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Kuharic M, Kulbokas V, Hanson K, Nazari JL, Shah KK, Nguyen A, Hensle T, Marras C, Armstrong MJ, Jalundhwala YJ, Pickard AS. OFF episode quality of life impact scale (OFFELIA): A new measure of quality of life for off episodes in Parkinson's disease. Parkinsonism Relat Disord 2024; 123:106070. [PMID: 38503261 DOI: 10.1016/j.parkreldis.2024.106070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/21/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION OFF Episodes occur in people with Parkinson's disease when their medication wears off, and motor and/or non-motor symptoms emerge. Existing measures used to assess OFF Episodes focus on the time spent in OFF Episodes through diaries or by identifying symptoms, but they are limited in their ability to capture the severity and functional impact of OFF episodes. The aim of this study was to develop and validate a new instrument, called "OFFELIA," that measures the impact of OFF episodes on the quality of life of individuals with Parkinson's disease. METHODS Participants completed a cross-sectional questionnaire, "Impact and Communication on OFF Periods," while enrolled in the online clinical study Fox Insights. The data collected was used to develop OFFELIA. Psychometric testing was performed on 18 candidate items using classical, exploratory factor analysis, and item response theory methods. RESULTS 569 individuals with Parkinson's disease completed the questionnaire. All items were retained for the final measure, with 17 items aggregated into two multi-item scales (functioning and psychological well-being) and one item reported separately as it did not function well with the other items (employment). Known group comparisons based on average duration, frequency and unpredictability of OFF episodes indicated that OFFELIA subscales were more sensitive than existing generic and condition-specific measures. CONCLUSION Initial evidence supports the validity of OFFELIA, a new instrument that assesses the impact of OFF periods on daily life. This instrument can be used in assessing clinical therapeutic strategies targeting OFF episodes in Parkinson's disease.
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Affiliation(s)
- Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, USA, 60611.
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Kent Hanson
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Kanya K Shah
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Ai Nguyen
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Tara Hensle
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada.
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Fixel Institute for Neurological Diseases, Gainesville, FL, USA.
| | - Yash J Jalundhwala
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612; Moderna, Inc., Cambridge, MA, USA.
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (MC 871), Chicago, IL, USA, 60612.
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Serbin M, Marras C, Mansfield C, Leach C, Yonan C, Sheehan M, Donnelly A, Klepitskaya O. Patients' Preferences for Adjunctive Parkinson's Disease Treatments: A Discrete-Choice Experiment. Patient Prefer Adherence 2023; 17:2263-2277. [PMID: 37724313 PMCID: PMC10505378 DOI: 10.2147/ppa.s420051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/12/2023] [Indexed: 09/20/2023] Open
Abstract
Background Several adjunctive medications are available to reduce OFF time between levodopa/carbidopa (LD/CD) doses for people with Parkinson's disease (PD). Objective To explore how individuals with PD balance benefits and burdens when considering adjunctive medications. Methods US adults (30-83 years) with self-reported PD, currently treated with LD/CD, who experienced OFF episodes were recruited through the Fox Insight study to complete a discrete-choice experiment survey. Respondents selected among experimentally designed profiles for hypothetical adjunctive PD treatments that varied in efficacy (additional ON time), potential adverse effects (troublesome dyskinesia, risk of diarrhea, risk of change in bodily fluid color), and dosing frequency or the option "No additional medicine". Data were analyzed with random-parameters logit models. Results Respondents (N=480) would require ≥60 additional minutes of daily ON time to accept either a 40% risk of change in bodily fluid color or 10 additional minutes with troublesome dyskinesia daily. Respondents would require 40 additional minutes of daily ON time to accept a 10% risk of diarrhea and 22 additional minutes of daily ON time to switch from 1 additional pill each day to 1 pill with each LD/CD dose. On average, respondents preferred adjunctive PD medication over no additional medication. Results predicted that 59.1% of respondents would select a hypothetical treatment profile similar to opicapone, followed by no additional medication (27.5%) and a hypothetical treatment profile similar to entacapone (13.4%). Limitations The data collected were based on responses to hypothetical choice profiles in the survey questions. The attributes and levels selected for this study were intended to reflect the characteristics of opicapone and entacapone; attributes associated with other adjunctive therapies were not evaluated. Conclusion Patients with PD expressed interest in adjunctive treatment to increase ON time and would accept reduced ON time to avoid adverse effects.
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Affiliation(s)
| | - Connie Marras
- The Edmond J. Safra Program in Parkinson’s Disease, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Colton Leach
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Anne Donnelly
- Kellogg School of Management, Northwestern University, Evanston, IL, USA
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Snowdon DA, Srikanth V, Beare R, Noeske KE, Le E, O'Bree B, Andrew NE. Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study. J Patient Rep Outcomes 2023; 7:81. [PMID: 37522943 PMCID: PMC10390450 DOI: 10.1186/s41687-023-00617-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. METHODS Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. RESULTS Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. CONCLUSIONS The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation.
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Affiliation(s)
- David A Snowdon
- National Centre for Healthy Ageing, Melbourne, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
| | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate E Noeske
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Elizabeth Le
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Bridget O'Bree
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
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Systematic Review of the Effect of a One-Day Versus Seven-Day Recall Duration on Patient Reported Outcome Measures (PROMs). THE PATIENT 2023; 16:201-221. [PMID: 36786931 PMCID: PMC10121527 DOI: 10.1007/s40271-022-00611-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND There is ongoing uncertainty around the most suitable recall period for patient-reported outcome measures (PROMs). METHOD This systematic review integrates quantitative and qualitative literature across health, economics, and psychology to explore the effect of a one-day (or '24-h') versus seven-day (or 'one week') recall period. The following databases were searched from database inception to 30 November 2021: MEDLINE, EMBASE, PsycINFO, Web of Science, EconLit, CINAHL Complete, Cochrane Library, and Sociological Abstracts. Studies were included that compared a one-day (or '24-h') versus seven-day (or weekly) recall period condition on patient-reported scores for PROM and Health-Related Quality-of-Life (HRQoL) instrument scores in adult populations (aged 18 and above) or combined paediatric and adult populations with a majority of respondents aged over 18 years. Studies were excluded if they assessed health behaviours only, used ecological momentary assessment to derive an index of daily recall, or incorporated clinician reports of patient symptoms. We extracted results relevant to six domains with generic health relevance: physical functioning, pain, cognition, psychosocial wellbeing, sleep-related symptoms and aggregated disease-specific signs and symptoms. Quantitative studies compared weekly recall scores with the mean or maximum score over the last seven days or with the same-day recall score. RESULTS Overall, across the 24 quantitative studies identified, 158 unique results were identified. Symptoms tended to be reported as more severe and HRQoL lower when assessed with a weekly recall than a one-day recall. A narrative synthesis of 33 qualitative studies integrated patient perspectives on the suitability of a one-day versus seven-day recall period for assessing health state or quality of life. Participants had mixed preferences, some noted the accuracy of recall for the one-day period but others preferred the seven-day recall for conditions characterised by high symptom variability, or where PROMs concepts required integration of infrequent experiences or functioning over time. CONCLUSION This review identified a clear trend toward higher symptom scores and worse quality of life being reported for a seven-day compared to a one-day recall. The review also identified anomalies in this pattern for some wellbeing items and a need for further research on positively framed items. A better understanding of the impact of using different recall periods within PROMs and HRQoL instruments will help contextualise future comparisons between instruments. Questionnaires ask patients about their health over different time periods (e.g., "what were your symptoms like over the last week?" versus "what were your symptoms like today?"). Studies find that people may report their symptoms as more severe when they are asked to think about their symptoms over the last week compared to the last day. Understanding how different time periods influence patient responses will allow researchers to compare and develop new questionnaires and may help clinicians to choose the best questionnaire to understand their patient's condition. We conducted a systematic literature review on studies which had looked at the impact of using different recall periods on patient responses. We found 24 studies that compared patient scores from questionnaires asking their health "over the last day" compared to "over the last week". Overall, symptoms tended to be reported as more severe and health as poorer when they were reported over the last week compared to the last day on average. We also found 33 studies that asked patients to describe which recall period they preferred. Patients had mixed preferences with more preferring a seven-day recall where symptoms and health impacts varied a lot.
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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Berger AA, Winnick A, Izygon J, Jacob BM, Kaye JS, Kaye RJ, Neuchat EE, Kaye AM, Alpaugh ES, Cornett EM, Han AH, Kaye AD. Opicapone, a Novel Catechol-O-methyl Transferase Inhibitor, for Treatment of Parkinson's Disease "Off" Episodes. Health Psychol Res 2022; 10:36074. [PMID: 35774903 DOI: 10.52965/001c.36074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
Parkinson's Disease (PD) is a common neurodegenerative disorder and the leading cause of disability. It causes significant morbidity and disability through a plethora of symptoms, including movement disorders, sleep disturbances, and cognitive and psychiatric symptoms. The traditional pathogenesis theory of PD involves the loss of dopaminergic neurons in the substantia nigra (SN). Classically, treatment is pursued with an assortment of medications that are directed at overcoming this deficiency with levodopa being central to most treatment plans. Patients taking levodopa tend to experience "off episodes" with decreasing medication levels, causing large fluctuations in their symptoms. These off episodes are disturbing and a source of morbidity for these patients. Opicapone is a novel, peripherally acting Catechol-O-methyl transferase (COMT) inhibitor that is used as adjunctive therapy to carbidopa/levodopa for treatment and prevention of "off episodes." It has been approved for use as an adjunct to levodopa since 2016 in Europe and has recently (April 2020) gained FDA approval for use in the USA. By inhibiting COMT, opicapone slows levodopa metabolism and increases its availability. Several clinical studies demonstrated significant improvement in treatment efficacy and reduction in duration of "off episodes." The main side effect demonstrated was dyskinesia, mostly with the 100mg dose, which is higher than the approved, effective dose of 50mg. Post-marketing surveillance and analysis are required to further elucidate its safety profile and contribute to patient selection. This paper reviews the seminal and latest evidence in the treatment of PD "off episodes" with the novel drug Opicapone, including efficacy, safety, and clinical indications.
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Affiliation(s)
- Amnon A Berger
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences; School of Optometry, University of California
| | - Jonathan Izygon
- Soroka University Medical Center and Faculty of Health Sciences
| | - Binil M Jacob
- Soroka University Medical Center and Faculty of Health Sciences
| | - Jessica S Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | | | | | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Edward S Alpaugh
- Department of Anesthesiology, Louisiana State University Health Sciences Center
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center
| | - Andrew H Han
- Georgetown University School of Medicine, Georgetown University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center
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Opicapone for the Treatment of Parkinson's Disease "Off" Episodes: Pharmacology and Clinical Considerations. Clin Drug Investig 2021; 42:127-135. [PMID: 34935105 DOI: 10.1007/s40261-021-01109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/27/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder. It is also the fastest-growing neurodegenerative disorder and has more than doubled between 1990 and 2016. Parkinson's disease causes significant morbidity and disability from motor dysfunction, sleep disturbances, and cognitive and psychiatric symptoms. This paper reviews recent evidence in the treatment of PD "off" episodes with the novel drug opicapone, including its efficacy, safety, and clinical indications. Opicapone is a novel, peripherally acting catechol-O-methyl transferase (COMT) inhibitor used as adjunctive therapy to carbidopa/levodopa for treatment and prevention of "off" episodes. It has been approved for use as an adjunct to levodopa since 2016 in Europe and has recently (April 2020) gained FDA approval for use in the USA. By inhibiting COMT, opicapone slows levodopa metabolism and increases its availability. Several clinical studies demonstrated significant improvement in treatment efficacy and reduction in the duration of "off" episodes The main side effect demonstrated was dyskinesia, mostly with the 100 mg dose, which is higher than the approved, effective dose of 50 mg.
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8
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Armstrong MJ, Rastgardani T, Gagliardi AR, Marras C. Impact of Off Periods on Persons With Parkinson Disease and Care Partners: A Qualitative Study. Neurol Clin Pract 2021; 11:e232-e238. [PMID: 34484896 DOI: 10.1212/cpj.0000000000000921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Abstract
Background The definition of off periods proposed in 2018 emphasizes functional disability as part of the off period experience, but limited research to date investigates the functional impact of off periods on persons with Parkinson disease and care partners. This study aimed to investigate the impact of off periods on both persons with Parkinson disease and care partners through interviews of dyads living with motor and/or nonmotor fluctuations. Methods Investigators performed interviews separately with persons with Parkinson disease and care partners using a semistructured questionnaire. Investigators used a qualitative descriptive approach to identify themes in interview transcripts relating to the impact of off periods on daily life. Identified themes were subsequently organized using World Health Organization quality of life domains. Results Twenty persons with Parkinson disease and their care partners (total n = 40) participated in interviews. Persons with Parkinson disease described impairments in level of independence (e.g., relating to employment, mobility, activities of daily living, and medication timing), socialization, leisure activities, driving, physical function, and psychological experiences relating to off periods. Care partners reported off period impacts on their own independence, socialization, leisure, and psychological experiences. Conclusions Clinicians should query the daily impact of off periods on both persons with Parkinson disease and care partners at clinical visits to inform treatment decisions and counseling. Measures of off period impact should be incorporated into clinical trials targeting fluctuations to fully understand the effects of interventions for fluctuations.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research (TR, CM), Toronto Western Hospital; and Toronto General Hospital Research Institute (ARG), University Health Network, Ontario, Canada
| | - Tara Rastgardani
- Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research (TR, CM), Toronto Western Hospital; and Toronto General Hospital Research Institute (ARG), University Health Network, Ontario, Canada
| | - Anna R Gagliardi
- Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research (TR, CM), Toronto Western Hospital; and Toronto General Hospital Research Institute (ARG), University Health Network, Ontario, Canada
| | - Connie Marras
- Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research (TR, CM), Toronto Western Hospital; and Toronto General Hospital Research Institute (ARG), University Health Network, Ontario, Canada
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9
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Mantri S, Lepore M, Edison B, Daeschler M, Kopil CM, Marras C, Chahine LM. The Experience of OFF Periods in Parkinson's Disease: Descriptions, Triggers, and Alleviating Factors. J Patient Cent Res Rev 2021; 8:232-238. [PMID: 34322575 DOI: 10.17294/2330-0698.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Wearing off of Parkinson's disease medication is common, but triggers and coping strategies for this transient phenomenon are poorly understood. We aimed to assess the lived experience of OFF periods for people with Parkinson's disease. Methods Participants in the longitudinal Fox Insight study who endorsed OFF periods were invited to complete a survey consisting of both multiple-choice and free-text responses. Descriptive statistics were used to summarize multiple-choice responses, and free-text responses were classified into themes through iterative discussion by 3 movement disorders specialists. Results A total of 2110 participants (52.4% male) completed the survey. Tremor was the most common description of OFF periods (n=1038, 49.2%), followed by gait changes (n=535, 25.4%) and rigidity (n=430, 20.4%). Of 1498 specific triggers for OFF symptoms, the most common was stress (n=920, 61.4%), followed by anxiety/depression (n=476, 31.8%) and tiredness/fatigue (n=351, 23.4%). Common coping strategies (n=1416 responses) included exercise (n=678, 47.9%), taking a break (n=504, 35.6%), and meditation (n=276, 19.5%). Conclusions Although OFF periods are common, the individual experiences of OFF vary. This knowledge could be used to develop new counseling strategies for OFF periods in people with Parkinson's disease.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC
| | - Madeline Lepore
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
| | | | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
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10
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Rastgardani T, Armstrong MJ, Gagliardi AR, Grabovsky A, Marras C. Experience and Impact of OFF Periods in Parkinson's Disease: A Survey of Physicians, Patients, and Carepartners. JOURNAL OF PARKINSONS DISEASE 2021; 10:315-324. [PMID: 31815702 DOI: 10.3233/jpd-191785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND OFF periods impair quality of life in Parkinson's disease but the nature and degree of this impact is largely unquantified. Optimal treatment relies on assessing the experience and impact of these periods on patients and their carepartners. OBJECTIVES To understand the experience and impact of OFF periods on their lives. METHODS Informed by qualitative interviews we designed questionnaires and surveyed neurologists, people with Parkinson's disease and carepartners. RESULTS 50 general neurologists, 50 movement disorder neurologists, 442 patients (median disease duration 5 years) and 97 carepartners were included. The most common OFF symptoms reported by patients and carepartners were stiffness, slowness of movement and changes in gait. Non-motor symptoms were less common. A higher proportion of carepartners reported each symptom. A minority of neurologists recognized pain, sweating and anxiety as possible symptoms of OFF periods. The three OFF symptoms most frequently designated as having great impact by people with Parkinson's disease were changes in gait, slowness and stiffness. In contrast, cognitive impairment was most frequently rated as having great impact on carepartners. OFF periods were reported to impact many aspects of the lives of both patients and carepartners. CONCLUSIONS In people with Parkinson's disease of under 10 years duration, motor symptoms of OFF periods predominate in impact, however cognitive impairment has great impact on carepartners. Education is needed for neurologists regarding the non-motor aspects of OFF. The importance of involving carepartners in the assessment regarding OFF periods is supported by the higher frequency of symptom reporting by carepartners, and the significant impact on their lives.
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Affiliation(s)
- Tara Rastgardani
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, ON, Canada
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11
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Blome C, Carlton J, Heesen C, Janssen MF, Lloyd A, Otten M, Brazier J. How to measure fluctuating impairments in people with MS: development of an ambulatory assessment version of the EQ-5D-5L in an exploratory study. Qual Life Res 2021; 30:2081-2096. [PMID: 33710593 PMCID: PMC8233275 DOI: 10.1007/s11136-021-02802-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Background Health fluctuations even within a single day are typical in multiple sclerosis (MS), but are not captured by widely used questionnaires like the EQ-5D-5L. This exploratory study aimed to develop an ambulatory assessment (AA) version of the EQ-5D-5L (EQ-5D-AA) where patients rate their health on mobile phones multiple times per day over several days, and to assess its feasibility and face validity. Methods An initial EQ-5D-AA version was based on two patient focus groups. It was then tested and continuously developed in an iterative process: patients completed it over several days, followed by debriefing interviews. Findings were used to refine the EQ-5D-AA, with the resulting version being tested by the subsequent wave of patients until participants declared no need for changes anymore. Before and after the AA period, participants completed the standard paper-based EQ-5D-5L asking about ‘today’. Results Focus group participants reported that their impairments often fluctuated between and within days. They regarded an AA with three assessments per day over seven days most appropriate; assessment should be retrospective to the previous assessment, but not all items should be assessed at each time point. Four waves of AA testing were conducted. Thirteen out of the 17 participants preferred the AA over standard assessment as they regarded it more informative, but not too burdensome. Conclusion The newly developed one-week AA of the EQ-5D-5L captures within-day and day-to-day health fluctuations in people with MS. From the patients’ perspective, it is a feasible and face valid way to provide important information beyond what is captured by the standard EQ-5D-5L. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02802-8.
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Affiliation(s)
- Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, Netherlands
| | | | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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12
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Thach A, Sutphin J, Coulter J, Leach C, Pappert E, Mansfield C. Patient Preferences for Treating "OFF" Episodes in Parkinson's Disease: A Discrete Choice Experiment. Patient Prefer Adherence 2021; 15:1187-1196. [PMID: 34103902 PMCID: PMC8179791 DOI: 10.2147/ppa.s301644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Several on-demand treatments are available for management of "OFF" episodes in patients with Parkinson's disease (PD). We evaluated patients' preferences for features of theoretical on-demand treatment options. METHODS In a discrete choice experiment, US adults with self-reported PD of ≥5 years, or <5 years with "OFF" episodes, taking oral carbidopa/levodopa, selected between pairs of theoretical on-demand treatments that varied by mode of administration (with and without mode-specific adverse events [AEs]), time to FULL "ON," duration of "ON," and out-of-pocket cost for a 30-day supply. Data were analyzed with a random parameters logit model; results were used to calculate relative importance of treatment attributes, preference shares, and willingness to pay. RESULTS Among 300 respondents, 98% had "OFF" episodes. Across the range of attribute levels included in the survey, avoiding $90 cost was most important to respondents, followed by a preferable mode of administration with associated AEs and decreasing time to FULL "ON." Duration of "ON" was relatively less important. On average, respondents preferred a theoretical dissolvable sublingual film versus other theoretical treatments with alternative modes of administration. Respondents were willing to pay $28-$52 US dollars to switch from least- to more-preferred mode of administration with associated AEs, $58 to reach FULL "ON" in 15 versus 60 min, and $9 to increase duration of FULL "ON" from 1 to 2 h. CONCLUSION Respondents with PD valued lower out-of-pocket cost and a sublingual mode of administration with its associated AEs when choosing an on-demand treatment for "OFF" episodes.
