1
|
Wu X, Shi M, Lian Y, Zhang H. Cognitive behavioral therapy approaches to the improvement of mental health in Parkinson's disease patients: a systematic review and meta-analysis. BMC Neurol 2024; 24:352. [PMID: 39300337 PMCID: PMC11411832 DOI: 10.1186/s12883-024-03859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) such as impaired cognition, anxiety, and depression can have a strong adverse effect on the quality of life (QoL) of Parkinson's disease (PD) patients. The clinical application of cognitive behavioral therapy (CBT) offers an opportunity to improve cognitive function, mental health, and overall QoL for these patients. OBJECTIVE CBT is frequently applied as a treatment option aimed at benefiting the mental health of PD patients, but the relative utility of CBT in this patient population has yet to be rigorously assessed. The present review was thus conducted with the goal of examining the relative safety and efficacy of CBT as a treatment option for PD patients suffering from cognitive impairment, anxiety, and depression, with a particular focus on the impact of CBT on PD patient QoL. METHODS The PubMed, Embase, Medline, and Cochrane Library databases were searched for all studies published from their inception to present using keywords including "cognitive behavioral therapy" and "Parkinson's disease". Two reviewers independently screened these published studies and extracted relevant data from studies that met with defined inclusion/exclusion criteria, in addition to assessing the risk of bias. Those randomized controlled trials (RCTs) assessing the impact of CBT on older PD patients were eligible for study inclusion. In total, 22 articles incorporating 1,053 patients were included in this meta-analysis. Study quality was examined as per the Cochrane risk of bias framework. Heterogeneity and associated outcomes were assessed based on mean difference (MD), I2, and 95% confidence interval (95%CI) values. RESULTS In total, 22 RCTs were ultimately found to be eligible for inclusion in the present meta-analysis. The results of this meta-analysis indicated that CBT significantly impacted cognition as compared to other treatment options (including placebo treatment, clinical monitoring, clinic-based treatment, psychoeducation, physical activity training, health enhancement) (I2 = 49%, MD = 0.23, 95%CI: 0.03-0.44, P = 0.03). CBT was also associated with significant improvements in PD patient QoL (I2 = 0%, MD = 3.45, 95%CI: 1.13-5.57, P = 0.04), anxiety symptoms (I2 = 57%, MD = -2.01, 95%CI: -4.01-0.01, P = 0.05), and depression symptoms (I2 = 74%, MD = -3.94, 95%CI: -6.47 to -1.42, P = 0.04). CONCLUSIONS These results reveal that CBT can have beneficial effects on PD patient cognitive status and QoL. Notably, CBT represents an effective option for treating NMS such as anxiety and depression in PD patients. These results offer strong evidence in favor of applying CBT as a means of enhancing the mental health, cognition, and QoL of individuals with PD. However, additional high-quality large-scale studies will be essential to confirm and expand upon these results.
Collapse
Affiliation(s)
- Xiaoke Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Mengmeng Shi
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
| |
Collapse
|
2
|
HongFei Z, Li Z, Liang L, Ru GW, Yi HL, Zhen W. Current interventional model for movement in Parkinson's disease: network meta-analysis based on the improvement of motor ability. Front Aging Neurosci 2024; 16:1431277. [PMID: 39318860 PMCID: PMC11419980 DOI: 10.3389/fnagi.2024.1431277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024] Open
Abstract
Aim To identify optimally therapeutic exercise interventions for improving motor ability among patients with Parkinson's disease (PD), we conducted a network meta-analysis (NMA) of randomized controlled trials comparing different exercise regimens. Methods Relevant RCTs were retrieved by searching PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, and other databases from inception to July 9, 2023 is available in English as the primary language. Exercise outcomes as measured by Movement Disorder Society- Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) score change were evaluated and ranked using STATA software version 18.0. All included studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Results The final NMA included 71 studies involving 3,732 participants, 87 intervention experiments, and 27distinct interventions. Although most exercise interventions showed some efficacy (reducing MDS-UPDRS-III score), cumulative ranking probability surface (SUCRA) values indicated that the best exercise interventions for motor function improvement were archery (95.6%), riding a bicycle (80.9%), and binary rhythm dance (80.8%). Conclusion An exercise intervention comprising archery, cycling, and(or) binary rhythm dance may yield superior improvements in motor function among patients with Parkinson's disease.
Collapse
Affiliation(s)
- Zhao HongFei
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Zhang Li
- Xiamen Medical College, Xiamen, China
| | - Li Liang
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Guo Wan Ru
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Huang Lan Yi
- School of Psychology, Shanghai Sport University, Shanghai, China
| | - Wang Zhen
- Wushu College, Shanghai Sport University, Shanghai, China
| |
Collapse
|
3
|
Zhao H, Zhang L, Yang J, Guo W, Sun C, Shi R, Wang Z. Parkinson's disease motor intervention patterns: a network meta-analysis based on patient motor function. Front Neurol 2024; 15:1432256. [PMID: 39314864 PMCID: PMC11418397 DOI: 10.3389/fneur.2024.1432256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Background Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients. Methods A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool. Results The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84). Conclusion Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.
Collapse
Affiliation(s)
- Hongfei Zhao
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Li Zhang
- Xiamen Medical College, Xiamen, Fujian, China
| | - Jingling Yang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanru Guo
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Chunyang Sun
- School of Exercise and Health, Shanghai Sport University, Shanghai, China
| | - Runbo Shi
- Wushu College, Shanghai Sport University, Shanghai, China
| | - Zhen Wang
- Wushu College, Shanghai Sport University, Shanghai, China
| |
Collapse
|
4
|
van der Heide A, Goltz F, de Vries NM, Bloem BR, Speckens AE, Helmich RC. Study protocol for the MIND-PD study: a randomized controlled trial to investigate clinical and biological effects of mindfulness-based cognitive therapy in people with Parkinson's disease. BMC Neurol 2024; 24:219. [PMID: 38918695 PMCID: PMC11197298 DOI: 10.1186/s12883-024-03736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) are very sensitive to the effects of stress. The prevalence of stress-related neuropsychiatric symptoms is high, and acute stress worsens motor symptoms. Animal studies suggest that chronic stress may accelerate disease progression, but evidence for this in humans is lacking. Mindfulness-based interventions (MBIs) train participants to focus on the present moment, on purpose and without judgement. Previous studies suggest that MBIs may alleviate stress and reduce depression and anxiety in PD. We aim to demonstrate the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) as a non-pharmacologic treatment strategy for neuropsychiatric (and motor) symptoms in PD, and to identify the mechanisms underlying stress and stress reduction in PD. METHODS In a prospective randomized controlled trial (RCT), we investigate whether 8 weeks of MBCT, as compared to care as usual, can reduce symptoms of anxiety and depression in people with PD. We aim to include 124 PD patients, who experience mild-moderate symptoms of anxiety and depression, are eligible for magnetic resonance imaging (MRI) and naïve to mindfulness, and who have a disease duration ≤ 10 years. Every participant is followed for 12 months. Clinical and biochemical assessments take place at baseline (T0), after 2 months (T1), and after 12 months (T2); MRI assessments take place at T0 and T2. Our primary outcome is the total score on the Hospital Anxiety and Depression Scale (HADS) at T1, while correcting for the HADS score at T0, age, and gender. Beyond testing the effects of MBCT on symptoms of anxiety and depression in PD, we explore whether MBCT: (1) has an effect on motor symptom severity, (2) influences cerebral and biochemical markers of stress, and (3) leads to a change in biomarkers of PD progression. DISCUSSION MIND-PD is one of the first RCTs with a 1-year follow-up to investigate the effects of MBCT on symptoms of anxiety and depression in PD, and to explore possible mechanisms underlying stress and stress reduction in PD. Insight into these mechanisms can pave the way to new treatment methods in the future. TRIAL REGISTRATION ClinicalTrials.gov, NCT05779137. Registered on 12 January 2023.
Collapse
Affiliation(s)
- Anouk van der Heide
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
- Neurology department, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Franziska Goltz
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
- Neurology department, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Nienke M de Vries
- Neurology department, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Neurology department, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne E Speckens
- Radboud University Medical Centre, Psychiatry department, Nijmegen, The Netherlands
| | - Rick C Helmich
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
- Neurology department, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Kwok JYY, Jiang D, Yeung DYL, Choi NG, Ho RTH, Warner LM, Chou KL. Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic: The HEAL-HOA Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2416767. [PMID: 38888923 PMCID: PMC11185980 DOI: 10.1001/jamanetworkopen.2024.16767] [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: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024] Open
Abstract
Importance Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. Objective To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. Design, Setting, and Participants This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. Intervention As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. Main Outcomes and Measures The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. Results A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. Conclusion and Relevance In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
Collapse
Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Da Jiang
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Dannii Yuen-lan Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lisa Marie Warner
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Kee-Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Tai Po, Hong Kong
| |
Collapse
|
6
|
Yi M, Zhang W, Zhao B, Wang Z. The Effects of Mindfulness-Based Interventions in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. Clin Gerontol 2024:1-19. [PMID: 38324289 DOI: 10.1080/07317115.2024.2314192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVES To examine the effectiveness of mindfulness-based interventions (MBIs) on psychological symptoms, motor symptoms, and quality of life in patients with Parkinson's disease (PD). METHODS Published studies in Chinese and English languages, conducted from inception to March 2023, were identified by searching PubMed, Web of Science, Cochrane Library, CINAHL, PsycINFO, and two Chinese electronic databases. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. RESULTS Twelve studies were selected for quantitative syntheses. The impact of MBIs on reducing depression and anxiety, and improving mindfulness and quality of life in PD patients was statistically significant compared to the control group. However, no statistically significant effect on motor symptoms was observed. Subgroup analysis indicated that participants from Asia, those who received face-to-face sessions, and those whose sessions lasted 1.5 hours showed a more positive effect than other subgroups. CONCLUSIONS Patients with PD may benefit from MBIs to improve psychological symptoms and quality of life. MBIs represent a pivotal non-pharmacological therapeutic approach in clinical practice. CLINICAL IMPLICATIONS MBIs confer positive improvements in psychological well-being and quality of life in PD patients. However, it remains challenging to conclusively determine their efficacy in addressing motor symptoms.
Collapse
Affiliation(s)
- Mo Yi
- School of Nursing, Peking University, Beijing, China
| | - Wenmin Zhang
- School of Nursing, Peking University, Beijing, China
| | - Baosheng Zhao
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
7
|
Zhang T, Liu W, Bai Q, Gao S. The therapeutic effects of yoga in people with Parkinson's disease: a mini-review. Ann Med 2023; 55:2294935. [PMID: 38109929 PMCID: PMC10732191 DOI: 10.1080/07853890.2023.2294935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative diseases, second only to Alzheimer's disease. Drugs and deep brain stimulation (DBS) are the main treatments for PD. However, the long-term side effects of drugs and the risks of surgery cannot be ignored. It is therefore important to research safe and effective complementary and alternative therapies for PD. Yoga, an ancient mind-body exercise, has been widely used in health promotion. Although, yoga can address a range of health problems, little is known about its role in people with PD. This article reviews the evidence that yoga improves PD symptoms, including movement disorders, balance function and emotional disturbance. The authors analyze the role and shortcomings of the yoga intervention process, with the aim of providing a scientific basis for the application of yoga training to people with PD.
