Effectiveness of case management interventions in reducing common and potentially preventable complications associated with Parkinson’s disease:A systematic review and meta-analysis

Abstract Objective We sought to systematically examine the effectiveness of case management interventions on common and potentially preventable complications associated with Parkinson’s disease, both in persons with Parkinson’s disease and in persons with other chronic health conditions. We specifically focused on falls, depression, anxiety, hallucinations, urinary tract infections and swallowing impairments. Background There is no systematic insight in the effect of case management on common complications associated with Parkinson’s disease. This is an important knowledge gap given that people living with Parkinson's have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by key patient characteristics, such as their age, gender or disease characteristics. Such insights would contribute to a shift from “one size fits all” healthcare resource allocation to personalized medicine. Methods Using predefined inclusion criteria, we identified studies published up till February 2021 from PubMed and Embase databases. For each study, data were extracted independently by two researchers. Narrative analysis, and when possible also meta-analysis and random-effects analyses were undertaken. Results 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on feelings of anxiety (8 studies) or symptoms of depression (26 studies). Only one study was conducted in people with Parkinson’s disease. No study were identified that reported on how case management affected falls, hallucinations, urinary tract infections or swallowing impairments. Across meta-analyses, we observed a statistically significant effect of case management on reducing anxiety (Standardized Mean Difference [SMD] = − 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depression (SMD = − 0.48; CI: -0.71, -0.25). We found a large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. Conclusions Among people with chronic health conditions, case management has beneficial effects on symptoms of depression and feelings of anxiety, which are two common complications of Parkinson’s disease. However, these findings were based almost exclusively on interventions in people with other diseases. Future studies should assess the utility of case management for preventing complications in people with Parkinson’s disease, with a particular focus on the optimal content, frequency, and intensity of case management.