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Affiliation(s)
- Andrew Thach
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
- Correspondence: Andrew Thach Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USATel +1 774-369-7123 Email
| | - Jessie Sutphin
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Joshua Coulter
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Colton Leach
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Eric Pappert
- Medical Affairs, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Carol Mansfield
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
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Sanghera S, Coast J. Measuring Quality-Adjusted Life-Years When Health Fluctuates. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:343-350. [PMID: 32197730 DOI: 10.1016/j.jval.2019.09.2753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 05/26/2023]
Abstract
Recurrent fluctuations in health states can occur as a result of long-term conditions with episodic symptoms or through side effects of cycles of treatment. Fluctuations and associated duration of symptoms can be predictable (eg, side effects of chemotherapy treatment) or unpredictable (eg, relapse in multiple sclerosis). Such recurrent fluctuations in health states can have an important impact on a person's health-related quality of life. When symptoms vary by time of day, day of the week, or during the month, it is challenging to obtain reliable health-related quality of life estimates for use in assessing cost-effectiveness of interventions. The adequacy of the quality of life estimate will be affected by (1) the standard recall period associated with the chosen measure (eg, "health today" EQ-5D, "past 4 weeks" for SF-36/SF-6D) and the way that respondents understand and make judgments about these recall periods, (2) the chosen time points for assessing health-related quality of life in relation to the fluctuations in health, and (3) the assumptions used to interpolate between measurement time points and thus calculate the quality-adjusted life-years. These issues have not received sufficient methodological attention and instead remain poorly accounted for in economic analyses. There is potential for these issues to considerably distort treatment decisions away from the optimal allocation. This article brings together evidence from health economics, psychology, and behavioral economics to explore these challenges in depth; presents the solutions that have been applied to date; and details a methodological research agenda for measuring quality-adjusted life-years in recurrent fluctuating health states.
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Affiliation(s)
- Sabina Sanghera
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK.
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
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Armstrong MJ, Rastgardani T, Gagliardi AR, Marras C. Barriers and facilitators of communication about off periods in Parkinson's disease: Qualitative analysis of patient, carepartner, and physician Interviews. PLoS One 2019; 14:e0215384. [PMID: 30998707 PMCID: PMC6472878 DOI: 10.1371/journal.pone.0215384] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Successful patient-physician communication is critical for improving health outcomes, but research regarding optimal communication practices in Parkinson’s disease is limited. The objective of the current study was to investigate barriers and facilitators of communication between persons with Parkinson’s disease, carepartners, and physicians, specifically in the setting of off periods, with the goal of identifying ways to improve patient-carepartner-physician communication. Method We interviewed persons with Parkinson’s, carepartners, and physicians (specialists and non-specialists) using a semi-structured questionnaire to identify and describe experiences, barriers, and facilitators relating to communication about off periods in Parkinson’s disease. We used a qualitative descriptive approach to analyze interview transcripts and compare themes between participating groups. Results Twenty persons with Parkinson’s and their carepartners and 20 physicians (10 specialists, 10 non-specialists) participated in interviews. Identified communication barriers included patient-level (e.g. cognitive impairment, reluctance to discuss symptoms), caregiver-level (e.g. caregiver absence), and physician-level (e.g. distraction by technology, lack of appreciation of the burden of off periods) factors. Other barriers included the challenging nature of off periods themselves. Positive physician characteristics such as empathy, respect, and taking time to listen were major facilitators of communication regarding off periods. Persons with Parkinson’s, carepartners, and physicians described using various tools (e.g. home diaries, questionnaires, mobile phone videos) to aid communication regarding off periods but participants identified a need for more formal educational materials. Conclusions Physicians caring for persons with Parkinson’s can improve communication through more patient-centered practice but there is a need for improved educational tools regarding off periods. Further research is needed to identify optimal strategies for communication about off periods and preferred approaches for off period education.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 408] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Rastgardani T, Armstrong MJ, Gagliardi AR, Marras C. Understanding, Impact, and Communication of "Off" Periods in Parkinson's Disease: A Scoping Review. Mov Disord Clin Pract 2018; 5:461-470. [PMID: 30515435 PMCID: PMC6207105 DOI: 10.1002/mdc3.12672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Off periods are a common and disabling symptom of Parkinson's disease. We reviewed published research on understanding, impact, and communication regarding off periods to identify issues warranting further research. METHODS We performed a scoping review, searching MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsycINFO from 2006 to January 2018 for studies examining the impact of, understanding of, or communication about off periods. RESULTS Twenty-six papers met eligibility criteria. Twenty-three studies evaluated the impact or experience of off periods in patients, three evaluated the impact upon carepartners, two papers addressed understanding of off periods, one study evaluated communication about off periods, and three studies evaluated a facilitator of communication about off periods. The findings indicate that (1) off periods are among the most troublesome symptoms to patients and that their impact on activities is broad; (2) the understanding of off periods by patients, carepartners, and nurses may be suboptimal; and (3) questionnaires hold promise as a mechanism for facilitating communication given the findings that they may enhance the detection of off periods and are rated as useful by physicians. No studies evaluated interventions to promote knowledge about off periods, and no studies identified barriers of communication about off periods. CONCLUSIONS There is a paucity of knowledge regarding the lived experiences of off periods, particularly for carepartners. Additionally, little knowledge exists in the literature regarding understanding of and communication about off periods between patients or carepartners and treating physicians. Further research is required to explore these issues to ultimately improve the treatment of off periods.
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Affiliation(s)
- Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's ResearchToronto Western HospitalTorontoONCanada
| | - Melissa J. Armstrong
- Department of NeurologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoONCanada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's ResearchToronto Western HospitalTorontoONCanada
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MEETING REPORTER. Curr Opin Neurol 2018; 30 Suppl 1:1-24. [DOI: 10.1097/wco.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matza LS, Boye KS, Jordan JB, Norrbacka K, Gentilella R, Tiebout AR, Browne C, Orsini Federici M, Biricolti G, Stewart KD. Patient preferences in Italy: health state utilities associated with attributes of weekly injection devices for treatment of type 2 diabetes. Patient Prefer Adherence 2018; 12:971-979. [PMID: 29922043 PMCID: PMC5995299 DOI: 10.2147/ppa.s159620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Several glucagon-like peptide-1 receptor agonists are administered as weekly injections for treatment of type 2 diabetes (T2D). These medications vary in their injection processes, and a recent study in the UK found that these differences had an impact on patient preference and health state utilities. The purpose of this study was to replicate the UK study in Italy to examine preferences of an Italian patient sample, while allowing for comparison between utilities in the UK and Italy. MATERIALS AND METHODS Participants with T2D in Italy valued health states in time trade-off interviews. All health states had the same description of T2D, but differed in description of the treatment process. As in the original UK study, the first health state described an oral treatment regimen, while additional health states added a weekly injection. The injection health states differed in three injection-related attributes: requirements for reconstituting the medication, waiting during medication preparation, and needle handling. RESULTS Interviews were completed by 238 patients (58.8% male; mean age = 60.2 years; 118 from Milan, 120 from Rome). The oral treatment health state had a mean (SD) utility of 0.90 (0.10). The injection health states had significantly (p < 0.0001) lower utilities, which ranged from 0.87 (requirements for reconstitution, waiting, and handling) to 0.89 (weekly injection with none of these requirements). Differences in health state utility scores suggest that each administration requirement was associated with a disutility (ie, negative utility difference): -0.006 (reconstitution), -0.006 (needle handling), -0.011 (reconstitution, needle handling), and -0.022 (reconstitution, waiting, needle handling). CONCLUSION Disutilities associated with the injection device characteristics were similar to those reported with the UK sample. Results suggest that injection device attributes may be important to some patients with T2D, and it may be useful for clinicians to consider these attributes when choosing medication for patients initiating these weekly treatments.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA
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