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Hong J, Xie H, Chen Y, Liu D, Wang T, Xiong K, Mao Z. Effects of STN-DBS on cognition and mood in young-onset Parkinson's disease: a two-year follow-up. Front Aging Neurosci 2024; 15:1177889. [PMID: 38292047 PMCID: PMC10824910 DOI: 10.3389/fnagi.2023.1177889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the cognition and mood of patients with PD are still not uniformly concluded, and young-onset Parkinson's disease (YOPD) is even less explored. Objective To observe the effectiveness of STN-DBS on the cognition and mood of YOPD patients. Methods A total of 27 subjects, with a mean age at onset of 39.48 ± 6.24 and age at surgery for STN-DBS of 48.44 ± 4.85, were followed up preoperatively and for 2 years postoperatively. Using the Unified Parkinson disease rating scale (UPDRS), H&Y(Hoehn and Yahr stage), 39-Item Parkinson's Disease Questionnaire (PDQ-39), Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) to assess motor, cognition, and mood. Results At the 2-year follow-up after STN-DBS, YOPD patients showed significant improvements in motor and quality of life (UPDRS III: p < 0.001, PDQ-39: p < 0.001); overall cognition was not significantly different from preoperative (MMSE: p = 0.275, MoCA: p = 0.913), although language function was significantly impaired compared to preoperative (MMSE: p = 0.004, MoCA: p = 0.009); depression and anxiety symptoms also improved significantly (HAMD: p < 0.001, HAMA: p < 0.001) and the depression score correlated significantly with motor (preoperative: r = 0.493, p = 0.009), disease duration (preoperative: r = 0.519, p = 0.006; postoperative: r = 0.406, p = 0.036) and H&Y (preoperative: r = 0.430, p = 0.025; postoperative: r = 0.387, p = 0.046); total anxiety scores were also significantly correlated with motor (preoperative: r = 0.553, p = 0.003; postoperative: r = 0.444, p = 0.020), disease duration (preoperative: r = 0.417, p = 0.031), PDQ-39 (preoperative: r = 0.464, p = 0.015) and H&Y (preoperative: r = 0.440, p = 0.022; postoperative: r = 0.526, p = 0.005). Conclusion STN-DBS is a safe and effective treatment for YOPD. The mood improved significantly, and overall cognition was not impaired, were only verbal fluency decreased but did not affect the improvement in quality of life.
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Affiliation(s)
- Jun Hong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huimin Xie
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuhua Chen
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Tianyu Wang
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Hebei Key Laboratory of Nerve Injury and Repair, Chengde Medical University, Chengde, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Leeper H, Cooper D, Armstrong T. Palliative Care Intervention Trials for Adults Living With Progressive Central Nervous System Diseases and Their Caregivers: A Systematic Review. J Pain Symptom Manage 2022; 63:e88-e110. [PMID: 34147576 PMCID: PMC8683574 DOI: 10.1016/j.jpainsymman.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Interest in implementing palliative care for adults living with progressive central nervous system diseases (PCNSD) and their caregivers is increasing. OBJECTIVES To inform evidence-based practice and future research by critically evaluating randomized clinical trials (RCTs) investigating palliative care interventions (PCIs) for adults living with PCNSD and their caregivers using self-reported outcomes and the patient- and caregiver-reported outcome measures employed. METHODS A systematic search using PRISMA methods of EMBASE, PubMed, Scopus, Web of Science databases using index and keyword methods for articles published from inception through February 28, 2021 was performed. RCTs investigating PCI as their primary aim using patient- and/or caregiver-reported outcomes to assess PCI effectiveness in adults living with PCNSD and their caregivers were included for qualitative synthesis. RESULTS Five RCTs met criteria and used 21 unique outcome measures. Pooled patient diagnoses included multiple sclerosis, motor neuron disease and movement disorders, primarily Parkinson's Disease. All five RCTs assessed PCI effectiveness on patient symptom burden and caregiver burden, and three RCTs used patient QOL as a primary outcome. Overall risk of bias was low. Pooled positive findings were limited to very modest changes in patient QOL, specific physical symptoms and caregiver burden. Most outcome measures lacked clinimetric responsiveness to detect change whether caused by disease or an intervention to the patient or caregiver. CONCLUSION Sparse, low-certainty evidence for PCI impact on patient QOL, symptom burden and caregiver burden indicate future research should consider refining study populations, interventions, outcomes assessed and outcome measures to detect any change due to PCI.
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Affiliation(s)
- HeatherE Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland.
| | - Diane Cooper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
| | - TerriS Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
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Nehra A, Sharma P, Narain A, Sharma S, Joshi G, Bhat P, Singh RK, Rajan R, Goyal V, Srivastava AK. Enhancing Quality of Life in Indian Parkinson's Disease Patients with Improved Measurement of Psychological Domains: A Perspective. Ann Indian Acad Neurol 2021; 24:132-137. [PMID: 34220053 PMCID: PMC8232502 DOI: 10.4103/aian.aian_410_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/11/2020] [Accepted: 09/11/2020] [Indexed: 12/03/2022] Open
Abstract
Parkinson's disease (PD) is the second most common progressive neuro-degenerative disorder. Research in PD is gradually increasing in India due to increased clinical cases, which could double by 2030 worldwide. Although its prevalence is low in India as compared to other countries, the total burden is much higher due to the large population size. PD is progressively debilitating, with pronounced motor and nonmotor symptoms (NMSs) that severely affect the quality of life (QoL) of patients and their caregivers. The progressive nature of the disease lays great emphasis on doctors to focus on the patients' QoL. As a consequence, Health-related QoL (HRQoL) has gradually become one of the main indicators for assessing health-related outcome. There is a growing need to pay attention to the NMSs and a pressing need to look at the QoL of Indian patients with PD through a culture and value specific lens. Research into the holistic QoL assessment with emphasis on psychological domains may allow for the early evaluation and intervention of depressive and cognitive symptoms in PD. This could result into increased productivity, reduced morbidity, and healthcare cost, which would in turn result into better QoL of Indian PD patients.
