, Wang X, Huang Q. Aberrant structure MRI in Parkinson’s disease and comorbidity with depression based on multinomial tensor regression analysis. J Pers Med. 2022;12(1):89. doi:10.3390/jpm12010089
  23. Mazzoni P, Shabbott B, Cortes JC. Motor control abnormalities in Parkinson’s disease. Cold Spring Harb Perspect Med. 2012;2(6):a009282. doi:10.1101/cshperspect.a009282
  24. Battaglia S, Cardellicchio P, Di Fazio C, Nazzi C, Fracasso A, Borgomaneri S. Stopping in (e)motion: Reactive action inhibition when facing valence-independent emotional stimuli. Front Behav Neurosci. 2022;16:998714. doi:10.3389/fnbeh.2022.998714
  25. Chung EJ, Cho HJ, Hur DY, Kim YS, Lee KH, Kim SJ. One autopsy proved neocortical Lewy body disease without the involvement of the olfactory bulb and brainstem. J Korean Med Sci. 2022;37(23):e195. doi:10.3346/jkms.2022.37.e195
  26. Lee SH, Kim M, Lee J, et al. Clinical factors and dopamine transporter availability for the prediction of outcomes after globus pallidus deep brain stimulation in Parkinson’s disease. Sci Rep. 2022;12(1):16870. doi:10.1038/s41598-022-19150-3
  27. Dickson DW. Neuropathology of Parkinson disease. Parkinsonism Relat Disord. 2018;46(Suppl 1):S30–S33. doi:10.1016/j.parkreldis.2017.07.033
  28. Karni L, Jusufi I, Nyholm D, Klein GO, Memedi M. Toward improved treatment and empowerment of individuals with Parkinson disease: Design and evaluation of an Internet of things system. JMIR Form Res. 2022;6(6):e31485. doi:10.2196/31485
  29. Riggare S, Stamford J, Hägglund M. A long way to go: Patient perspectives on digital health for Parkinson’s disease. J Parkinsons Dis. 2021;11(Suppl 1):S5–S10. doi:10.3233/JPD-202408
  30. Dunn D, Williams A, Giust J, Kronenberger W. Epilepsy and attention-deficit hyperactivity disorder: Links, risks, and challenges. Neuropsychiatr Dis Treat. 2016;12:287–296. doi:10.2147/NDT.S81549
  31. Simonet C, Noyce AJ. Domotics, smart homes, and Parkinson’s disease. J Parkinsons Dis. 2021;11(Suppl 1):S55–S63. doi:10.3233/JPD-202398
  32. Spreadbury JH, Young A, Kipps CM. A comprehensive literature search of digital health technology use in neurological conditions: Review of digital tools to promote self-management and support. J Med Internet Res. 2022;24(7):e31929. doi:10.2196/31929
  33. Battaglia S, Cardellicchio P, Di Fazio C, Nazzi C, Fracasso A, Borgomaneri S. The influence of vicarious fear-learning in “infecting” reactive action inhibition. Front Behav Neurosci. 2022;16:946263. doi:10.3389/fnbeh.2022.946263
  34. Klucken J, Krüger R, Schmidt P, Bloem BR. Management of Parkinson’s disease 20 years from now: Towards digital health pathways. J Parkinsons Dis. 2018;8(Suppl 1):S85–S94. doi:10.3233/JPD-181519
  35. Bloem BR, Okun MS, Klein C. Parkinson’s disease. Lancet. 2021;397(10291):2284–2303. doi:10.1016/S0140-6736(21)00218-X
  36. Borgomaneri S, Serio G, Battaglia S. Please, don’t do it! Fifteen years of progress of non-invasive brain stimulation in action inhibition. Cortex. 2020;132:404–422. doi:10.1016/j.cortex.2020.09.002
  37. Mai T. Stand und Entwicklung der Rolle als Parkinson Nurse in Deutschland: Eine Online-Befragung. Pflege. 2018;31(4):181–189. doi:10.1024/1012-5302/a000617
  38. Vlaanderen FP, Rompen L, Munneke M, Stoffer M, Bloem BR, Faber MJ. The voice of the Parkinson customer. J Parkinsons Dis. 2019;9(1):197–201. doi:10.3233/JPD-181431
  39. Battaglia S, Fabius JH, Moravkova K, Fracasso A, Borgomaneri S. The neurobiological correlates of gaze perception in healthy individuals and neurologic patients. Biomedicines. 2022;10(3):627. doi:10.3390/biomedicines10030627
  40. Poewe W. Clinical measures of progression in Parkinson’s disease. Mov Disord. 2009;24(Suppl 2):S671–S676. doi:10.1002/mds.22600
  41. Ebersbach G, Baas H, Csoti I, Müngersdorf M, Deuschl G. Scales in Parkinson’s disease. J Neurol. 2006;253(Suppl 4):iv32–iv35. doi:10.1007/s00415-006-4008-0
  42. Stroup DF. Meta-analysis of observational studies in epidemiology: A proposal for reporting. JAMA. 2000;283(15):2008. doi:10.1001/jama.283.15.2008
  43. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–e34. doi:10.1016/j.jclinepi.2009.06.006
  44. Gupta A, Das A, Majumder K, et al. Obesity is independently associated with increased risk of hepatocellular cancer-related mortality: A systematic review and meta-analysis. Am J Clin Oncol. 2018;41(9):874–881. doi:10.1097/COC.0000000000000388
  45. Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). Cochrane Collaboration, 2011. https://handbook-5-1.cochrane.org/.
