A modified Delphi consensus study to support and enhance Parkinson's disease management

Background
Levodopa is still the cornerstone of symptomatic treatment for people with Parkinson's disease (PwP). With disease progression and long-term use, PwP can develop motor complications such as wearing off and dyskinesia. There is limited practical guidance on the early identification of motor fluctuations and the optimal timing of adjunctive therapies in clinical practice.

Objective
To develop expert consensus on best practices for initiating and monitoring levodopa therapy, recognising early motor fluctuations, incorporating adjunctive therapies, and improving patient education in the management of Parkinson's disease (PD).

Methods
A modified Delphi methodology was used. A steering committee (SC) of nine clinicians with experience in managing PD drafted 59 consensus statements across four thematic domains. Statements were developed into an online survey and distributed to a panel of UK-based healthcare professionals (HCPs). Respondents rated their agreement using a four-point Likert scale. Consensus was defined as ≥75% agreement.

Results
A total of 150 HCPs completed the survey, including neurologists, geriatricians, and PD nurse specialists. Consensus was achieved for all 59 statements (100%). Key areas of agreement included early alignment of treatment with individual patient goals, the need for routine monitoring using standardised tools, timely initiation of adjunctive therapies, and the importance of accessible, ongoing patient and caregiver education.

Conclusions
This Delphi consensus provides a set of expert-derived, clinically applicable recommendations to support proactive and individualised management of PD. Adoption of these practices may enhance the recognition and treatment of motor fluctuations, improve patient quality of life, and support better long-term outcomes.