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Affiliation(s)
- Ashima Nehra
- Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Priya Sharma
- Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Avneesh Narain
- Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Shivani Sharma
- Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Garima Joshi
- Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | | | | | - Roopa Rajan
- Department of Neurology, AIIMS, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Medanta, Gurgaon, Haryana, India
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Ehlers C, Timpka J, Odin P, Honig H. Levodopa infusion in Parkinson's disease: Individual quality of life. Acta Neurol Scand 2020; 142:248-254. [PMID: 32383152 DOI: 10.1111/ane.13260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) features both motor and non-motor symptoms that substantially impact quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) reduces motor complications and improves some non-motor symptoms in advanced PD (APD). Change in patients' health-related quality of life (hrQoL) is a common endpoint in PD trials and has become an important factor in judging overall effect of LCIG. However, hrQoL is considered to be only one dimension of QoL. The primary aim of this prospective observational study was to observe the effects of LCIG on individual quality of life (iQoL) in PD and caregivers. The secondary aim was to investigate its effects on patients' motor and non-motor symptoms as well as effects on caregiver burden. MATERIALS & METHODS Utilizing the Schedule for the Evaluation of Individual Quality of Life-Questionnaire (SEIQoL-Q) and the Personal Wellbeing Index-Adult (PWI-A), twelve patients with advanced PD and their caregivers were followed for six months after initiation of LCIG treatment. RESULTS At the final follow-up, improvements of iQoL for patients (median SEIQoL index improvement 0.16, P < .05) and caregivers (median SEIQoL index improvement 0.20, P < .05) were seen together with improvements of motor and non-motor symptoms. There were no significant improvements of hrQoL. CONCLUSIONS The study results indicate that LCIG improves iQoL in PD in addition to the improvement of motor and non-motor symptoms. Furthermore, this study signals that LCIG may also contribute to improvement of iQoL in caregivers.
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Affiliation(s)
- Claas Ehlers
- Department of Neurology Hospital Bremerhaven Reinkenheide Bremerhaven Germany
| | - Jonathan Timpka
- Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Neurology Skane University Hospital Lund Sweden
| | - Per Odin
- Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Neurology Skane University Hospital Lund Sweden
| | - Holger Honig
- Department of Neurology Hospital Bremerhaven Reinkenheide Bremerhaven Germany
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Wiblin L, Lee M, Burn D. Palliative care and its emerging role in Multiple System Atrophy and Progressive Supranuclear Palsy. Parkinsonism Relat Disord 2017; 34:7-14. [DOI: 10.1016/j.parkreldis.2016.10.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 12/25/2022]
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Martinez-Martin P. What is quality of life and how do we measure it? Relevance to Parkinson's disease and movement disorders. Mov Disord 2016; 32:382-392. [PMID: 27911002 DOI: 10.1002/mds.26885] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/13/2022] Open
Abstract
Health-related quality of life is a patient-reported outcome that complements clinical evaluation and provides information about disease activity and effects of the treatment. The objective of this review is to present the conceptual framework, the measures, and some of their most relevant applications in the field of Parkinson's disease and movement disorders. Health-related quality of life is a subjective, individual, and multidimensional construct, and its main dimensions are physical, mental, and social, besides global perceptions of health and personal domains. Health-related quality of life measurement is carried out by means of questionnaires or scales, ideally self-applied by patients, and has a diversity of important applications for clinical practice, research, and health policy. Movement disorders and Parkinson's disease are complex conditions impacting all components of patients' health-related quality of life. The use of health-related quality of life tools provides important information on a variety of aspects that are important to patients while complementing clinical evaluations. In particular, studies using this kind of assessment can identify and monitor the most important health-related quality of life determinant factors, allowing tailored assistance and prioritized interventions. In addition, maintaining or improving the patients' health-related quality of life is an objective of care for chronic diseases and, therefore, it has to be monitored over time and as an outcome of clinical trials. Several methods are available for the interpretation of the change in scores of health-related quality of life measures, although a definitive agreement on the most appropriate method is yet to be determined. Presently, health-related quality of life assessment is an important outcome for research and management of chronic conditions such as Parkinson's disease and other movement disorders. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
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Fereshtehnejad SM. Strategies to maintain quality of life among people with Parkinson's disease: what works? Neurodegener Dis Manag 2016; 6:399-415. [PMID: 27600287 DOI: 10.2217/nmt-2016-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among chronic neurodegenerative disorders, Parkinson's disease (PD) is one of the most difficult and challenging to tackle as several motor and nonmotor features influence the patients' quality of life (QoL) and daily activities. Assessing patients QoL with valid instruments and gathering knowledge about the determinants that affect QoL in individuals with PD are the basis of an efficient caring strategy. In addition to the known motor symptoms, nonmotor disorders must also be comprehensively tracked and targeted for treatment to enhance QoL. A holistic strategy to maintain QoL in people with PD should consist of a multidisciplinary, personalized and patient-centered approach with timely administration of palliative care and efficient involvement of caregivers and family members.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences & Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal General Hospital, Montreal, Québec, Canada
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Individualized quality of life of severely affected multiple sclerosis patients: practicability and value in comparison with standard inventories. Qual Life Res 2016; 25:2755-2763. [PMID: 27125955 DOI: 10.1007/s11136-016-1303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Individualized quality of life (QoL) measures differ from traditional inventories in that QoL domains/weights are not predetermined, but identified by the individual. We assessed practicability of the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW) interview in severely affected multiple sclerosis (MS) patients; the key QoL dimensions identified; and the correlation of the SEIQoL-DW index score with standard patient-reported outcome measures (PROMs). METHODS Participants were people with severe MS who performed the baseline visit of the PeNSAMI trial (ISRCTN73082124). The SEIQoL-DW was administered at the patient's home by a trained examiner. Patients then received the following PROMs: the Core-Palliative care Outcome Scale (Core-POS), the Palliative care Outcome Scale-Symptoms-MS (POS-S-MS), the European Quality of Life Five Dimensions-3L (EQ-5D-3L), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Of 59 enrolled patients, 11 (19 %) did not receive the SEIQoL-DW (and the other PROMs) because of severe cognitive compromise or inability to communicate. SEIQoL-DW administration was completed and deemed valid in all 48 cases (mean age 60 years, 58 % women, median Expanded Disability Status Scale score 8.5). Mean SEIQoL-DW index score was 59.1 (SD 25.5). The most commonly nominated SEIQoL-DW areas were family (94 % of the patients), relationships, and leisure activities (both 65 %). Core-POS and POS-S-MS contained 70 % of the SEIQoL-DW-nominated areas. Nevertheless, correlations between SEIQoL-DW index, Core-POS, and POS-S-MS (and the other PROMs) were negligible. CONCLUSIONS Individualized QoL can be assessed in severely affected MS patients, providing information that is not tracked by the standard inventories Core-POS, POS-S-MS, EQ-5D-3L, and HADS.
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Takahashi K, Kamide N, Suzuki M, Fukuda M. Quality of life in people with Parkinson's disease: the relevance of social relationships and communication. J Phys Ther Sci 2016; 28:541-6. [PMID: 27065542 PMCID: PMC4793007 DOI: 10.1589/jpts.28.541] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/06/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Maintaining high quality of life is crucial for the rehabilitation of patients
with Parkinson’s disease. The quality of life scales currently in use do not assess all
quality of life domains or their importance for each individual. Therefore, a new quality
of life measure, the Schedule for the Evaluation of Individual Quality of Life-Direct
Weighting, was used to investigate quality of life in people with Parkinson’s disease.
[Subjects and Methods] Fifteen people with idiopathic Parkinson’s disaese (average age =
80.0 years, standard deviation = 10.3 years, Hoehn & Yahr stages 1–4) were interviewed
using the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting. Its
quality of life constructs were tested by comparing them against disease-specific quality
of life (39-items Parkinson’s Disease Questionnaire), motor functioning (Unified
Parkinson’s Disease Rating Scale Part III), and activities of daily living (Barthel
Index). [Results] Social connections such as “family” and “friends” were revealed as
important constructs of life satisfaction. The Schedule for the Evaluation of Individual
Quality of Life-Direct Weighting was not significantly correlated with the 39-items
Parkinson’s Disease Questionnaire, Unified Parkinson’s Disease Rating Scale Part III, or
Barthel Index but was significantly correlated with the “communication” dimension of the
39-items Parkinson’s Disease Questionnaire. [Conclusion] The Schedule for the Evaluation
of Individual Quality of Life-Direct Weighting detected various domains of quality of
life, especially social relationships with family and friends. “Being heard” was also
revealed as an essential component of life satisfaction, as it provides patients with a
feeling of acceptance and assurance, possibly resulting in better quality of life.
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Affiliation(s)
| | - Naoto Kamide
- School of Allied Health Sciences, Kitasato University, Japan
| | - Makoto Suzuki
- School of Allied Health Sciences, Kitasato University, Japan
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Effect of subthalamic nuclei electrical stimulation in the treatment of Parkinson's disease. Cell Biochem Biophys 2016; 71:113-7. [PMID: 25099644 DOI: 10.1007/s12013-014-0169-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of this study was to evaluate the clinical efficacy of deep brain stimulation (DBS) and subthalamic nuclei stimulation (STN) in the treatment of Parkinson's disease. A total of 32 patients with Parkinson's disease who continuously treated in our hospital with STN-DBS from November 2011 to November 2013 were selected. All the patients received follow-up evaluation, psychological status questionnaire survey and analysis before surgery and 3 months after surgery using unified Parkinson's disease rating scale (UPDRS), Self-rating depression scale (SDS), and symptom checklist (SCL-90). After turned on the impulse generator (IPG), the daily activities and motor function of UPDRS in all the 32 cases of Parkinson's disease patients were in "turn off" state; the mean improvement rates were 51.7 and 60.9%; when the daily activities and motor function in the state of "turn on", the mean improvement rates were 21.4 and 22.3%. In 20 cases, the preoperative SDS > 50, the levels of depression, anxiety, somatization, interpersonal sensitivity, hostility, fear, and paranoia of SCL-90 were significant higher than the Chinese traditional levels (P < 0.05). Comparison of the preoperative and postoperative depression, somatization, fear, anxiety, and psychotic factor of SCL-90 found that there was negative correlation between preoperation and postoperation, and the differences were significant (P < 0.05), while there were no significant differences in interpersonal sensitivity and paranoia (P > 0.05). STN-DBS can improve the motor function and ability of daily life of Parkinson's disease patients and can significantly improve the psychological condition of the patients with Parkinson's disease and depression; it is a safe and effective method to the treatment of Parkinson's disease.
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Health-Related Quality of Life in patients with Parkinson's disease--A systematic review based on the ICF model. Neurosci Biobehav Rev 2015; 61:26-34. [PMID: 26645499 DOI: 10.1016/j.neubiorev.2015.11.014] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 01/16/2023]
Abstract
We analyzed features associated with a reduction in Health-Related Quality of Life (HRQoL) in people with idiopathic Parkinson's disease (PD). As a new approach, features were embedded in the WHO framework for measuring health and disability, the ICF model. From 609 articles screened, 114 articles were included. Features aligned with the ICF's body functions and structures domain (BFS) were investigated more often than personal features, activities of daily living, environmental factors, and participation in societal roles (95, 42, 35, 29 and 14 times, respectively). The strongest associations were found for the relationships between HRQoL and "psychosocial functioning" from the participation domain and HRQoL, and "mobility limitations" from the activities domain. For the BFS, non-motor symptoms were more closely associated with reduced HRQoL than motor symptoms. In conclusion, this systematic review (i) provides entirely new insights in the association of HRQoL with PD features, (ii) shows an imbalance between most extensively investigated and most relevant features for HRQoL, and (iii) demonstrates the usefulness of the ICF model for such an approach.
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Cavalla P, Zibetti M, Rivoiro C, Oliver DJ. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Support Palliat Care 2015; 7:164-172. [DOI: 10.1136/bmjspcare-2014-000788] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
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Titova NV, Katunina EA. [Current possibilities of quality of life improvement in the late stages of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:94-100. [PMID: 26171484 DOI: 10.17116/jnevro20151153194-100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this review, the authors describe the influence of Parkinson's disease on of the quality of life (QoL) of patients and highlight the importance of this parameter for assessment of treatment efficacy. Special attention is drawn to improvement of QoL in patients with resistant motor complications using invasive methods based on continuous dopaminergic stimulation. In the aspect of the influence on QoL, the main results of the studies of levodopa-carbidopa intestinal gel are reviewed.
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Affiliation(s)
- N V Titova
- Pirogov Russian Research Medical University, Moscow
| | - E A Katunina
- Pirogov Russian Research Medical University, Moscow
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Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, Palmisano L, Amadeo R, Martino G, Ponzio M, Casale G, Borreani C, Causarano R, Veronese S, Zaratin P, Battaglia MA. Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial. Trials 2015; 16:184. [PMID: 25899519 PMCID: PMC4409986 DOI: 10.1186/s13063-015-0695-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background Preliminary evidence suggests that palliative care may be useful for people with severe multiple sclerosis (MS). The aim of this study is to determine the effectiveness of a home-based palliative approach (HPA) for people with severe MS and their carers. Methods/design This is a single-blind randomized controlled trial with a nested qualitative study. Seventy-five severe MS-carer dyads are being randomized (at three centers, one in each area of Italy) to HPA or usual care (UC) in a 2:1 ratio. Each center has a specially trained team consisting of four professionals (physician, nurse, psychologist, social worker). The team makes a comprehensive assessment of the needs of the dyads. HPA content is then agreed on, discussed with the patient’s caring physician, and delivered over six months. The intervention is not intended to replace existing services. At later visits, the team checks the HPA delivery and reviews/modifies it as necessary. HPA and UC dyads are assessed at home by a blind examiner at baseline, and three and six months later; they also receive monthly telephone interviews. Dyads assigned to UC receive the examiner’s visits and telephone interviews, but not the team visits. Primary outcome measures are changes in symptoms (Palliative care Outcome Scale-Symptoms-MS, POS-S-MS), and quality of life (the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), not assessed in patients with severe cognitive compromise) at three and six months. Other outcomes are changes in patient functional status and mood; changes in carer quality of life, mood and caregiving burden; costs; incorporation with standard care; unplanned hospital admissions; referrals to hospice; and deaths. The experience of participants will be evaluated qualitatively by individual semi-structured interviews (HPA patients and carers) and focus group meetings (HPA patients’ caring physicians). Discussion The results of our study will show whether the HPA is feasible and beneficial to people with severe MS and their carers living in the three Italian geographic areas. The nested qualitative study will add to the understanding of the strengths and limitations of the intervention. Trial registration The trial was registered with Current Controlled Trials (identifier: ISRCTN73082124) on 19 June 2014.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Via Ardeatina 306, 00179, Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania; MS Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Roberta Amadeo
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giovanni Martino
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Michela Ponzio
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giuseppe Casale
- Antea Charitable Association, Piazza Santa Maria della Pietà 5, 00135, Rome, Italy.
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Renzo Causarano
- Unit of Palliative Care-Hospice, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Morgari 12, 10125, Turin, Italy.
| | - Paola Zaratin
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
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15
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Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK. Improved nutritional status is related to improved quality of life in Parkinson's disease. BMC Neurol 2014; 14:212. [PMID: 25403709 PMCID: PMC4237731 DOI: 10.1186/s12883-014-0212-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/27/2014] [Indexed: 01/04/2023] Open
Abstract
Background Quality of life is poorer in Parkinson’s disease than in other conditions and in the general population without Parkinson’s disease. Malnutrition also results in poorer quality of life. This study aimed at determining the relationship between quality of life and nutritional status. Methods Community-dwelling people with Parkinson’s disease >18 years old were recruited. The Patient-Generated Subjective Global Assessment (PG-SGA) assessed nutritional status. The Parkinson’s Disease Questionnaire 39 (PDQ-39) measured quality of life. Phase I was cross-sectional. The malnourished in Phase I were eligible for a nutrition intervention phase, randomised into 2 groups: standard care (SC) with provision of nutrition education materials only and intervention (INT) with individualised dietetic advice and regular weekly follow-up. Data were collected at baseline, 6 weeks, and 12 weeks. Results Phase I consisted of 120 people who completed the PDQ-39. Phase II consisted of 9 in the SC group and 10 in the INT group. In Phase I, quality of life was poorer in the malnourished, particularly for mobility and activities of daily living domains. There was a significant correlation between PG-SGA and PDQ-39 scores (Phase I, rs = 0.445, p = .000; Phase II, rs = .426, p = .002). In Phase II, no significant difference in the PDQ-39 total or sub-scores was observed between the INT and SC groups; however, there was significant improvement in the emotional well-being domain for the entire group, X2(2) = 8.84, p = .012. Conclusions Malnourished people with Parkinson’s disease had poorer quality of life than the well-nourished, and improvements in nutritional status resulted in quality of life improvements. Attention to nutritional status is an important component of quality of life and therefore the total care of people with Parkinson’s disease. Trial registration ACTRN12610000819022
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Affiliation(s)
- Jamie M Sheard
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
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16
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Antonini A, Tolosa E. Apomorphine and levodopa infusion therapies for advanced Parkinson’s disease: selection criteria and patient management. Expert Rev Neurother 2014; 9:859-67. [DOI: 10.1586/ern.09.48] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Conceptualizing and prioritizing clinical trial outcomes from the perspectives of people with Parkinson's disease versus health care professionals: a concept mapping study. Qual Life Res 2014; 23:1687-700. [PMID: 24390766 DOI: 10.1007/s11136-013-0614-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Focusing clinical investigations on outcomes that are meaningful from an end-user perspective is central in clinical research, particularly in chronic disorders such as Parkinson's disease (PD). However, little is known about how end-users such as people with PD (PwPD) and health care professionals (HCPs) view and prioritize therapeutic outcomes. PURPOSE To compare the perspectives of PwPD and HCPs regarding prioritized areas for outcome measurement in clinical PD trials. METHODS Concept mapping was used to identify prioritized outcomes (statements) through focus groups (n = 27; 12 PwPD, 12 HCPs, three researchers), statement sorting and importance rating (n = 38; 19 PwPD, 19 HCPs), followed by quantitative (multidimensional scaling, cluster analysis, procrustes analysis) and qualitative analysis. RESULTS Sorting of 99 statements by PwPD and HCPs yielded 2D maps (PwPD/HCPs stress values, 0.31/0.21) with eight clusters per group. The correlation between raw sorting data of PwPD and HCPs was 0.80, and there was a significant concordance (m 12 = 0.53; P < 0.001; i.e., r = 0.68) between the spatial arrangements in their respective maps. Qualitatively, the maps from the two groups represented partially different perspectives. There were no significant differences between PwPD and HCP item importance ratings. CONCLUSION Although similarities dominated, there were differences in how the relationships between items were perceived by the two groups, emanating from different perspectives, i.e., the clinical biomedical ("disease") versus the lived experience ("illness"). This study illustrates the clinical importance of attention to the perspective of PwPD; taking this into account is likely to provide evidence from clinical investigations that are meaningful and interpretable for end-users.
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18
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Kudlicka A, Clare L, Hindle JV. Quality of life, health status and caregiver burden in Parkinson's disease: relationship to executive functioning. Int J Geriatr Psychiatry 2014; 29:68-76. [PMID: 23625583 DOI: 10.1002/gps.3970] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/12/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-quality person-centred care for people with Parkinson's disease (PwPD) and their families relies on identifying and addressing factors that specifically impact on quality of life (QoL). Deficits in executive functions (EF) are common in Parkinson's disease, but their impact on PwPD and their caregivers is not well understood. The present study evaluated how EF contributes to QoL and health status for the PwPD and caregiver burden. METHODS Sixty-five PwPD completed measures of QoL, health status and EF, and 50 caregivers rated the EF of the PwPD and their own burden. Multiple regression analyses examined predictors of QoL (general life, health and movement disorders domains), health status and caregiver burden. RESULTS Quality of life in the health and movement disorders domains was best explained by caregiver-rated EF, whereas QoL in the general life domain was best explained by level of depression. Health status was predicted by self-rated EF, with an objective EF measure also included in the regression model. Caregiver burden was best explained by caregiver-rated EF and disease severity, with general cognition and other factors also included in the regression model. CONCLUSIONS Executive functions-related behavioural problems may contribute to QoL and health status in PwPD and affect caregiver burden. The findings support the view that the concepts of subjective QoL and self-assessed health status are only partially related and should not be seen as identical. Adequate strategies to reduce the impact of EF deficits are needed as this may have the potential to improve QoL in PwPD.
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19
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Walker RW. Palliative care and end-of-life planning in Parkinson's disease. J Neural Transm (Vienna) 2013; 120:635-8. [PMID: 23328948 DOI: 10.1007/s00702-013-0967-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
In Parkinson's disease (PD) typical "palliative care" type symptoms, such as pain, nausea, weight loss and breathlessness can occur throughout the condition, but become more prevalent in later disease stages. Pain may be specifically related to PD, e.g. dystonic pain with wearing off, but is more commonly due to other conditions. The cause can usually be elicited by a careful history and examination, and this guides intervention, both non-pharmaceutical, and pharmaceutical. For example, dystonic pain will respond best to appropriate changes to dopaminergic medication. In later disease stages people have increasing problems with swallowing, and also cognitive impairment. Impaired swallowing may lead to aspiration pneumonia, which is a common cause of hospital admission, and also death. Decisions about interventions towards the end of life, such as insertion of percutaneous endoscopic gastrostomy (PEG) tube for nutrition, can be very challenging, particularly if, as in most cases, the person with PD has not previously expressed their views upon this while they still maintained capacity to make decisions. Advance care planning (ACP) in PD should be encouraged in relation to interventions such as PEG tubes. It may also cover issues such as preferred place of death. Over recent years lower proportions of people have been dying at home, and this is especially true for PD, but home may well be where they would have preferred to die. However, there is little evidence to guide health professionals about how, when, and by whom, ACP should be approached.
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Affiliation(s)
- Richard William Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
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20
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Social support associated with quality of life in home care patients with intractable neurological disease in Japan. Nurs Res Pract 2012; 2012:402032. [PMID: 23091713 PMCID: PMC3467861 DOI: 10.1155/2012/402032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/12/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to investigate what kinds of social supports contribute to the higher quality of life (QOL) of home care patients with intractable neurological disease. We investigated the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and social supports to 74 patients with intractable neurological disease in a city of the Aichi prefecture, Japan. Association between WHOQOL and social supports was examined using multiple logistic regression analyses adjusting activities of daily living (ADL). High WHOQOL scores were associated with “attending patient gatherings held by the public health center,” “having someone who will listen empathically to anxieties or troubles,” and ADL. Physical health was associated with ADL, while psychological well-being was related to “having a hobby,” “having someone who will listen,” and “having a hospital for admission in emergencies.” Patients not having someone who will listen were more likely to participate in the gatherings. The present findings suggest that having someone who will provide emotional support is important for home care patients with neurological diseases. Patient gatherings held by the public health center were expected to provide patients with emotional support.
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21
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Sjödahl Hammarlund C, Nilsson MH, Hagell P. Measuring outcomes in Parkinson’s disease: a multi-perspective concept mapping study. Qual Life Res 2011; 21:453-63. [DOI: 10.1007/s11136-011-9995-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2011] [Indexed: 11/24/2022]
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22
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Rendas-Baum R, Buck PO, White MK, Castelli-Haley J. Psychometric validation of the revised SCOPA-Diary Card: expanding the measurement of non-motor symptoms in Parkinson's disease. Health Qual Life Outcomes 2011; 9:69. [PMID: 21851616 PMCID: PMC3173285 DOI: 10.1186/1477-7525-9-69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/18/2011] [Indexed: 11/11/2022] Open
Abstract
Background To identify key non-motor symptoms of Parkinson's disease (PD) to include in a daily diary assessment for off-time, revise the Scales for Outcomes of Parkinson's disease Diary Card (SCOPA-DC) to include these non-motor symptoms, and investigate the validity, reliability and predictive utility of the Revised SCOPA-DC in a U.S. population. Methods A convenience sample was used to recruit four focus groups of PD patients. Based on findings from focus groups, the SCOPA-DC was revised and administered to a sample of 101 PD patients. Confirmatory factor analysis was conducted to test the domain structure of the Revised SCOPA-DC. The reliability, convergent and discriminant validity, and ability to predict off-time of the Revised SCOPA-DC were then assessed. Results Based on input from PD patients, the Revised SCOPA-DC included several format changes and the addition of non-motor symptoms. The Revised SCOPA-DC was best represented by a three-factor structure: Mobility, Physical Functioning and Psychological Functioning. Correlations between the Revised SCOPA-DC and other Health-Related Quality of Life scores were supportive of convergent validity. Known-groups validity analyses indicated that scores on the Revised SCOPA-DC were lower among patients who reported experiencing off-time when compared to those without off-time. The three subscales had satisfactory predictive utility, correctly predicting off-time slightly over two-thirds of the time. Conclusions These findings provide evidence of content validity of the Revised SCOPA-DC and suggest that a three-factor structure is an appropriate model that provides reliable and valid scores to assess symptom severity among PD patients with symptom fluctuations in the U.S.
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Martinez-Martin P, Jeukens-Visser M, Lyons KE, Rodriguez-Blazquez C, Selai C, Siderowf A, Welsh M, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG, Schrag A. Health-related quality-of-life scales in Parkinson's disease: Critique and recommendations. Mov Disord 2011; 26:2371-80. [PMID: 21735480 DOI: 10.1002/mds.23834] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/28/2011] [Accepted: 05/02/2011] [Indexed: 11/08/2022] Open
Affiliation(s)
- Pablo Martinez-Martin
- Alzheimer Disease Research Unit, CIEN Foundation-Reina Sofia Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain.
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24
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Hall S, Opio D, Dodd RH, Higginson IJ. Assessing quality-of-life in older people in care homes. Age Ageing 2011; 40:507-12. [PMID: 21459859 DOI: 10.1093/ageing/afr027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND many measures of quality-of-life (QoL) may not be suitable for older people in care homes, and do not cover the most relevant domains for individuals. OBJECTIVE to describe QoL of older people living in care homes using the SEIQoL-DW and the two 10-point rating scales, and to describe how people were using these measures. DESIGN we used quantitative methods to describe QoL, and qualitative methods to explore residents' experiences of completing the measures. SETTING three care homes in the United Kingdom. SAMPLE twenty residents. METHODS residents completed the measures in interviews. We report descriptive statistics for QoL, the most important QoL domains for residents, completion rates and experiences of administering the instruments. RESULTS the most important QoL domains identified in the SEIQoL-DW were leisure activities; family; relationships; social life; independence and peace and contentment. Physical limitations and difficulty in understanding the instructions and concepts made completing it a challenge. The SEIQoL index was strongly correlated with a single 10-point rating of current QoL (rho = 0.67, P = 0.007). CONCLUSIONS to fully understand residents' QoL, detailed interview-based instruments, administered by an experienced interviewer are needed. To measure current QoL, for example, as an outcome measure, a simple single rating scale may suffice.
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Affiliation(s)
- Sue Hall
- King's College London, Palliative Care, Policy and Rehabilitation, London, UK.
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25
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Müller T, Woitalla D. Quality of life, caregiver burden and insurance in patients with Parkinson's disease in Germany. Eur J Neurol 2011; 17:1365-9. [PMID: 20443985 DOI: 10.1111/j.1468-1331.2010.03033.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND German health politicians claim that maintenance and thus quality of life (QoL) of patients with chronic disease do not differ between the various healthcare insurance systems in Germany. Patient organizations i.e. the Deutsche Parkinson Vereinigung for patients with Parkinson's disease (PD), physicians, patients themselves and their carers controversially discuss this opinion making by politicians. METHODS We performed a survey to analyse the relations between QoL, insurance, disability and caregiver burden in 2603 patients with PD and their carers. RESULTS Insurance with private reimbursement provides a significant better self-reported patient disability and QoL according to the various employed rating instruments in patients with PD. Government employees with PD, who have additional private insurance, demand for significant shorter intervals of care giving by their carers. In general, caregiver burden did not significantly differ between patients with PD of the different healthcare insurance systems. CONCLUSION At least in Germany, obligatory medical insurance with associated state regulation of health care is inferior to private reimbursement insurance in various domains of QoL.
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Affiliation(s)
- T Müller
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Gudrunstrasse, Bochum, Germany.
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26
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Miyashita M, Narita Y, Sakamoto A, Kawada N, Akiyama M, Kayama M, Suzukamo Y, Fukuhara S. Health-related quality of life among community-dwelling patients with intractable neurological diseases and their caregivers in Japan. Psychiatry Clin Neurosci 2011; 65:30-8. [PMID: 21105961 DOI: 10.1111/j.1440-1819.2010.02155.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The aims of this study were: (i) to clarify the general quality of life (QOL) of patients with intractable neurological disease; (ii) to clarify the general QOL of the caregivers of these patients; and (iii) to explore the association of QOL in patient-caregiver pairs. METHODS A cross-sectional survey was conducted between November 2003 and May 2004 among community-dwelling patients diagnosed with Parkinson's disease (PD), spinocerebellar degeneration (SCD), multiple system atrophy (MSA), and amyotrophic lateral sclerosis (ALS) and their caregivers using a mailed, self-administered questionnaire. To measure QOL, we used the Medical Outcome Study 36-Item Short Form (SF-36) for patients and the short form of the health-related QOL scale SF-36 (SF-8) for caregivers. RESULTS A total of 418 questionnaires were analyzed. For the patients, all of the general QOL domains of the SF-36 were significantly lower than the national standard value for all of the diagnoses. Physical function, role physical, and role emotional domains were also low. For caregivers, all of the QOL summary scores of the SF-8 for all diagnoses were significantly lower than the national standard value. Although there were several significant correlations of QOL between patients and caregivers, overall the correlations were low. CONCLUSIONS Support for patients with neurological diseases and their caregivers is needed in order to maintain physical and mental QOL.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
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27
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Farquhar M, Ewing G, Higginson IJ, Booth S. The experience of using the SEIQoL-DW with patients with advanced chronic obstructive pulmonary disease (COPD): issues of process and outcome. Qual Life Res 2010; 19:619-29. [PMID: 20224901 DOI: 10.1007/s11136-010-9631-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the experience of using the SEIQoL-DW for the measurement of quality of life with patients with advanced COPD and consider its feasibility, acceptability and appropriateness for a Phase III randomised controlled trial (RCT). METHODS The SEIQoL-DW was administered according to its instructions within a Phase II RCT 3-5 times per patient, across 13 patients and the process audio-recorded. Quantitative and qualitative criteria were used to assess feasibility, acceptability and appropriateness. Qualitative analysis of the transcripts and fieldwork notes was conducted using Framework Analysis. RESULTS The SEIQoL-DW steps (of identifying five quality of life cues, rating their functioning and importance) were completed at 48/51 interviews. However, some respondents were overwhelmed by the scripted introduction, experienced difficulty with cue identification, and focused only on certain types of cues (Step 1); some had difficulty interpreting and rating the concept of Step 2; and some had difficulty interpreting 'importance' and manipulating the SEIQoL-DW disc (Step 3). CONCLUSIONS Patients with advanced COPD were able to complete the SEIQoL-DW but analysis of its administration identified practical and conceptual concerns which question the validity of the results obtained. Suggestions for the development of the SEIQoL-DW and future feasibility studies are given.
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Affiliation(s)
- Morag Farquhar
- General Practice and Primary Care Research Unit, Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, and Addenbrooke's Hospital, Cambridge University Hospitals' NHS Foundation Trust, Robinson Way, Cambridge, CB2 0SR, UK.
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28
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Antonini A, Chaudhuri KR, Martinez-Martin P, Odin P. Oral and infusion levodopa-based strategies for managing motor complications in patients with Parkinson's disease. CNS Drugs 2010; 24:119-29. [PMID: 20088619 DOI: 10.2165/11310940-000000000-00000] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Levodopa is the most effective treatment for Parkinson's disease (PD) signs and symptoms, and patients invariably will require it during the course of the disease. It also provides benefits in activities of daily living, quality of life and life expectancy. However, after a few years of levodopa treatment the majority of patients will experience motor fluctuations and dyskinesia. Initial use of a dopamine receptor agonist may delay the emergence of motor fluctuations but at the cost of reduced symptomatic control compared with the use of levodopa in some cases. Adequate management of motor fluctuations and dyskinesia is essential to maintaining satisfactory quality of life at the advanced stage of disease. Various levodopa-based strategies are currently available that aim to control motor complications (wearing-off and dyskinesia) in PD and each approach has its own unique benefit and risk profile. Strategies such as dose fragmentation (smaller, more frequent dosing) or the use of orally administered, liquid levodopa formulations or melevodopa can reduce off-time intervals or facilitate absorption. More recently introduced, continuous delivery of dopaminergic medications may represent a more effective approach to treat motor complications in advanced PD and its effect can be perceived from improvement in clinical scales, as well as in health-related items. Indeed, continuous levodopa delivery by duodenal infusion may stabilize and significantly improve motor function as well as patients' quality of life. We propose a treatment algorithm that takes into account all currently available levodopa-based treatment strategies for motor complications in patients with PD.
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29
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Taminiau-Bloem EF, Visser MRM, Tishelman C, Koeneman MA, van Zuuren FJ, Sprangers MAG. Somatically ill persons' self-nominated quality of life domains: review of the literature and guidelines for future studies. Qual Life Res 2010; 19:253-91. [PMID: 20047087 PMCID: PMC2816248 DOI: 10.1007/s11136-009-9569-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review which domains somatically ill persons nominate as constituting their QoL. Specific objective is to examine whether the method of enquiry affect these domains. METHODS We conducted two literature searches in the databases PubMed/Medline, CINAHL and Psychinfo for qualitative studies examining patients' self-defined QoL domains using (1) SEIQoL and (2) study-specific questions. For each database, two researchers independently assessed the eligibility of the retrieved abstracts and three researchers subsequently classified all QoL domains. RESULTS Thirty-six eligible papers were identified: 27 studies using the SEIQoL, and nine presenting data derived from study-specific questions. The influence of the method of enquiry on patients' self-nominated QoL domains appears limited: most domains were presented in both types of studies, albeit with different frequencies. CONCLUSIONS This review provides a comprehensive overview of somatically ill persons' self-nominated QoL domains. However, limitations inherent to reviewing qualitative studies (e.g., the varying level of abstraction of patients' self-defined QoL domains), limitations of the included studies and limitations inherent to the review process, hinder cross-study comparisons. Therefore, we provide guidelines to address shortcomings of qualitative reports amenable to improvement and to stimulate further improvement of conducting and reporting qualitative research aimed at exploring respondents' self-nominated QoL domains.
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Affiliation(s)
- Elsbeth F Taminiau-Bloem
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Abstract
Parkinson's Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life.
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Affiliation(s)
- F Dewhurst
- Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK.
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31
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Fung VSC, Herawati L, Wan Y. Quality of life in early Parkinson's disease treated with levodopa/carbidopa/entacapone. Mov Disord 2009; 24:25-31. [PMID: 18846551 DOI: 10.1002/mds.21878] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We aimed to investigate whether treatment with levodopa/carbidopa/entacapone when compared with levodopa/carbidopa improves quality of life in Parkinson's disease (PD) patients with no or minimal, nondisabling motor fluctuations. This is a multicenter, randomized, double-blind study. One hundred eighty-four patients on 3 to 4 equal doses of 100/25 to 200/50 mg levodopa/carbidopa or levodopa/benserazide, 0 to 3 hours of nondisabling OFF time over a 48 hour period and no dyskinesia were randomized to levodopa/carbidopa/entacapone or levodopa/carbidopa treatment for 12 weeks. The primary outcome measure was quality of life as assessed by the PDQ-8. Secondary outcome measures were the UPDRS parts I-IV, and the Wearing Off Card. Treatment with levodopa/carbidopa/entacapone resulted in significantly greater improvements in PDQ-8 scores compared to treatment with levodopa/carbidopa (mean difference 1.4 points, P = 0.021). Statistically significant improvements were seen predominantly in nonmotor domains (depression, personal relationships, communication, stigma, all P < 0.05; dressing P = 0.056). Patients who were randomly assigned to levodopa/carbidopa/entacapone also showed significantly greater improvement in UPDRS part II scores (P = 0.032) with UPDRS part III scores showing borderline significance. Differences in UPDRS parts I and IV and Wearing Off Card scores were not significant. Treatment with levodopa/carbidopa/entacapone results in improved quality of life compared with levodopa/carbidopa in PD patients with mild or minimal, nondisabling motor fluctuations.
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Affiliation(s)
- Victor S C Fung
- Movement Disorder Unit, Department of Neurology, Westmead Hospital, NSW, Australia.
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The use, feasibility and psychometric properties of an individualised quality-of-life instrument: a systematic review of the SEIQoL-DW. Qual Life Res 2009; 18:737-46. [DOI: 10.1007/s11136-009-9490-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 05/09/2009] [Indexed: 12/13/2022]
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Hagell P, Reimer J, Nyberg P. Whose quality of life? Ethical implications in patient-reported health outcome measurement. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:613-617. [PMID: 19900259 DOI: 10.1111/j.1524-4733.2008.00488.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Patient-reported health status questionnaires intend to assess illness and therapy from the patients' perspective. To provide fair and valid assessments, they should be equally relevant to major subsets of respondents. Furthermore, disease-specific measures are assumed to be perceived as more relevant than generic ones. This study assessed these assumptions among people with Parkinson's disease. METHODS Cross-sectional data from 202 people with Parkinson's disease (54% men; mean age, 70) were analyzed regarding patient-rated relevance and predictors of patient-rated poor relevance of two generic [the 36-item Short Form Health Survey (SF-36) and Nottingham Health Profile (NHP)] and one disease-specific [Parkinson's Disease Questionnaire (PDQ-39)] health status questionnaire. RESULTS There were no differences in relevance ratings across the questionnaires. Poorer overall quality of life [odds ratio (OR), 2.459] and mental health (OR, 1.023) were associated with poorer patient-rated relevance of the SF-36, and higher age was associated with poorer patient-rated relevance of the PDQ-39 (OR, 1.040). No significant predictors were found for the NHP. CONCLUSIONS The PDQ-39 failed to meet the assumption that disease-specific scales are more relevant than generic ones. Nevertheless, the most important implication of this study is an ethical one. Because the relevance of the SF-36 and PDQ-39 is perceived as poorer by those who fare least well and by older people, these scales may not reflect the perspectives of these groups. This challenges bioethical principles and threatens scientific validity. Perceived relevance of patient-centered outcomes needs to be considered, or the voice of vulnerable groups may be silenced, fair inferences prohibited, and opportunities for improved care lost.
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Affiliation(s)
- Peter Hagell
- Department of Health Sciences, Lund University, Lund, Sweden.
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Abstract
RATIONALE, AIMS AND OBJECTIVES The concept of quality of life (QoL) has emerged as an important psychological dimension in individuals experiencing Parkinson's disease (PD). The current study sought to determine the factor structure of the Medical Outcomes Study Short-Form 36 (SF-36) version 2 in patients with PD in order to evaluate how this measure might best be used to assess QoL in this clinical population. METHOD Confirmatory factor analyses were conducted on self-report SF-36 data from 339 individuals diagnosed with PD. Six structural models of the SF-36 were evaluated against the participants' data. RESULTS The underlying factor structure of the SF-36 in PD was observed to be inconsistent with the assumed measurement model of SF-36 but consistent with contemporary theoretical models of the instrument. CONCLUSIONS The use of the SF-36 in individuals with PD can be recommended when eight subscales are used and reported. Evidence to support the use of the instrument as a two-subscale measure of physical health and mental health components was not found.
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Affiliation(s)
- Pauline Banks
- School of Health Studies, University of the West of Scotland, Ayr, UK
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Antonini A. Apomorphine and levodopa infusion therapies for advanced Parkinson's disease. J Mov Disord 2009; 2:4-9. [PMID: 24868344 PMCID: PMC4027699 DOI: 10.14802/jmd.09002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 03/21/2009] [Indexed: 11/24/2022] Open
Abstract
Continuous infusion of levodopa or apomorphine provide constant dopaminergic stimulations are good alternatives to deep brain stimulation to control motor fluctuations in patients with advanced Parkinson’s disease (PD). Apomorphine provides motor benefit similar to dopamine, but its long-term use is limited by compliance, mostly injection site skin reactions. Administration of levodopa/carbidopa by continuous duodenal infusion allows replacement of all oral medications and permits achievement of a satisfactory therapeutic response paralleled by a reduction in motor complication severity. However, this procedure is more invasive than apomorphine as it requires a percutaneous endoscopic gastrostomy Clinical experience with infusions shows that continuous dopaminergic stimulation of dopaminergic medications reduces dyskinesia and widens the therapeutic window in advanced PD.
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Affiliation(s)
- Angelo Antonini
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
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Ferguson LW, Rajput ML, Rajput A. Comment on “Individualized Assessment of Quality of Life in Idiopathic Parkinson's Disease”. Mov Disord 2009; 24:630-2. [DOI: 10.1002/mds.22064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Isacson D, Bingefors K, Kristiansen IS, Nyholm D. Fluctuating functions related to quality of life in advanced Parkinson disease: effects of duodenal levodopa infusion. Acta Neurol Scand 2008; 118:379-86. [PMID: 18547273 DOI: 10.1111/j.1600-0404.2008.01049.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess fluctuations in quality of life (QoL) and motor performance in patients with advanced Parkinson disease (PD) treated with continuous daytime duodenal levodopa/carbidopa infusion or conventional therapy. METHODS Of 18 patients completing a 6-week trial (DIREQT), 12 were followed for up to 6 months and assessed using electronic diaries and the PD Questionnaire-39 (PDQ-39). RESULTS During the trial and follow-up, major diurnal fluctuations were observed, especially for hyperkinesia, 'off' time, ability to walk and depression. Duodenal infusion was associated with significantly more favourable outcomes compared with conventional treatment for satisfaction with overall functioning, 'off' time and ability to walk, with improved outcomes with PDQ-39. CONCLUSIONS Relative to conventional treatment, infusion therapy may stabilize and significantly improve motor function and patient's QoL. The potential for daily fluctuation in PD symptoms means single measures of treatment effectiveness can result in bias in effect estimates and hence repeated measures are recommended.
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Affiliation(s)
- D Isacson
- Department of Pharmacy, Pharmacoepidemiology and Pharmacoeconomics, Uppsala University, Sweden
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Ribi K, Bernhard J, Schuller JC, Weder W, Bodis S, Jörger M, Betticher D, Schmid RA, Stupp R, Ris HB, Stahel RA. Individual versus standard quality of life assessment in a phase II clinical trial in mesothelioma patients: Feasibility and responsiveness to clinical changes. Lung Cancer 2008; 61:398-404. [DOI: 10.1016/j.lungcan.2008.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 12/11/2007] [Accepted: 01/10/2008] [Indexed: 12/13/2022]
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Den Oudsten BL, Van Heck GL, De Vries J. Quality of life and related concepts in Parkinson's disease: A systematic review. Mov Disord 2007; 22:1528-37. [PMID: 17523198 DOI: 10.1002/mds.21567] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several studies have investigated the quality of life (QOL) of patients with Parkinson's disease (PD). The purpose of this study was to review the conceptual and methodological quality of quality of life (QOL) studies among patients with PD and to identify factors associated with poor (HR)QOL. Computerized bibliographic databases were screened for publications from 1960 to January 2007. According to a list of predefined criteria, the methodological quality of the 61 studies, was moderate. The term 'QOL' was often used inappropriately. In fact, almost all studies in this review actually assessed health status (HS) instead of QOL. The functioning of patients with PD on physical, social, and emotional domains is affected by PD. Their HS seems to be lower when compared to healthy persons or patients with other chronic diseases. HS studies augment the insight in self-perceived functioning. Therefore, HS is conceived as a valuable construct. However, QOL is also an important factor in health care. Attention towards QOL is needed in order to draw valid conclusions regarding a person's subjective experience of well-being in a broad sense. In order to accomplish this, future studies should apply the QOL concept with more rigor, should use an adequate operational definition, and should employ sound measures.
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Affiliation(s)
- Brenda L Den Oudsten
- Medical Psychology, Department of Psychology and Health, Tilburg University, and St. Elisabeth Hospital, Tilburg, The Netherlands.
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