Quality statement 3: Referral to physiotherapy, occupational therapy or speech and language therapy

Quality statement

Adults with Parkinson's disease are referred to physiotherapy, occupational therapy or speech and language therapy if they have problems with balance, motor function, activities of daily living, communication, swallowing or saliva.

Rationale

Adults with Parkinson's disease may experience a wide range of symptoms. Physiotherapy, occupational therapy and speech and language therapy can help people to manage their symptoms, maintain their independence and avoid hospital admission. After a referral to therapy services, it is important to ensure that therapists are included as part of the person's multidisciplinary team.

Quality measures

Structure

a) Evidence that physiotherapy, occupational therapy, and speech and language therapy specific for Parkinson's disease are available locally.

Data source: Local data collection, for example, service specifications.

b) Evidence of local processes to identify adults with Parkinson's disease and problems with balance, motor function, activities of daily living, communication, swallowing or saliva.

Data source: Local data collection, for example, service protocol. The UK Parkinson's Excellence Network UK Parkinson's Audit identifies whether reviews include a formal assessment tool or checklist for activities of daily living and the Parkinson's non-motor symptoms questionnaire or other form of checklist to screen for non-motor symptoms.

Process

a) Proportion of adults with Parkinson's disease and balance or motor function problems identified within the past 12 months who are referred for physiotherapy specific for Parkinson's disease.

Numerator – the number in the denominator who are referred for physiotherapy specific for Parkinson's disease.

Denominator – the number of adults with Parkinson's disease and balance or motor function problems identified within the past 12 months.

Data source: Local data collection, for example, audit of electronic patient health records. The UK Parkinson's Excellence Network UK Parkinson's Audit includes evidence of a physiotherapy referral.

b) Proportion of adults with Parkinson's disease and difficulties with activities of daily living identified within the past 12 months who are referred for occupational therapy specific for Parkinson's disease.

Numerator – the number in the denominator who are referred for occupational therapy specific for Parkinson's disease.

Denominator – the number of adults with Parkinson's disease and difficulties with activities of daily living identified within the past 12 months.

Data source: Local data collection, for example, audit of electronic patient health records. The UK Parkinson's Excellence Network UK Parkinson's Audit includes evidence of an occupational therapy referral.

c) Proportion of adults with Parkinson's disease and problems with communication, swallowing or saliva identified within the past 12 months who are referred for speech and language therapy specific for Parkinson's disease.

Numerator – the number in the denominator who are referred for speech and language therapy.

Denominator – the number of adults with Parkinson's disease and problems with communication, swallowing or saliva identified within the past 12 months.

Data source: Local data collection, for example, audit of electronic patient health records. The UK Parkinson's Excellence Network UK Parkinson's Audit includes evidence of speech and language therapy referrals for communication and swallowing.

Outcome

a) Health-related quality of life for adults with Parkinson's disease.

Data source: Local data collection, for example, patient survey.

b) Hospital admission rate for falls among adults with Parkinson's disease.

Data source: Local data collection, for example, audit of electronic patient health records.

c) Hospital admission rate for aspiration pneumonia among adults with Parkinson's disease.

Data source: Local data collection, for example, audit of electronic patient health records.

What the quality statement means for different audiences

Service providers (such as hospital elderly care services, neurology services, general practices and NHS community providers) ensure that adults with Parkinson's disease have regular assessments of balance, motor function, activities of daily living, communication, swallowing and saliva. If problems are identified they are referred for physiotherapy, occupational therapy or speech and language therapy specific for Parkinson's disease.

Healthcare professionals (such as neurologists, elderly care consultants, Parkinson's disease nurse specialists and GPs) are aware of local referral pathways to physiotherapy, occupational therapy and speech and language therapy for adults with Parkinson's disease. Healthcare professionals carry out regular assessments of balance, motor function, activities of daily living, communication, swallowing and saliva for adults with Parkinson's disease and refer them for physiotherapy, occupational therapy or speech and language therapy specific for Parkinson's disease if problems are identified.

Commissioners (such as clinical commissioning groups) commission physiotherapy, occupational therapy, and speech and language therapy specific for adults with Parkinson's disease and ensure that referral pathways are in place.

Adults with Parkinson's disease are referred to a physiotherapist for specialist treatment if they have problems with movement or balance. They are referred to an occupational therapist if they have difficulties with everyday activities such as dressing, cooking and working, and to a speech and language therapist if they have speech problems or problems with swallowing or drooling.

Source guidance

Parkinson's disease in adults (2017) NICE guideline NG71, recommendations 1.7.3, 1.7.6 and 1.7.8

Definitions of terms used in this quality statement

Activities of daily living

Includes personal care, dressing and bathing, housework, shopping, food preparation, eating and drinking, and ability to continue with current work and usual activities.

[NICE's guideline on motor neurone disease, recommendation 1.9.1]

Physiotherapy, occupational therapy and speech and language therapy specific for Parkinson's disease

Adults with Parkinson's disease should have contact with a physiotherapist, occupational therapist or speech and language therapist with experience of Parkinson's disease to ensure disease-specific care is given.

[NICE's guideline on Parkinson's disease in adults, recommendations 1.7.2, 1.7.5 and 1.7.7 and full guideline]