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Loidl V, Ziegler K, Hoppmann D, Wagner C, Fietzek UM, Ceballos-Baumann AO, Grill E. Implementation and the effects of a Parkinson Network Therapy (PaNTher) on activities of daily living and health-related quality of life in Parkinson's disease patients: study protocol of an mixed-method observational cohort study in outpatient care. BMJ Open 2023; 13:e075338. [PMID: 38011978 PMCID: PMC10685942 DOI: 10.1136/bmjopen-2023-075338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Parkinson's disease (PD) represents the fastest growing neurodegenerative disease with an increasing prevalence worldwide. It is characterised by complex motor and non-motor symptoms that lead to considerable disability. Specialised physiotherapy has been shown to benefit patients with PD. The Parkinson Netzwerk Therapie (PaNTher) was created to improve access to specialised physiotherapy tailored to care priorities of PD patients. This study aims to evaluate the effectiveness, acceptability and needs of the PaNTher network by neurologists and physiotherapists involved in the network in outpatient care. METHODS AND ANALYSIS This is a mixed-method, prospective, pragmatic non-randomised cohort study of parallel groups, with data collection taking place in Bavaria, Germany, between 2020 and 2024. Patients with PD insured by the Allgemeine Ortskrankenkasse Bayern (AOK Bayern) living in Bavaria will be recruited for study participation by network partners. Patients in the intervention group must reside in Munich or the surrounding area to ensure provision of specialised physiotherapy in close proximity to their place of residence. Controls receive care as usual. Six and 12 months after baseline, all patients receive a follow-up questionnaire. Mixed-effect regression models will be used to examine changes in impairment of activities of daily living and quality of life of patients with PD enrolled in the programme over time compared with usual care. Qualitative interviews will investigate the implementation processes and acceptability of the PaNTher network among neurologists and physiotherapists. The study is expected to show that the PaNTher network with an integrative care approach will improve the quality and effectiveness of the management and treatment of patients with PD. ETHICS AND DISSEMINATION The study has been approved by the ethics committee at the medical faculty of the Ludwig-Maximilians-University Munich (20-318). Results will be published in scientific, peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Verena Loidl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Ziegler
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schoen Clinic Munich Schwabing, Munich, Germany
| | - Dagmar Hoppmann
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schoen Clinic Munich Schwabing, Munich, Germany
| | | | - Urban M Fietzek
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schoen Clinic Munich Schwabing, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Andrés O Ceballos-Baumann
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schoen Clinic Munich Schwabing, Munich, Germany
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Terrens AF, Soh SE, Morgan P. Perceptions of aquatic physiotherapy and health-related quality of life among people with Parkinson's disease. Health Expect 2021; 24:566-577. [PMID: 33591629 PMCID: PMC8077086 DOI: 10.1111/hex.13202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 01/19/2023] Open
Abstract
Background Enablers for people with Parkinson's disease (PD) participating in aquatic physiotherapy have been identified, and exercise improves health‐related quality of life (HRQoL) but it is unclear whether all enablers and barriers for aquatic physiotherapy specific to the PD population have been explored. Objective To describe HRQoL in people with PD who have undertaken aquatic physiotherapy, and explore their perceptions and attitudes regarding the programme. Methods Twenty‐one participants who participated in a pilot trial on aquatic physiotherapy were included. Participants completed a survey regarding their experiences. The Parkinson's Disease Questionnaire‐39 (PDQ‐39) and Personal Well‐being Index‐Adult (PWI) were used to quantify HRQoL, whilst focus groups were conducted to explore their perceptions and attitudes. Descriptive statistics were used to summarize HRQoL scores. Focus group data were analysed using the deductive coding method. Results Most participants felt that the aquatic programme was worthwhile (n = 20/21, 95%). However, they had poor overall well‐being (mean 41.6, SD 13.5) and HRQoL (mean 31.0, SD 13.2) as measured by the PWI and PDQ‐39. Several barriers to aquatic therapy including safety when getting dressed, fatigue and transport were identified although many enablers were also identified, including an improvement in function, less falls and group socialization. Conclusions Aquatic physiotherapy was well‐accepted. Participants felt their function improved and felt safe in the water. HRQoL is lower in individuals with PD when compared to Australian norms; thus, interventions to optimize HRQoL need to be explored further. Patient or Public Contribution Patients participated in the aquatic intervention, survey and focus groups.
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Affiliation(s)
- Aan Fleur Terrens
- Movement Disorder Program, Peninsula Health, Frankston, VIC, Australia.,Department of Physiotherapy, Monash University, Frankston, VIC, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Frankston, VIC, Australia
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
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Mirzania M, Khajavi A, Kharazmi A, Moshki M. Health literacy and quality of life among Iranian pregnant women: The mediating role of health locus of control. Med J Islam Repub Iran 2020; 34:161. [PMID: 33816360 PMCID: PMC8004579 DOI: 10.47176/mjiri.34.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Main health challenge of the 21st century is improving quality of life (QoL). This study aimed to investigate the mediating role of health locus of control (HLC) between health literacy and QoL among Iranian pregnant women. Methods: In this cross sectional survey, 400 pregnant women referred to the community health centers of Gonabad, Iran, and completed the demographic, health literacy, QoL, and multidimensional HLC questionnaires during 2015-2016. Descriptive statistics and structural equation modeling were conducted using SPSS 22.0 version and AMOS 24.0 software. Results: The findings showed that health literacy has a significant positive effect on the physical (β= 0.54, p< 0.001) and mental (β= 0.57, p< 0.001) health. Also, it has a significant positive effect on internal subscale (β= 0.42, p< 0.001) and a significant negative effect on the chance (β= -0.51, p< 0.001) and powerful others (β= -0.33, p< 0.001) subscale of HLC. From HLC subscales, internal HLC had a significant positive effect on physical (β= 0.26, p< 0.001) and mental (β= 0.12, p= 0.010) health, while the effects of chance and powerful others on QoL dimensions were not significant. The findings indicated that internal HLC is a partial mediator between health literacy and physical dimension of QoL. Conclusion: The results indicate that health literacy can be considered as an effective factor in HLC orientations and can improve QoL. This reflects the need for more attention on health literacy and the recognition of the type of HLC beliefs, especially the internal belief in health promotion programs for pregnant women.
