Specialized versus Generic Allied Health Therapy and the Risk of Parkinson’s Disease Complications

ABSTRACT: Background: Specialized versus generic physiotherapy (PT) reduces Parkinson’s disease (PD)–related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S&LT), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications.

Objectives: To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S&LT was associated with the incidence rate of PD‐related complications. Methods: We used claims data of all insured persons
with PD in the Netherlands between January 1, 2010, and December 31, 2018. Parkinson Net-trained therapists were classified as specialized, and other therapists as
generic. We used mixed-effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics.

Results: The population of 51,464 persons with PD(mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD-related complications during follow-up
(median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74–0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77–0.99]; P = 0.03). We found a trend of an association between specialized S&LT and a lower
rate of PD-related complications (IRR = 0.88 [0.74–1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42–0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73–0.82]; P < 0.0001) and of S&LT
with pneumonia (IRR = 0.70 [0.53–0.93]; P = 0.03).

Conclusions: These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions.