Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study
Background. Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson’s disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Objective. Fi...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Hindawi Limited
2024-01-01
|
| Series: | Parkinson's Disease |
| Online Access: | http://dx.doi.org/10.1155/2024/5522824 |
| _version_ | 1797206081917681664 |
|---|---|
| author | Trine Hørmann Thomsen Nick Schou Nielsen Asher Lou Isenberg Michael Hougaard Møller Jesper Bøje Clausen Inge Mona Schack Frederiksen Louise Olsen Mahsa Javidi Jeanet Vilhelmsen Marc Klee Olsen Bo Biering-Sørensen |
| author_facet | Trine Hørmann Thomsen Nick Schou Nielsen Asher Lou Isenberg Michael Hougaard Møller Jesper Bøje Clausen Inge Mona Schack Frederiksen Louise Olsen Mahsa Javidi Jeanet Vilhelmsen Marc Klee Olsen Bo Biering-Sørensen |
| author_sort | Trine Hørmann Thomsen |
| collection | DOAJ |
| description | Background. Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson’s disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Objective. Firstly, to evaluate the feasibility and safety of a home-based LCIG titration program and patients’/caregivers’ satisfaction. Secondly, to identify barriers and facilitators for home-based titration. Method. This study assesses the feasibility and safety of home-based titration of levodopa duodenal infusions with the use of self-reported evaluation questionnaires with open-ended questions included, registration of total time used, and number of contacts/visits. A telemedicine solution was used to remotely monitor the patients, adjust treatment, and provide support and guidance to patients and caregivers. Results. Ten of 12 PwPs (5 females and 7 males) completed the total titration program. Eight of the 12 PwPs were dependent on help. These 8 PwPs also had a high burden of nonmotor symptoms (NMS). Cognitive impairments varied in severity (range 16–30). Time spent with home visits was on average 93.4 minutes (ranging from 35 to 180 minutes), and the length of the total titration (LCIG initiation to termination of titration) was on average 3.4 days with 2–5 (mean 3.2) contacts/visits with PD team members. The average score on the satisfaction evaluation questionnaires was lower in the caregiver group (mean 31.8) than the PwP outcome (mean 36.2). Conclusions. Telehealth-assisted home-based titration programs are feasible due to the length of the titration period, number of contacts, and time spent in PwPs’ private homes, are rated satisfactory and safe by PwPs and caregivers, and may be a substitute for in-hospital treatment. Clinical recommendations including facilitators and barriers from a patient/caregiver perspective are displayed. This trial is registered with NCT4196647. |
| first_indexed | 2024-04-24T09:01:21Z |
| format | Article |
| id | doaj.art-faca256340d347228a9e724386047312 |
| institution | Directory Open Access Journal |
| issn | 2042-0080 |
| language | English |
| last_indexed | 2024-04-24T09:01:21Z |
| publishDate | 2024-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | Parkinson's Disease |
| spelling | doaj.art-faca256340d347228a9e7243860473122024-04-16T00:00:04ZengHindawi LimitedParkinson's Disease2042-00802024-01-01202410.1155/2024/5522824Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility StudyTrine Hørmann Thomsen0Nick Schou Nielsen1Asher Lou Isenberg2Michael Hougaard Møller3Jesper Bøje Clausen4Inge Mona Schack Frederiksen5Louise Olsen6Mahsa Javidi7Jeanet Vilhelmsen8Marc Klee Olsen9Bo Biering-Sørensen10Movement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicMovement Disorder ClinicBackground. Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson’s disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Objective. Firstly, to evaluate the feasibility and safety of a home-based LCIG titration program and patients’/caregivers’ satisfaction. Secondly, to identify barriers and facilitators for home-based titration. Method. This study assesses the feasibility and safety of home-based titration of levodopa duodenal infusions with the use of self-reported evaluation questionnaires with open-ended questions included, registration of total time used, and number of contacts/visits. A telemedicine solution was used to remotely monitor the patients, adjust treatment, and provide support and guidance to patients and caregivers. Results. Ten of 12 PwPs (5 females and 7 males) completed the total titration program. Eight of the 12 PwPs were dependent on help. These 8 PwPs also had a high burden of nonmotor symptoms (NMS). Cognitive impairments varied in severity (range 16–30). Time spent with home visits was on average 93.4 minutes (ranging from 35 to 180 minutes), and the length of the total titration (LCIG initiation to termination of titration) was on average 3.4 days with 2–5 (mean 3.2) contacts/visits with PD team members. The average score on the satisfaction evaluation questionnaires was lower in the caregiver group (mean 31.8) than the PwP outcome (mean 36.2). Conclusions. Telehealth-assisted home-based titration programs are feasible due to the length of the titration period, number of contacts, and time spent in PwPs’ private homes, are rated satisfactory and safe by PwPs and caregivers, and may be a substitute for in-hospital treatment. Clinical recommendations including facilitators and barriers from a patient/caregiver perspective are displayed. This trial is registered with NCT4196647.http://dx.doi.org/10.1155/2024/5522824 |
| spellingShingle | Trine Hørmann Thomsen Nick Schou Nielsen Asher Lou Isenberg Michael Hougaard Møller Jesper Bøje Clausen Inge Mona Schack Frederiksen Louise Olsen Mahsa Javidi Jeanet Vilhelmsen Marc Klee Olsen Bo Biering-Sørensen Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study Parkinson's Disease |
| title | Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study |
| title_full | Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study |
| title_fullStr | Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study |
| title_full_unstemmed | Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study |
| title_short | Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson’s Disease: An Observational Feasibility Study |
| title_sort | home based titration with duodenal infusion of levodopa carbidopa intestinal gel in people with parkinson s disease an observational feasibility study |
| url | http://dx.doi.org/10.1155/2024/5522824 |
| work_keys_str_mv | AT trinehørmannthomsen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT nickschounielsen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT asherlouisenberg homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT michaelhougaardmøller homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT jesperbøjeclausen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT ingemonaschackfrederiksen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT louiseolsen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT mahsajavidi homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT jeanetvilhelmsen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT marckleeolsen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy AT bobieringsørensen homebasedtitrationwithduodenalinfusionoflevodopacarbidopaintestinalgelinpeoplewithparkinsonsdiseaseanobservationalfeasibilitystudy |