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Establishing Consensus to Support and Enhance Parkinson’s Disease Management

A UK Modified Delphi Consensus Study
This study was initiated and funded by Bial Pharma UK.

Background and Rationale

Motor fluctuations, including wearing off and dyskinesia, affect up to 40% of patients within 4–6 years of L Dopa use2. Although L Dopa remains the cornerstone of Parkinson’s disease (PD) treatment, long term therapy is associated with motor complications4,2. Current guidelines recommend adjunctive therapies but provide limited practical guidance, contributing to variation in clinical practice and sub optimal care3.
This UK‑wide consensus sought to provide real‑world, expert‑led guidance to support earlier and more individualised treatment decisions.

Study Objectives

  • Agree a set strategy to optimise and implement L-Dopa therapy with adjunctive therapies

  • Agree on a set framework on the best practices for Parkinson’s disease management within NHS capacity

  • Gain consensus to support and enhance Parkinson's disease management

Methodology

  • Delphi consensus is a widely recognised and well-established methodology for capturing expert opinion and driving alignment where evidence is limited or evolving.

  • By using a structured, anonymised, and iterative process, it reduces bias and builds credible agreement among healthcare professionals. This rigour makes Delphi outputs both highly useful in clinical decision-making and suitable for peer-reviewed publication.

There is a growing need for healthcare consensus

The Delphi method is a credible, approach to support healthcare decision-making

Delphi process summary

  1. Statement development (Steering committee): 59 draft statements across 4 domains.

  2. Survey testing (wider expert panel, n=150): Ratings using a 4-point Likert scale.

  3. Consensus threshold: ≥75% agreement.

  4. Results analysis workshop (Steering committee): Interpretation of results.

  5. Manuscript development (Steering committee): Peer-reviewed article submission.

Expert consensus methodology

Using a modified Delphi approach

Expert Panel

The steering committee consisted of nine highly experienced UK experts across neurology, geriatrics, nursing, and clinical neuroscience. A wider multidisciplinary expert panel (n=150) participated in the Delphi survey, with balanced representation by role and level of experience.

Steering committee members

  • 9 experts in the panel across the UK

    • 3 neurologists

    • 2 geriatricians

    • 1 professor of clinical neuroscience

    • 1 professor of nursing

    • 1 advanced nurse practitioner

    • 1 Parkinson's disease specialist nurse


Consensus Results

Consensus was achieved for all 59 statements (100%).

Consensus results by topic and statement, final statement set (59 statements)

Agreement levels

≥90% agreement:

51 statements (86%).

<90% and ≥75% agreement:

8 statements (14%).

Overview of consensus domains:

Consensus domains

  • A: Initiating and monitoring L Dopa (14 statements).

  • B: Early identification of motor fluctuations (27 statements).

  • C: Use of adjunctive therapies (12 statements).

  • D: Best practice and education (6 statements).

Key Recommendations

Recomendations

Full Peer‑Reviewed Article

The full peer‑reviewed manuscript describing the methodology and detailed findings of this Delphi consensus study is available online.
Article link: A modified Delphi consensus study to support and enhance Parkinson's disease management

Conclusion

This modified Delphi consensus was led by 9 multidisciplinary experts across the UK.

All consensus statements achieved high levels of agreement from a multidisciplinary panel of 150 healthcare professionals involved in PD management.

Six evidence-based recommendations were reported in this study, aiming to enhance the management of PD. They emphasise earlier, individualised treatment decisions aligned with patient goals, timely detection of motor fluctuations such as wearing off, and the early* use of adjunctive therapies when appropriate within license.

By promoting earlier intervention and more structured follow-up, this consensus supports a proactive approach that may improve long-term outcomes and quality of life for people living with PD.

Use of medicines outside of their licensed indications cannot be recommended by Bial Pharma UK.

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WEB-NPD-UNB-GB-26-0005

April 2026