Entry 3: Evidence-Based Practice

Situation: During the second week of my placement I was told by my supervisor that in my final week I would be conducting a home visit on a gentleman with Parkinson’s Disease. The purpose of the visit would be to conduct a bi-annual assessment on his condition state. At this initial point in time I wasn’t provided with any more information than this.
It was at the start of my fourth week when I noticed the home visit in the appointment book again and I asked my supervisor if I could view the gentleman’s file at the practice so that I may begin preparing for the following week. I was granted this access and over the week took time to read his history and the results of the previous two assessments that had been conducted on this man. The assessment was an outcome measure designed especially for Parkinson’s Disease, the Unified Parkinson’s Disease Rating Scale (UPDRS).

Task: My task for the home visit was to complete the UPDRS and compare it to the previous results to assess how this man’s condition state was progressing.

Action: I read over the UPDRS a few times to familiarise myself with it, so as to enable me to conduct the assessment efficiently and effectively when the time came. To further prepare, I did some research on the UPDRS to see what additional information was available which would assist with my understanding of the scale. In my research I found that the UPDRS is one of, if not the most common assessment used by health care professionals, involving both a detailed subjective and objective assessment component to measure the severity of Parkinson’s symptoms and the stage of disease progression as well as for treatment and research strategies such as clinical trials for new treatment medications. In addition to this I found that there has recently been a series of modifications made to the scale to update it to meet the current perceptions and beliefs about Parkinson’s Disease, as opposed to what was understood when the scale was first developed over 20 years ago. The Movement Disorder Society’s new updated scale (MDS-UPDRS) has been devised to not only assess the motor aspects of Parkinson’s Disease, but to include assessment of the non-motor symptoms, such as thought and emotional processes which encompasses the new-age perception by specialists that Parkinson’s Disease is not just a movement disorder.
So I had a good read of the MDS-UPDRS and realised that the new scale was more than just the old scale with some additional questions, but it had been largely overhauled to incorporate the new changes. As a result of this, it would be difficult to infer results from the MDS-UPDRS to the original UPDRS to compare previous results for the gentleman. I presented my findings to my supervisor at the start of my last week and after a discussion we decided that for the sake of completeness that I should conduct both scales during my visit. The original UPDRS so that I could assess the disease progression by comparison to previous scores and the MDS-UPDRS so that we would have a rating using the most up to date resource, which could be used for the next assessment in six months time.
Result: I conducted both the UPDRS and the MDS-UPDRS for the gentleman on Thursday without any problems and then collated all the information to assess the results before presenting my findings to my supervisor. Comparison of the UPDRS results showed a minor increase in scores, reflecting a slight degree of disease progression compared with the last time the scale was conducted, but certainly nothing significant. With this I then compiled a letter which was sent to the man’s GP detailing the findings of my assessment.

Evaluation: On evaluation I feel that I did a very good job. I completed the task that was asked of me and feel I achieved much more than just what was asked of me by conducting additional research and implementing my findings into the task. It should also be easier for the future assessor(s) of this gentleman to perform the visit because I found the MDS-UPDRS to be a far superior scale than the original UPDRS. It was much more clear and concise with its instructions to both the examiner and the participant and the answers and scoring system was also much improved compared to the original UPDRS. I feel that conducting both assessments during my visit was the best action for me to take and was in the best interests of the whole team who is looking after this man and his condition. It took me personally more time and effort to conduct both assessments in the one visit, but it means that in future visits only the MDS-UPDRS will need to be conducted, which will serve even better than the UPDRS for identifying disease progression for the gentleman. My supervisor was also very pleased with my efforts and ability to conduct effective research which was very satisfying for me.

Strategies: What I’ve learnt from this experience is that science is always evolving and as a science-based profession we as therapists need to stay up to date with new developments and progressions. That it isn’t satisfactory when performing any assessment or treatment technique to simply say “this is the way I’ve always done it,” because it may be so, but it may not best option or method any more. For this reason we need to continually be researching and staying up to date with current best practice methods and techniques in order to provide the best possible quality of care for the people who are under our care. The other strategy that I’ll take from this is that through some self sacrifice and putting in the hard yards initially you can make things much easier for yourself in the future. In this case, it is not me that will benefit directly from my extra time and effort, but my supervisor and his future students performing the assessments on the man will reap the benefits of the MDS-UPDRS and my initial assessment using this tool. The gentleman will also benefit from this because the new scale will provide a better, more effective measure of the progression of his Parkinson’s Disease symptoms, enabling better quality of care and manageability of the condition.