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Affiliation(s)
- Marjan Mirzania
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdoljavad Khajavi
- Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Akram Kharazmi
- Faculty of Nursing, Kashmar, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Moshki
- Department of Health Education and Promotion, School of Health; Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Suicidal risk and demoralization in Parkinson disease. J Neurol 2019; 267:966-974. [DOI: 10.1007/s00415-019-09632-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 11/26/2022]
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Lee J, Kim Y, Kim S, Kim Y, Lee YJ, Sohn YH. Unmet needs of people with Parkinson's disease: A cross-sectional study. J Adv Nurs 2019; 75:3504-3514. [PMID: 31287176 DOI: 10.1111/jan.14147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/04/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022]
Abstract
AIMS To identify the type and extent of unmet needs in people with Parkinson's disease and to examine the impact of health locus of control and family support on these needs. DESIGN A cross-sectional study. METHODS This study was conducted from October 2015 - February 2016 in Korea. Data were collected through questionnaires focusing on unmet needs, health locus of control, family support and clinical features. RESULTS Therapeutic needs represented the highest percentage of unmet needs in people with Parkinson's disease (85.05%), followed by social/spiritual/emotional needs (82.72%). Physical needs were the lowest reported score (75.01%). Unmet needs were more frequent in those with more severe non-motor symptoms. Also, higher family support, internal locus of control and doctor locus of control were correlated with more unmet needs. CONCLUSION Understanding factors that determine the type and degree of unmet needs in people with PD is important to provide appropriate nursing care. The findings of this study can be used for providing nursing interventions reflecting unmet needs and reducing their unmet needs to improve the overall well-being of people with PD. IMPACT This study addressed unmet needs unmet needs specific to Parkinson's disease with respect to their nursing needs. Therapeutic needs were the highest unmet needs in people with PD, followed by social/spiritual/emotional needs, need for certainty and physical needs. The findings may be useful for nurses to identify the unmet needs of people with PD which need to be addressed. By reflecting on unmet needs, nurses can give personally tailored nursing care.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - YonJi Kim
- Graduate School, College of Nursing, Yonsei University, Seoul, South Korea
| | - SungHae Kim
- Graduate School, College of Nursing, Yonsei University, Seoul, South Korea
| | - Yielin Kim
- Graduate School, College of Nursing, Yonsei University, Seoul, South Korea
| | - Young Joo Lee
- College of Nursing, Daegu Catholic University, Gyeongsan, South Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Dhar SS, Jeenger J, Singroha V, Sharma M, Mathur DM. Psychiatric morbidity, cognitive dysfunction and quality of life in drug-naive patients with Parkinson's disease: A comparative study. Ind Psychiatry J 2019; 28:13-18. [PMID: 31879441 PMCID: PMC6929235 DOI: 10.4103/ipj.ipj_64_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To better understand the psychiatric disorders and cognition in Parkinson's disease (PD) and its impact on quality of life (QoL), patients need to be studied soon after diagnosis, before initiation of dopamine replacement therapy. AIM This study aims to compare the nature and frequency of psychiatric morbidity, cognitive dysfunction, and quality of life in drug-naive patients with PD and healthy controls. MATERIALS AND METHODS The cross-sectional, comparative study was conducted in tertiary care center. Fifty drug-naive PD patients and fifty healthy controls were included and assessed on Modified Hoehn and Yahr scale, PD Questionnaire 8, Kolkata cognitive screening battery, General Health Questionnaire-12, and Hamilton Anxiety and Depression Rating Scale (HAM-A and HAM-D). RESULTS The mean scores of HAM-A and HAM-D of patients with PD were significantly higher than that of the comparison group. The patients with PD had statistically significant impairment in verbal fluency, Mini-Mental State Examination, calculation, memory immediate recall, visuoconstructional ability, and memory (delayed recall and recognition) in comparison to patients without PD. No statistically significant difference was observed with respect to object naming between the two groups. CONCLUSION QoL of a PD patient is adversely affected by both the motor and nonmotor symptoms of the disease such as depression, anxiety, apathy, sleep disturbances, and cognitive impairment. The link between nonmotor symptoms and reduced QoL has important implications for the management of PD because the nonmotor symptoms often appear before patients are given anti-parkinsonian therapy. Screening of nonmotor symptoms in early stage of disease will decrease the morbidity and mortality and improve the QoL.
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Affiliation(s)
- Subhendu Shekhar Dhar
- Department of Psychiatry, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Jitendra Jeenger
- Department of Psychiatry, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Vikas Singroha
- Department of Psychiatry, Saheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | - Manu Sharma
- Department of Psychiatry, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Devendra Mohan Mathur
- Department of Psychiatry, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
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Gison A, Bonassi S, Rizza F, Giaquinto S. Comparison of three scales to evaluate personality traits in Parkinson's disease: which one to use? Eur J Phys Rehabil Med 2018; 55:183-190. [PMID: 30311492 DOI: 10.23736/s1973-9087.18.05240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Personality traits have gained interest in the field of disability and stress, because they may either prompt or deny compliance. They can also foster motivation and influence outcome. Parkinson disease (PD) is a disabling and stressful condition that requires coping strategies and rehabilitation plans. Three constructs and their relative scales have been a matter of investigation, namely dispositional optimism (DO), locus-of-control (LOC), and sense-of-coherence (SOC). AIM The present study compared the psychometric properties of three constructs in Parkinson's disease (PD). The health-related variables were: emotional distress (ED), quality of life (HR-QoL) and activities of daily living (ADL). The final objective was to provide guidance on scale selection to be implemented in clinical protocols. DESIGN A cross sectional study. SETTING Community-based general physicians. POPULATION Participants with PD (N.=84) from community-based general physicians. METHODS PD patients completed 3 self-report scales, namely Life Orientation Test-Revised (LOT-R, measuring Dispositional Optimism), Internal and External Locus Of Control (LOC-int. LOC-ext) and Sense of Coherence (SOC). All participants had magnetic resonance imaging. The MDS-UPDRS and the Barthel Scale were compiled by the investigator with the assistance of a caregiver. RESULTS LOC-ext was the only scale to be associated with PD severity and disability (P<0.05). A higher level of LOC-ext was also associated with a higher level of ED (P<0.005). LOT-R was inversely associated with ED. Subjects in the highest tertile had a 41% lower ED (P<0.001). SOC was also inversely associated with degree of ED. Subjects in the highest tertile have a 44% lower ED (P<0.01). Moreover, HR-QoL is associated with several parameters, but LOT-R is the one with the strongest association (P<0.001). CONCLUSIONS DO and SOC are predictive of important end-points, namely HR-QoL and ED. DO is even better under this respect. Conversely, those clinicians who are more interested in motor problems may find LOC more suitable. DO may be the most efficient construct to use in PD because of its favorable psychometric properties. CLINICAL REHABILITATION IMPACT DO, LOC and SOC are constructs to be implemented in both research and clinical PD protocols. It is recommended to implement these, because they have predictive value especially when HR-QoL and ED are studied.
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Affiliation(s)
- Annalisa Gison
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy -
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Federica Rizza
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Salvatore Giaquinto
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
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Mullin RL, Chaudhuri KR, Andrews TC, Martin A, Gay S, White CM. A study investigating the experience of working for people with Parkinson’s and the factors that influence workplace success. Disabil Rehabil 2017; 40:2032-2039. [DOI: 10.1080/09638288.2017.1323237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rebecca L. Mullin
- Division of Health and Social Care Research, King’s College London, London, UK
- Department of Neurology, Guys and St. Thomas’ NHS Foundation Trust, London, UK
| | - K. Ray Chaudhuri
- Department of Movement Disorders, King’s College Hospitals NHS Foundation Trust, London, UK
| | - Thomasin C. Andrews
- Department of Neurology, Guys and St. Thomas’ NHS Foundation Trust, London, UK
| | - Anne Martin
- Department of Movement Disorders, King’s College Hospitals NHS Foundation Trust, London, UK
| | - Stella Gay
- Department of Neurology, Guys and St. Thomas’ NHS Foundation Trust, London, UK
| | - Claire M. White
- Division of Health and Social Care Research, King’s College London, London, UK
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Rizza F, Gison A, Bonassi S, Dall’Armi V, Tonto F, Giaquinto S. ‘Locus of control’, health-related quality of life, emotional distress and disability in Parkinson’s disease. J Health Psychol 2015; 22:844-852. [DOI: 10.1177/1359105315616471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This cross-sectional study evaluated locus of control and its subscales in Parkinson’s disease. A total of 50 consecutive Parkinson’s disease participants and 50 healthy volunteers (control group) were enrolled. External locus of control was significantly higher in Parkinson’s disease participants, whereas internal locus of control had no significant differences. External locus of control and internal locus of control were correlated in control group, but not in Parkinson’s disease. In Parkinson’s disease participants, external locus of control was negatively associated with health-related quality of life as well as positively associated with emotional distress and disease severity (but not with disability). After adjusting to confound variables, the associations remained. On the other hand, internal locus of control was negatively associated with depression.
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Affiliation(s)
- Federica Rizza
- Department of Neurological Rehabilitation , I.R.C.C. S San Raffaele Pisana, Rome, Italy
| | - Annalisa Gison
- Department of Neurological Rehabilitation , I.R.C.C. S San Raffaele Pisana, Rome, Italy
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, I.R.C.C. S San Raffaele Pisana, Rome, Italy
| | - Valentina Dall’Armi
- Unit of Clinical and Molecular Epidemiology, I.R.C.C. S San Raffaele Pisana, Rome, Italy
| | - Francesca Tonto
- Department of Neurological Rehabilitation , I.R.C.C. S San Raffaele Pisana, Rome, Italy
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Eklund M, Erlandsson LK, Hagell P. Psychometric properties of a Swedish version of the Pearlin Mastery Scale in people with mental illness and healthy people. Nord J Psychiatry 2012; 66:380-8. [PMID: 22339394 DOI: 10.3109/08039488.2012.656701] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mastery refers to the degree to which people perceive that they can control factors that influence their life situation, and has been found important for people's quality of life and well-being. It is thus essential to be able to measure mastery in a valid and reliable way. AIM This study aimed at using the Rasch measurement model to investigate the psychometric properties of a Swedish version of the Pearlin Mastery Scale (Mastery-S). METHODS A sample of 300 healthy individuals and 278 persons with mental illness responded to the Mastery-S. Item responses were Rasch analysed regarding model fit, response category functioning, differential item functioning (DIF) and targeting, using the partial credit model. RESULTS The Mastery-S items represented a logical continuum of the measured construct but one item displayed misfit. Reliability (Person Separation Index) was 0.7. The response categories did not work as expected in three items, which could be corrected for by collapsing categories. Three items displayed DIF between the two subsamples, which caused a bias when comparing mastery levels between subsamples, suggesting the Mastery-S is not truly generic. CONCLUSIONS The Mastery-S may be used to obtain valid and reliable data, but some precautions should be made. If used to compare groups, new analyses of DIF should first be made. Users of the scale should also consider exempting item 6 from the scale and analyse it as a separate item. Finally, rewording of response categories should be considered in order to make them more distinct and thereby improve score reliability.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Lund University, Sweden
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Lokk J, Delbari A. Clinical aspects of palliative care in advanced Parkinson's disease. BMC Palliat Care 2012; 11:20. [PMID: 23098090 PMCID: PMC3528486 DOI: 10.1186/1472-684x-11-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 08/27/2012] [Indexed: 12/31/2022] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative disorders of the elderly population. Few therapeutic options are available for patients with PD requiring palliative care. Treatment of the early stages of PD is entirely different from later stages. During the later stages, the palliative care model is introduced to provide the patient with comfort and support. Early palliative care in PD requires minimization of dyskinesias and decreasing occurrence of motor and non-motor off times in an effort to maximize independent motor function. In the later stages, the focus of treatment shifts to treating the predominant non-motor symptoms and having a more supportive and palliative nature. The purpose of this review is to provide a summary of the palliative care management issues and palliative care management options of end-stage PD patients.
