Assessment of ADLs and non-motor symptoms: Role of patient questionnaire

By Dr Sion Jones, Consultant Geriatrician, Ysbyty Gwynedd Hospital

NICE mandates the assessment of non-motor symptoms (NMS), activities of daily living (ADLs), appropriate review by allied health professionals and signposting to support services. Compliance (over the past year) was assessed during the recent national PD audit. 40 consecutive patients with PD attending two outpatient clinics (BCU West) were audited.

Generally we found good compliance, although there were notable exceptions: NMS including pain (2.5%), bladder function (55.5%), ADLs including hygiene and bed mobility (both 82.5%), and signposting and referrals including Parkinson’s UK (10%) and information support worker (12.5%).

Some patients had difficulties with the questionnaire (due to eyesight/handwriting). Complex patients gave multiple yes responses which led to long clinics!

As part of an intervention we introduced a patient questionnaire and formalised post clinic MDT proforma. Following approval gained by local audit department, we re-audited using a proforma based on selected domains of the national PD audit. This prospective audit covers 18 patients so far; we are aiming for 40 patients.

Enquiry/assessment re NMS before and after intervention (%):

Comparing results before and after the intervention, enquiry/assessment in all areas are improved, especially enquiries regarding pain and bladder symptoms. Signposting to Parkinson’s UK and information support worker were also improved.

This audit has demonstrated that introduction of a patient questionnaire and formalised MDT proforma increased the range of problems assessed in clinics. Further work is required to ascertain whether this leads to improved patient satisfaction or better outcomes.

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'The things you can't get from the books'

Parkinson's Academy, our original and longest running Academy, houses 20 years of inspirational projects, resources, and evidence for improving outcomes for people with Parkinson's. Led by co-founder and educational director Dr Peter Fletcher, the Academy has a truly collegiate feel and prides itself on delivering 'the things you can't get from books' - a practical learning model which inspires all Neurology Academy courses.