  46. Sheikhbahaei S, Trahan TJ, Xiao J, et al. FDG-PET/CT and MRI for evaluation of pathologic response to neoadjuvant chemotherapy in patients with breast cancer: A meta-analysis of diagnostic accuracy studies. Oncologist. 2016;21(8):931–939. doi:10.1634/theoncologist.2015-0353
  47. Higgins JPT. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. doi:10.1136/bmj.327.7414.557
  48. Wade DT, Gage H, Owen C, Trend P, Grossmith C, Kaye J. Multidisciplinary rehabilitation for people with Parkinson’s disease: A randomised controlled study. J Neurol Neurosurg Psychiatry. 2003;74(2):158–162. doi:10.1136/jnnp.74.2.158
  49. Tickle-Degnen L, Ellis T, Saint-Hilaire MH, Thomas CA, Wagenaar RC. Self-management rehabilitation and health-related quality of life in Parkinson’s disease: A randomized controlled trial. Mov Disord. 2010;25(2):194–204. doi:10.1002/mds.22940
  50. van der Marck MA, Bloem BR, Borm GF, Overeem S, Munneke M, Guttman M. Effectiveness of multidisciplinary care for Parkinson’s disease: A randomized, controlled trial. Mov Disord. 2013;28(5):605–611. doi:10.1002/mds.25194
  51. Gage H, Grainger L, Ting S, et al. Specialist rehabilitation for people with Parkinson’s disease in the community: A randomised controlled trial. Health Serv Deliv Res. 2014;2(51):1–376. doi:10.3310/hsdr02510
  52. Eggers C, Dano R, Schill J, Fink GR, Hellmich M, Timmermann L; CPN study group. Patient-centered integrated healthcare improves quality of life in Parkinson’s disease patients: A randomized controlled trial. J Neurol. 2018;265(4):764–773. doi:10.1007/s00415-018-8761-7
  53. Lo Buono V, Palmeri R, De Salvo S, et al. Anxiety, depression, and quality of life in Parkinson’s disease: The implications of multidisciplinary treatment. Neural Regen Res. 2021;16(3):587–590. doi:10.4103/1673-5374.293151
  54. Mitsui T, Arii Y, Tsukamoto A, et al. Sociability‐based fitness approach in Parkinson’s disease: Comparison with conventional rehabilitation. Eur J Neurol. 2021;28(6):1893–1900. doi:10.1111/ene.14798
  55. Kruis AL, Smidt N, Assendelft WJ, et al. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;9(9):CD009437. doi:10.1002/14651858.CD009437.pub2
  56. Wang SM, Hsiao LC, Ting IW, et al. Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis. Eur J Intern Med. 2015;26(8):640–645. doi:10.1016/j.ejim.2015.07.002
  57. Hoerger M, Wayser GR, Schwing G, Suzuki A, Perry LM. Impact of interdisciplinary outpatient specialty palliative care on survival and quality of life in adults with advanced cancer: A meta-analysis of randomized controlled trials. Ann Behav Med. 2019;53(7):674–685. doi:10.1093/abm/kay077
  58. Galbraith L, Jacobs C, Hemmelgarn BR, Donald M, Manns B, Jun M. Chronic disease management interventions for people with chronic kidney disease in primary care: A systematic review and meta-analysis. Nephrol Dial Transplant. 2017;33(1):112–121. doi:10.1093/ndt/gfw359
  59. Üstün TB, Kostanjesek N, Chatterji S, Rehm J, eds. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva, Switzerland: World Health Organization; 2010. https://apps.who.int/iris/handle/10665/43974. ISBN:978-92-4-154759-8.
  60. Valentijn PP, Vrijhoef HJM, Ruwaard D, Boesveld I, Arends RY, Bruijnzeels MA. Towards an international taxonomy of integrated primary care: A Delphi consensus approach. BMC Fam Pract. 2015;16(1):64. doi:10.1186/s12875-015-0278-x
  61. Valentijn PP, Pereira F, Sterner CW, et al. Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers. PLoS One. 2019;14(9):e0222593. doi:10.1371/journal.pone.0222593
  62. Stember M. Advancing the social sciences through the interdisciplinary enterprise. Soc Sci J. 1991;28(1):1–14. doi:10.1016/0362-3319(91)90040-B
  63. World Health Organization. Regional Office for Europe. Roadmap: Strengthening people-centred health systems in the WHO European Region. A framework for action towards Coordinated/Integrated Health Services Delivery (CIHSD). 2013. https://apps.who.int/iris/bitstream/handle/10665/108628/WHO-EURO-2013-4492-44255-62514-eng.pdf?sequence=1&isAllowed=y. Accessed March 1, 2022.
  64. Radder DLM, de Vries NM, Riksen NP, et al. Multidisciplinary care for people with Parkinson’s disease: The new kids on the block! Exp Rev Neurother. 2019;19(2):145–157. doi:10.1080/14737175.2019.1561285
  65. Marumoto K, Yokoyama K, Inoue T, et al. Inpatient enhanced multidisciplinary care effects on the quality of life for Parkinson disease: A quasi-randomized controlled trial. J Geriatr Psychiatry Neurol. 2019;32(4):186–194. doi:10.1177/0891988719841721
  66. Rajan R, Brennan L, Bloem BR, et al. Integrated care in Parkinson’s disease: A systematic review and meta-analysis. Mov Disord. 2020;35(9):1509–1531. doi:10.1002/mds.28097
  67. Seid AA, Demirdel E, Aychiluhm SB, Mohammed AA. Multidisciplinary rehabilitation for people with Parkinson’s disease: A systematic review and meta-analysis. Parkinson’s Dis. 2022;2022:2355781. doi:10.1155/2022/2355781
© Wroclaw Medical University