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Affiliation(s)
- Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatric, Huddinge Hospital, R94, Karolinska Institute, Stockholm, Sweden, SE-141 86.
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Khlebtovsky A, Rigbi A, Melamed E, Ziv I, Steiner I, Gad A, Djaldetti R. Patient and caregiver perceptions of the social impact of advanced Parkinson’s disease and dyskinesias. J Neural Transm (Vienna) 2012; 119:1367-71. [DOI: 10.1007/s00702-012-0796-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/07/2012] [Indexed: 11/30/2022]
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Eccles FJR, Murray C, Simpson J. Perceptions of cause and control in people with Parkinson's disease. Disabil Rehabil 2011; 33:1409-20. [DOI: 10.3109/09638288.2010.533241] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Eccles FJR, Simpson J. A review of the demographic, clinical and psychosocial correlates of perceived control in three chronic motor illnesses. Disabil Rehabil 2011; 33:1065-88. [DOI: 10.3109/09638288.2010.525287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sjödahl Hammarlund C, Nilsson MH, Hagell P. Measuring outcomes in Parkinson’s disease: a multi-perspective concept mapping study. Qual Life Res 2011; 21:453-63. [DOI: 10.1007/s11136-011-9995-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2011] [Indexed: 11/24/2022]
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Tickle-Degnen L, Ellis T, Saint-Hilaire MH, Thomas CA, Wagenaar RC. Self-management rehabilitation and health-related quality of life in Parkinson's disease: a randomized controlled trial. Mov Disord 2010; 25:194-204. [PMID: 20077478 DOI: 10.1002/mds.22940] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of this randomized controlled trial was to determine whether increasing hours of self-management rehabilitation had increasing benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment, whether effects persisted at 2 and 6 months of follow-up, and whether targeted compared with nontargeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomly assigned to one of three conditions for 6 weeks intervention: 0 hours of rehabilitation; 18 hours of clinic group rehabilitation plus 9 hours of attention control social sessions; and 27 hours of rehabilitation, with 18 in clinic group rehabilitation and 9 hours of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at 6 weeks, there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (F(1,112) = 6.48, eta = 0.23, CI = 0.05-0.40, P = 0.01). Benefits persisted at follow-up. The difference between 18 and 27 hours was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hours (54% improved) than for 0 hours (18% improved), a significant 36% difference in rates (95% CI = 20-52% difference). Effects were largest in two targeted domains: communication and mobility. More concerns with mobility and activities of daily living at baseline predicted more benefit from rehabilitation.
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Affiliation(s)
- Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts 02155, USA.
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Lökk J. Reduced life-space of non-professional caregivers to Parkinson's disease patients with increased disease duration. Clin Neurol Neurosurg 2009; 111:583-7. [DOI: 10.1016/j.clineuro.2009.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 04/24/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
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Jones CA, Pohar SL, Patten SB. Major depression and health-related quality of life in Parkinson's disease. Gen Hosp Psychiatry 2009; 31:334-40. [PMID: 19555793 DOI: 10.1016/j.genhosppsych.2009.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/20/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Depression is a common psychiatric condition in Parkinson's disease (PD), yet the burden of depression on health-related quality of life (HRQL) has not been clearly delineated in this patient population. OBJECTIVE To evaluate the impact of depression and life stress on HRQL in the Canadian community dwelling population with PD. METHODS A total of 259 respondents from the Canadian Community Health Survey (CCHS 1.1) with self-reported PD were interviewed. Measures included Health Utilities Index Mark 3 (HUI3), Composite International Diagnostic Interview Short Form for Major Depression and a single question regarding the amount of stress in their lives most days. Adjusted HUI3 scores were compared according to depression and life stress using ANCOVA models. RESULTS Respondents without depression had overall HUI3 scores that were 0.29 units higher than respondents with depression [adjusted mean (95% CI) 0.49 (0.39-0.59) vs. 0.20 (0.03-0.37)]. The difference in overall HUI3 scores between respondents who reported high levels of stress as those who did not was 0.19 [adjusted mean (95% CI) 0.42 (0.29-0.55) vs. 0.23 (0.10-0.36)]. CONCLUSIONS Substantial impact of depression and life stress, two modifiable factors, on HRQL is seen in PD. HRQL may be improved by clinical management of these nonmotor symptoms in PD.
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Affiliation(s)
- C Allyson Jones
- School of Public Health, University of Alberta, Edmonton, AB T6G 2G4, Canada.