Collapse
Affiliation(s)
- Ting Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- University Hospital, Zhejiang Normal University, Jinhua, China
| | - Wei Liu
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Qingping Bai
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Song Gao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| |
Collapse
|
8
|
Kwok JYY, Cheung DSK, Zarit S, Cheung KSL, Lau BHP, Lou VW, Cheng ST, Gallagher-Thompson D, Chou KL. Multiphase optimization of a multicomponent intervention for informal dementia caregivers: a study protocol. Trials 2023; 24:791. [PMID: 38053147 DOI: 10.1186/s13063-023-07801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Family caregiver interventions are essential to support dementia caregiving. However, such interventions are typically complex and consist of multiple components. Existing evidence rarely delineates the effectiveness and interactions between individual components. To optimise intervention, we adopt the multiphase optimisation strategy (MOST) to test the implementation fidelity and determine the effect of each component and the interactions between each component and the corresponding outcome. METHODS A prospective, assessor-blinded, randomised clinical trial with fractional factorial design using the MOST principle. Two hundred fifty family dementia caregivers will be randomised to one of 16 experimental conditions in a fractional factorial design involving six intervention components: (1) dementia and caregiving education; (2) self-care skills; (3) behavioural symptom management; (4) behavioural activation; (5) modified mindfulness-based cognitive therapy; and (6) support group. The first one is the core component, and the five remaining will be examined. Physical health, caregiver burden, stress, psychological well-being, anxiety and depressive symptoms, and social support will be assessed over the 12-month study period. Following the intention-to-treat principle, linear mixed models and regression analyses will be used to examine the specific effect of the five components and their two-way interactions to propose the most effective combination. DISCUSSION This is the first study adopting the multiphase optimisation strategy to identify the most active and engaging components of a psychological intervention for caregivers of patients with dementia. In view that dementia caregiver interventions are increasingly diversified and complex, such knowledge is important to maximise the intervention efficacy and allow the intervention to be implemented within an efficient timeframe and dosage. The optimisation of caregiver support interventions is critical to enhance the health outcomes of caregivers and care recipients, thereby, delaying possible institutionalisation and reducing the costs of long-term dementia care. TRIAL REGISTRATION This study was retrospectively registered in the WHO Primary Registry - Chinese Clinical Trials Registry (ChiCTR2300071235). (Protocol date 30/10/2020; version identifier 2020-2021-0045). Registered on 9 May, 2023. REPORTING METHOD SPIRIT guideline was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
Collapse
Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR.
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Steven Zarit
- Human Development & Family Studies, Penn State University, University Park, USA
| | - Karen Siu-Lan Cheung
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
- WHO Collaborating Centre (WHO CC), School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- Asia-Pacific Institute of Ageing Studies (APIAS), Lingnan University, Tuen Mun, Hong Kong SAR
| | - Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR
| | - Vivian Weiqun Lou
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong SAR
| | | | - Kee-Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Tai Po, Hong Kong SAR
| |
Collapse
|
9
|
Parra-Soto S, Duran-Aguero S, Vargas-Silva F, Vázquez-Morales K, Pizarro-Mena R. Social Outbreak in Chile, and Its Association with the Effects Biological, Psychological, Social, and Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7096. [PMID: 38063526 PMCID: PMC10706229 DOI: 10.3390/ijerph20237096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
The World Health Organization has defined collective violence as the instrumental use of violence by people who identify themselves as members of a group against other individuals and have political, economic, or social objectives. In Chile, the "Social Outbreak" was used to describe an episode of collective violence, which began on October 18, 2019, triggered by a multitude of socioeconomic and political factors, with protests and mobilizations in the country's large and small cities; in central, commercial, and residential areas, that lasted for several months, affecting a large part of the population. The objective of the present study was to associate the social outbreak in Chile with its biological, psychological, and social effects on people's health and quality of life, as well as its characteristics in terms of exposure, proximity, type, and frequency. This was a cross-sectional study with non-probabilistic national-level sampling, conducted from 28 November 2019, to 3 March 2020. The instrument had four sections. A total of 2651 participants answered the survey; 70.8% were female, and the mean age was 35.2. The main disturbances perceived were protests (70.9%), alarm sounds (68.1%), shooting sounds (59.0%), and tear gas bombs (56.9%). When quantifying the magnitude of these associations, people who had a medium exposure have a higher probability (OR: 1.99, CI: 1.58; 2.50) of suffering three or more biological effects than people that have a low exposure, while people with higher exposition have a 4.09 times higher probability (CI: 3.11; 5.38). A similar pattern was observed regarding psychological effects, although social effects were primarily experienced by those with high exposure. Social networks, TV, and radio were the most used media among people who perceived a greater effect. People who lived, worked, or shopped near the disturbance's areas show a higher proportion negative effect.
Collapse
Affiliation(s)
- Solange Parra-Soto
- Departamento de Nutrición y Salud Pública, Universidad del Bío-Bío, Chillan 3780000, Chile;
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel Duran-Aguero
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile;
| | - Francisco Vargas-Silva
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| | - Katherine Vázquez-Morales
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| | - Rafael Pizarro-Mena
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| |
Collapse
|
10
|
Lin HW, Tam KW, Kuan YC. Mindfulness or meditation therapy for Parkinson's disease: A systematic review and meta-analysis of randomized controlled trials. Eur J Neurol 2023; 30:2250-2260. [PMID: 37158296 DOI: 10.1111/ene.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. Mindfulness and meditation therapies have been demonstrated as effective alternative treatments for patients with neurological disorders. However, the effects of mindfulness and meditation therapies on PD remain unclear. This meta-analysis investigated the effects of mindfulness and meditation therapies in PD patients. METHODS A literature search was conducted using PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials comparing mindfulness and meditation therapies with control treatments in patients with PD. RESULTS Nine articles involving eight trials were included, with a total of 337 patients. Our meta-analysis revealed that mindfulness and meditation therapies significantly improved Unified Parkinson's Disease Rating Scale-Part III score (mean difference [MD] = -6.31, 95% confidence interval [95% CI] = -8.57 to -4.05) and cognitive function (standard mean difference [SMD] = 0.62, 95% CI = 0.23 to 1.02). However, no significant differences were discovered between mindfulness therapies and control in gait velocity (MD = 0.05, 95% CI = -0.23 to 0.34), Parkinson's Disease Questionnaire-39 Summary Index (MD = 0.51, 95% CI = -1.12 to 2.14), activities of daily living (SMD = -1.65, 95% CI = -3.74 to 0.45), depression (SMD = -0.43, 95% CI = -0.97 to 0.11), anxiety (SMD = -0.80, 95% CI = -1.78 to 0.19), pain (SMD = 0.79, 95% CI = -1.06 to 2.63), or sleep disturbance (SMD = -0.67, 95% CI = -1.58 to 0.24). CONCLUSION Mindfulness and meditation therapies may serve as complementary and alternative treatments for PD patients.
Collapse
Affiliation(s)
- Ho-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Chun Kuan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
11
|
Kwok JYY, Auyeung M, Pang SYY, Ho PWL, Yu DSF, Fong DYT, Lin CC, Walker R, Wong SYS, Ho RTH. A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol. BMC Complement Med Ther 2023; 23:241. [PMID: 37461018 PMCID: PMC10351114 DOI: 10.1186/s12906-023-04049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Between 40 and 50% of patients with Parkinson's disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants' experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management. METHODS We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews. DISCUSSION The study would also generate important insights to enhance the patients' adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services. TRIAL REGISTRATION WHO Primary Registry - Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 ( https://www.chictr.org.cn/showproj.html?proj=125878 ).
Collapse
Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | | | - Philip Wing Lok Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- The State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon Tong, Hong Kong SAR
| | - Doris Sau Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Chia-chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Samuel Yeung-shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- CUHK Thomas Jing Centre for Mindfulness Research and Training, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| |
Collapse
|