Missing appointments in Parkinson´s Disease: A longitudinal study on the pattern of attendance and its effects on motor and non-motor symptoms, quality of life and disability progression

Abstract

Background and purpose: Parkinson's Disease (PD) requires regular therapeutic adjustments and ongoing outpatient clinic follow-up. Nevertheless, the impact of appointment non-attendance on PD patients concerning the different symptomatic dimensions of the condition remains uncertain. We compared the level of attendance of PD and Essential Tremor (ET) patients and assessed the value of attendance variables as predictors of progression in cognition, motor dysfunction, affect, disability and health-related quality of life in PD.

Methods: The number of attended, no-shows and cancelled appointments of PD and ET patients were collected over 4 years. PD patients were assessed at baseline and 4 years later with the Non-Motor Symptoms Scale (NMSS), cognition (MoCA), disability (Schwab and England [S&E]), motor dysfunction (UPDRS-III), health-related quality of life measured with EQ-5D and hospital anxiety and depression scale (HADS). Linear regression (univariate) was used to test the correlation between the number of appointments (predictors) and absolute change in the NMSS, MoCA, S&E, UPDRS-III, EQ-5D and HADS.

Results: 62 PD and 35 ET patients were assessed. PD patients attended more appointments (8,08 ± 3,13 vs 5,43 ± 2,09) and had a similar number of no-shows (0,39 ± 0,66 vs 0,46 ± 0,70) and cancelled (0,74 ± 0,88 vs 0,54 ±0,65) appointments than ET patients. In the univariate analysis there was a significant relation between the number of cancelled appointments and change in the S&E score (B=6375; p=0022).

Conclusion: Our findings suggest the number of cancelled appointments, but not no-shows, could be considered a predictor of disability progression in PD.

Keywords: Appointments; Attendance; Disability; Parkinson disease.