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Gruber-Baldini AL, Ye J, Anderson KE, Shulman LM. Effects of optimism/pessimism and locus of control on disability and quality of life in Parkinson's disease. Parkinsonism Relat Disord 2009; 15:665-9. [PMID: 19362510 DOI: 10.1016/j.parkreldis.2009.03.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 02/06/2009] [Accepted: 03/25/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess optimism/pessimism and locus of control in a sample of Parkinson's disease patients and to evaluate their impact on disability and health-related quality of life. METHODS 99 patients with Parkinson's disease completed the Life Orientation Test, Multidimensional Health Locus of Control, Older Americans Resource and Services Activities of Daily Living Subscale, and Short Form-12 Health Status Survey. Disease stage and severity measures were completed by movement disorder specialists. Correlations and multivariate regressions compared optimism/pessimism and locus of control with disability and health-related quality of life. RESULTS Higher optimism and less pessimism were associated with better mental health quality of life. Greater internal locus of control was associated with less disability. These results remained significant when controlling for disease severity. CONCLUSIONS Low optimism or high pessimism is associated with reduced quality of life in Parkinson's disease. Patients with less internal locus of control have greater disability. Interventions that promote personal control and positive attitudes may assist in reducing disability and improving quality of life in Parkinson's disease.
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Affiliation(s)
- Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Visser M, van Rooden SM, Verbaan D, Marinus J, Stiggelbout AM, van Hilten JJ. A comprehensive model of health-related quality of life in Parkinson's disease. J Neurol 2008; 255:1580-7. [PMID: 18821041 DOI: 10.1007/s00415-008-0994-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 04/11/2008] [Accepted: 05/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Insight in how impairments and disabilities related to Parkinson's disease (PD) influence health-related quality of life (HRQoL) is required to review adequacy of current management strategies. METHODS The Scales for Outcomes in Parkinson's disease (SCOPA) evaluation was used to assess impairments and disabilities. HRQoL was assessed with the EuroQol-5D Visual Analogue Scale. 378 patients with PD who participated in the SCOPA/PROPARK cohort were assessed while on their usual treatment. Multiple linear regression analysis and structural equation modelling were used to construct a model of factors that influence HRQoL. RESULTS A model with good fit was constructed that identified various impairments and disabilities as important contributors to HRQoL in PD. Of the disabilities, psychosocial well-being had a larger impact on HRQoL than physical functioning. Of the impairments, depression had the largest contribution to HRQoL, followed by axial motor symptoms, gastrointestinal symptoms, and urinary symptoms. In addition, pain, psychiatric and motor complications, and daytime sleepiness had small but significant influences on HRQoL. CONCLUSION Multiple factors, including disabilities, nonmotor symptoms and axial motor symptoms, affect HRQoL in patients with PD. In patients who are on symptomatic treatment aiming to alleviate mainly motor symptoms, there is a large impact on HRQoL of nonmotor and nondopaminergic symptoms. Research is warranted to develop and evaluate management strategies for the aspects that currently impact on HRQoL as psychosocial well-being, depressive symptoms, axial motor symptoms, gastrointestinal symptoms, and urinary symptoms. These findings call for a multidisciplinary approach in the care of these features.
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Affiliation(s)
- M Visser
- Department of Neurology, K5 Q 92, Leiden University Medical Center, 9600, 2300 RC Leiden, The Netherlands.
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Lindskov S, Westergren A, Hagell P. A controlled trial of an educational programme for people with Parkinson's disease. J Clin Nurs 2007; 16:368-76. [DOI: 10.1111/j.1365-2702.2007.02076.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Miriam Boelen
- Evanston Northwestern Healthcare, Glenbrook Hospital, Glenview, Illinois, USA
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Abstract
Parkinson's disease (PD) is a chronic, progressive, degenerative disorder of the nervous system, causing substantial morbidity and has the capacity to shorten life. People with PD and their families can find the disease devastating. Nevertheless, this population of patients is not usually considered a group to be supported by palliative care specialists. But the nature of the illness and the challenges of managing its many physical and psychological effects raises questions about the potential benefits of a palliative care approach. The purpose of this project was to describe the experience of PD and consider the relevance of palliative care for this population. Semi-structured interviews were conducted with eight people with PD, 21 family caregivers and six health professionals. Five themes were developed from the data analysis: (1) emotional impact of diagnosis; (2) staying connected; (3) enduring financial hardship; (4) managing physical challenges; and (5) finding help for advanced stages. These data revealed that people with PD and family caregivers are confronted with similar issues to people with typical palliative care diagnoses, such as advanced cancer, and that a palliative approach may be helpful in the care of people with PD and their families.
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Affiliation(s)
- Peter L Hudson
- Centre for Palliative Care, St. Vincent's Health, Australia.
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Lyons KD, Tickle-Degnen L, DeGroat EJ. Inferring personality traits of clients with Parkinson's disease from their descriptions of favourite activities. Clin Rehabil 2005; 19:799-809. [PMID: 16250200 DOI: 10.1191/0269215505cr897oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the extent to which practitioners effectively use cues from clients' verbal descriptions of their favourite activities to form accurate impressions of the personality of clients with Parkinson's disease. PARTICIPANTS Ninety-nine practitioners from disciplines of occupational, physical and speech therapy, nursing or medicine. PROCEDURE Six men and six women with Parkinson's disease completed a self-report measure of personality and were individually interviewed regarding their favourite activities. The practitioners viewed 2-min segments of those videotaped interviews and provided judgements of the clients' personality. MEASURE The NEO-Five Factor Inventory and a coding scheme to describe characteristics of clients' favourite activities. ANALYSIS Clients' self-reported personality was correlated with the activity characteristics to identify the degree to which each characteristic was a cue of personality. Practitioners' judgements of personality were correlated with the activity characteristics to identify how heavily the practitioners weighted each cue. These two sets of weightings were compared using Pearson's correlations to determine whether practitioners used an appropriate cue strategy related to the activity descriptions. RESULTS Practitioners appropriately used the personality cues found in the clients' favourite activity descriptions to assess the traits of Openness to Experience, Agreeableness and Conscientiousness (r = 0.66, r = 0.60, and r = 0.55, respectively, all p < or = 0.02). Practitioners appeared to use less effective cue strategies for the traits of Neuroticism and Extraversion. CONCLUSION Clients with Parkinson's disease appear to express their personality in their descriptions of favourite activities, and practitioners appear to make use of these expressive verbal cues effectively for some aspects of personality.
