Study Finds Home-Based Postoperative Management of Deep Brain Stimulation Safe, Effective

A home health-based deep brain stimulation (DBS) model may effectively manage postoperative care needs for patients with Parkinson disease (PD), while also expanding the pool of clinicians who can provide such care, according to study findings published in JAMA Neurology.

Associated with significant long-term improvement of motor function in people with PD, the efficacy of DBS was noted by researchers to rely on postoperative management provided over 4 to 5 clinic visits during the first 6 months after surgery and regular adjustments for the remainder of a patient’s life.

Furthermore, due to the importance and perceived complexity of DBS management, the process is commonly performed by highly experienced experts based out of urban-located academic medical centers.

“As a result, patients, especially those who do not live close to a major medical center offering DBS, experience substantial out-of-pocket costs and travel-associated burdens to access DBS programming,” said the study authors. “Travel demands also create a substantial burden for patients’ caregivers, because PD-associated mobility deficits and other comorbidities often prevent independent travel.”

Seeking to address these notable barriers to care, the researchers examined the efficacy of a home-based DBS postoperative care model that would leverage nurses to conduct the DBS processes, including programming, within the home setting. Recruiting nurses who had no experience providing DBS care, the researchers developed Mobile Application for PD DBS (MAP DBS), a mobile decision support system to aid them during DBS programming.

“MAP DBS contains patient-specific computational models that provide interactive visual feedback on the association between DBS settings and activation of anatomical structures near the active electrode(s),” explained the study authors.

The 2-arm clinical trial randomized eligible patients with PD from University of Florida (UF) Health at a 1:1 ratio to receive either standard-of-care treatment (n = 19; mean [SD] age, 64.1 [10.0] years) or home health postoperative DBS management (n = 23; mean [SD] age, 65.0 [10.9] years) for 6 months after surgery.

The primary outcome assessed was the number of times each patient traveled to the UF Center for Movement Disorders and Neurorestoration during the study period from November 2017 to April 2020, with secondary outcomes including changes from baseline on the Unified Parkinson’s Disease Rating Scale Part III.

In their findings, patients randomized to the intervention group reported significantly fewer clinic visits compared with the standard-of-care group (mean [SD], 0.4 [0.8] visits vs 4.8 [0.4] visits; P < .001).

Overall, there was no significant difference in total DBS postoperative management visits, including in-person and telephone visits, for participants of the intervention and standard of care groups (mean, 5.2 [0.7] visits vs 4.8 [0.4] visits; P = .06).

No significant differences were found between the groups in the secondary outcomes measuring efficacy of DBS, with no adverse events associated with the study procedure or devices reported.

“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 DBS therapy,” concluded the study authors.

Reference

Duffley G, Lutz BJ, Szabo A, et al. Home health management of Parkinson disease deep brain stimulation: a randomized clinical trial. JAMA Neurol. 2021 Aug 1;78(8):972-981. doi:​10.1001/jamaneurol.2021.1910