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Chapuis S, Ouchchane L, Metz O, Gerbaud L, Durif F. Impact of the motor complications of Parkinson's disease on the quality of life. Mov Disord 2004; 20:224-30. [PMID: 15384126 DOI: 10.1002/mds.20279] [Citation(s) in RCA: 363] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The impact of motor complications of Parkinson's disease (PD), especially levodopa-induced dyskinesias, on quality of life (QL) was studied in 143 patients with PD. All were evaluated on the Hoehn and Yahr (H&Y) scale, and the Motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Motor complications were analyzed using the UPDRS Parts IV(A) and IV(B) and the Abnormal Involuntary Movement Scale. A specific Parkinson's disease quality of life questionnaire (39-item version, PDQ-39) was used. Motor complications significantly worsened the PDQ-39 Summary Index (PDQ-SI) of patients with PD. The dimensions of Mobility, Activities of Daily Living, Stigma, and Communication were the most strongly affected. "Peak dose" dyskinesia decreased Mobility, Emotional Well-Being, and Cognition, whereas biphasic dyskinesia affected Mobility, Stigma, Communication, and Activities of Daily Living. Morning akinesia, end-of-dose fluctuations, and "unpredictable offs" decreased QL on the dimensions of Mobility, Activities of Daily Living, Stigma, and Communication. Nocturnal akinesia led to a deterioration of all dimensions of the PDQ-39. Thus, motor complications and especially nocturnal akinesia and biphasic dyskinesias worsened the QL of PD patients.
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Welsh M. Parkinson's disease and quality of life: issues and challenges beyond motor symptoms. Neurol Clin 2004; 22:S141-8. [PMID: 15501362 DOI: 10.1016/j.ncl.2004.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mickie Welsh
- Department of Neurology, University of Southern California, 1520 San Pablo, Suite 3000, Los Angeles, CA 90033, USA.
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Quittenbaum BH, Grahn B. Quality of life and pain in Parkinson's disease: a controlled cross-sectional study. Parkinsonism Relat Disord 2004; 10:129-36. [PMID: 15036166 DOI: 10.1016/j.parkreldis.2003.12.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 12/16/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare health-related quality of life (HRQL) and pain symptoms in patients with PD with a matched control group. To our knowledge, controlled studies of Parkinson's disease (PD) patients within this area are rare. SCOPE Fifty-seven patients and 95 controls took part in a self-administered questionnaire study. The instruments were the SF-36, visual analogue scales, pain drawing and pain-specific questions. CONCLUSIONS Pain problems are common in PD patients but also to a large extent in the normal population. HRQL was reduced (p < or = 0.001) for the PD patients on all the scales on the SF-36 and consequently also in the pain dimension. The study indicates that even PD patients, who are optimally diagnosed and treated by a neurologist, might require additional rehabilitation treatment to improve their HRQL and pain problems.
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Tsang HWH, Cheang CTK, Tong BYM, Tse SSL. Psychosocial functioning of Chinese older people with chronic physical illness. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2004. [DOI: 10.12968/ijtr.2004.11.3.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using the Chinese Geriatric Depression Scale, The World Health Organization Quality of Life (WHOQoL) scale and the Self-concept Questionnaire, this article examined the relationship between depression and psychosocial functioning among 80 older people with chronic physical illness in Hong Kong. It aimed to test the hypothesis that people with chronic physical illness are prone to depression, which in turn leads to lower quality of life and negative self-esteem. The group with chronic physical illness scored higher on the Geriatric Depression Scale than the control group. The control group had higher scores than the illness group in the physical health and psychological health domains of the WHO-QoL scale and had better functioning in activities of daily living and leisure. Despite some contradictory findings, the results of this study support the proposed hypothetical framework relating chronic physical illness to depression and support findings of previous research. Data from this study highlight the negative impact of chronic physical illness on the physical and psychological status of older people. Implications for rehabilitation services are discussed.
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Affiliation(s)
- Hector WH Tsang
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hunghom, Hong Kong
| | - Callas TK Cheang
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hunghom, Hong Kong
| | - Betsey YM Tong
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hunghom, Hong Kong
| | - Shirley SL Tse
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hunghom, Hong Kong
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Hagell P, Whalley D, McKenna SP, Lindvall O. Health status measurement in Parkinson's disease: validity of the PDQ-39 and Nottingham Health Profile. Mov Disord 2003; 18:773-83. [PMID: 12815656 DOI: 10.1002/mds.10438] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the feasibility and psychometric properties of two commonly used health status questionnaires in Parkinson's disease (PD): the generic Nottingham Health Profile (NHP) and the disease-specific 39-item Parkinson's disease Questionnaire (PDQ-39), from a cross-sectional postal survey of PD patients (N = 81), using traditional and Rasch measurement methodologies. Overall response rate was 88%. Both questionnaires were found feasible, although the NHP performed less well. The PDQ-39 had fewer floor effects and was better able to separate respondents into distinct groups than the NHP, whereas the latter exhibited less ambiguous dimensionality and better targeting of respondents with non-extreme scores. Reliability and validity indices were similar, and potential differential item functioning by age and gender groups was found for both questionnaires. PDQ-39 response alternatives indicated ambiguity. With few exceptions, questionnaire scales were unable to meet recommended standards fully. While preliminary, this study illustrates the need for thorough evaluation of outcome measures and has implications beyond the questionnaires used here. Although promising, both questionnaires warrant further developmental work and stronger support of measurement validity before they could be considered fully suitable for valid use in PD, in particular in earlier stages of the disease.
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Affiliation(s)
- Peter Hagell
- Section of Restorative Neurology, Department of Clinical Neuroscience, University Hospital, Lund, Sweden.
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Spliethoff-Kamminga NGA, Zwinderman AH, Springer MP, Roos RAC. Psychosocial problems in Parkinson's disease: evaluation of a disease-specific questionnaire. Mov Disord 2003; 18:503-9. [PMID: 12722163 DOI: 10.1002/mds.10388] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Our objective was to evaluate the BELA-P-k, a questionnaire for measuring psychosocial problems and need for help in Parkinson's disease (PD) patients. The Belastungsfragebogen Parkinson kurzversion (BELA-P-k) was translated from German into Dutch. It consists of 19 items distributed over four subscales: achievement capability/physical symptoms, fear/emotional functioning, social functioning and partner-bonding/family, with a "Bothered by" (Bb) and a "Need for Help" (NfH) score. The BELA-P-k was tested for cultural differences, relevance, and feasibility in a pilot study (n = 10) and compared in a validation study (n = 54) with the Sickness Impact Profile, the COOP/WONCA Functional Health Assessment Charts and the Loneliness Questionnaire. All questionnaires were administered in person at home, in a prescribed order. The BELA-P-k was completed by 64 patients with PD. The internal-consistency reliability coefficients for the total Bb (0.90) and NfH (0.93) scales were excellent. The internal consistency of the subscales exceeded the 0.70 standard except for the "Bothered by partner-bonding/family scale" (0.61). Almost all BELA-P-k subscales correlated highly (P < 0.001) with the corresponding scales of the standard quality-of-life indices. There was no significant relationship between disease severity (Hoehn and Yahr) and the BELA-P-k. We conclude that the BELA-P-k is a relevant, reliable and valid measure for assessing psychosocial problems and need for help of PD patients.
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McQuillen AD, Licht MH, Licht BG. Contributions of disease severity and perceptions of primary and secondary control to the prediction of psychosocial adjustment to Parkinson's disease. Health Psychol 2003; 22:504-12. [PMID: 14570534 DOI: 10.1037/0278-6133.22.5.504] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Seventy-four people with Parkinson's disease (PD) completed questionnaires and were interviewed to determine the degree to which the severity of PD and perceptions of primary and secondary control over PD predicted psychosocial adjustment. Significant unique contributions to PD-related participation restrictions were made by disease severity (positive relationship) and perceived internal secondary control (negative relationship). Also, participation restrictions had a significant direct effect, and disease severity and perceived internal secondary control significant indirect effects, on both depressive symptomatology and life satisfaction. Results are consistent with theories that suggest the importance of enhancing internal secondary control processes in situations in which actual control over objective circumstances is limited, such as with chronic and progressive diseases like PD.
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Affiliation(s)
- Anita D McQuillen
- Florida State University, Dept of Psychology, Tallahassee, FL 32306, USA
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Affiliation(s)
- Angela Birleson
- Institute of Rehabilitation, Hunter's Moor Regional Neurological Rehabilitation Centre, University of Northumbria, Newcastle upon Tyne NE2 4NR
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Schenkman M, Cutson TM, Zhu CW, Whetten-Goldstein K. A longitudinal evaluation of patients' perceptions of Parkinson's disease. THE GERONTOLOGIST 2002; 42:790-8. [PMID: 12451160 DOI: 10.1093/geront/42.6.790] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Parkinson's disease (PD) is a chronic progressive neurological disorder that frequently results in nearly total disability. This study examined changes over 3 years in patients' experiences living with PD, and explored how participants' health perceptions and predicted mortality at baseline related to their actual death by Year 3. DESIGN AND METHODS Data were obtained from a local sample of 109 participants by in-home interviews. RESULTS The collected results (1) suggested a disconnection between the participants' responses to open-ended questions about the disorder, compared with their responses to questions structured by the investigators; (2) demonstrated changes in responses to structured and open-ended questions; and (3) demonstrated that respondents who declined to predict whether they would be living in 10 years were three times more likely to die by Year 3 than those who answered the question. IMPLICATIONS Results demonstrate the importance of identifying the most important issues for the individual with PD and suggest that these issues may change over time. Results also raise issues surrounding how patients' perceptions influence the course of their disease.
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Affiliation(s)
- Margaret Schenkman
- Physical Therapy Program, University of Colorado Health Sciences Center, Campus Box C-244, 1400 E. Ninth Avenue, Denver, CO 80262-0244, USA.
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Ben-Shlomo Y, Camfield L, Warner T. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry 2002; 72:608-14. [PMID: 11971047 PMCID: PMC1737851 DOI: 10.1136/jnnp.72.5.608] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. OBJECTIVE To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. METHODS Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. RESULTS 289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. CONCLUSIONS Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.
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Affiliation(s)
- Y Ben-Shlomo
- Department of Social Medicine, MRC Health Services Collaboration, University of Bristol, Bristol, UK.
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Chrischilles EA, Rubenstein LM, Voelker MD, Wallace RB, Rodnitzky RL. Linking clinical variables to health-related quality of life in Parkinson's disease. Parkinsonism Relat Disord 2002; 8:199-209. [PMID: 12039432 DOI: 10.1016/s1353-8020(01)00044-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL). BACKGROUND Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms. DESIGN/METHODS A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews. RESULTS The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures. CONCLUSION PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.
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Affiliation(s)
- Elizabeth A Chrischilles
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA 52242, USA.
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William J. Weiner, Lisa M. Shulman, and Anthony E. Lang Parkinson's disease: A complete guide for patients and families. Baltimore, MD: Johns Hopkins University Press, 2001. Can J Aging 2002. [DOI: 10.1017/s0714980800001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLa maladie de Parkinson est une affection chronique neurologique dégénérative qui affecte environ un million de personnes en Amérique du Nord. Or, tous les patients atteints de la maladie doivent être bien informés; ils ont surtout besoin d'en comprendre les symptômes et la progression pour être en mesure de l'affronter efficacement. Parkinsons disease: A complete guide for patients and families par Weiner, Shulman et Lang (2001) constitue une ressource précieuse pour les patients, leurs familles et les soignants qui travaillent auprès de cette population. Le livre fournit une bonne quantité d'information biomédicale sur la maladie. Les données sont communiquées selon un modèle élémentaire qui éduque le lecteur mais qui lui permet aussi de s'assumer et qui lui aide éventuellement à faire face à sa maladie. Le livre présente toutefois certaines faiblesses qu'il faut signaler, dont entre autres, le fait que l'approche biomédicale écarte les questions psychosociales reliées à la maladie. Une autre faiblesse porte sur l'absence de mention des efforts scientifiques récents dans d'autres secteurs que la médecine clinique. Enfin, il porte peu d'attention aux interventions thérapeutiques qui ne sont pas du domaine médical ou pharmacologique. Les auteurs renvoient à d'autres sources les lecteurs qui souhaitent se renseigner sur ces éléments.
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Schenkman M, Wei Zhu C, Cutson TM, Whetten-Goldstein K. Longitudinal evaluation of economic and physical impact of Parkinson's disease. Parkinsonism Relat Disord 2001; 8:41-50. [PMID: 11472879 DOI: 10.1016/s1353-8020(00)00079-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The cost of parkinsonism and Parkinson's disease (PD) is largely unknown although clinical experience suggests that the impact of this disease is substantial. Longitudinal data is presented for health status, disease symptoms, functional status, and financial costs for 70 participants with PD or parkinsonism. The sample was dichotomized into those rating their health as excellent, good, or very good ('good health') and those rating their health as fair or poor ('poor health'). The 'poor health' group were significantly more disabled at baseline. Symptoms increased between year 1 and 3 with greatest increases in fatigue, pain, and depression for the 'good health' group. At year 1, total direct cost/capita was about dollars 5000/year for both groups; indirect costs were dollars 5000 for the 'good health' group and dollars 15,000/year for the 'poor health' group. By year 3, total expenditures increased over 25% for the 'good health' group and nearly doubled for the 'poor health' group, while percent costs that were compensated declined for groups. Out of pocket, expenses were as high as dollars 3000/year for the 'poor health' group by year 3. Through analysis of the broad impact of PD, including non-neurological symptoms and economic ramifications, it is possible to better appreciate the impact of this chronic condition on overall quality of life.
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Affiliation(s)
- M Schenkman
- Department of Rehabilitation Medicine, University of Colorado Health Sciences Center, Denver 80262-0244, USA.
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Dodel RC, Berger K, Oertel WH. Health-related quality of life and healthcare utilisation in patients with Parkinson's disease: impact of motor fluctuations and dyskinesias. PHARMACOECONOMICS 2001; 19:1013-1038. [PMID: 11735671 DOI: 10.2165/00019053-200119100-00004] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Idiopathic Parkinson's disease (PD) is a common chronic progressive neuro-degenerative disorder associated with the progressive loss of dopaminergic neurons in the substantia nigra. The natural course of the disease may lead to severe disability despite a variety of pharmacological and surgical treatment options. Levodopa is still the most effective symptomatic treatment for PD; however, long term use can cause a number of adverse effects including motor complications, nausea and vomiting, postural hypotension and changes in mental status. The onset of motor complications marks a crucial point in the management of PD. They may present as changes between akinetic and mobile phases (motor fluctuations) or as abnormal involuntary movements (dyskinesias). After levodopa treatment for 3 to 5 years, motor complications occur in approximately 50% of patients, and after 10 years in >80% of patients. Treatment options have recently expanded as new drugs have been licensed and surgical procedures refined. Patients with motor complications present a demanding task in disease management, and often multiple drugs and high dosages are necessary to achieve only suboptimal control, resulting in increased healthcare utilisation. Costs increase considerably in patients with motor fluctuations and dyskinesias compared with patients without these symptoms. In a French study, 6-month direct medical costs per patient increased from 1648 euros (EUR) to EUR3028 in patients without and with motor fluctuations, respectively. In a recent French study a significant difference in monthly direct medical costs was found in patients with and without dyskinesias (EUR560 vs 170). Unfortunately, no data are available on the effect of motor complications on indirect costs. Several studies have shown that health-related quality of life (HR-QOL) is reduced when motor fluctuations occur. This may also be true of dyskinesias, but because of the limited number of studies a definite conclusion is not yet possible. Recently, surgical treatment options have been used to deal with advanced PD and late stage complications. Although their effect on motor complications and HR-QOL is well documented, they result in increased costs (total medical cost: EUR28920) compared with drug treatment alone and are increasingly restricted by healthcare providers. The purpose of this article is to review the available data from pharmacotherapeutic. surgical and economic studies on HR-QOL and healthcare expenditure in patients with PD, with a major focus on the impact of motor fluctuations and dyskinesias.
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Affiliation(s)
- R C Dodel
- Department of Neurology, Philipps-University Marburg, Germany.
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