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Kinger SB, Moran J, McLarin A, Fox-Fuller JT, Salazar RD, Gordillo ML, Long KA, Cronin-Golomb A. We Hope You're Listening: Qualitative Study of Advice Given by Individuals with Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 39248156 DOI: 10.1002/mdc3.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/15/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Patient-centered care for persons with Parkinson's disease (PwPD) is associated with positive outcomes, but is lacking in current healthcare systems. OBJECTIVE In this qualitative study, we solicited advice from PwPD to medical professionals, family members/friends, and newly-diagnosed PwPD. METHODS Through an online survey, 275 PwPD answered open-ended questions asking for their advice. Responses were analyzed using content analysis. Interrater reliability was 94.5%. RESULTS Three qualitative themes were identified. First, participants advised enhancing care and communication, with healthcare professionals balancing clinical constraints with compassion, and family/friends balancing support with appreciating autonomy of PwPD. The second theme was empowering PwPD through increasing their knowledge of the disease and care options. The third reflected the importance of focusing on well-being and connection. CONCLUSION The results highlight several gaps in meeting the needs of PwPD in healthcare settings and personal relationships, underscoring the importance of integrating their perspectives in shaping approaches to care.
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Affiliation(s)
- Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Jacqueline Moran
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Amber McLarin
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Joshua T Fox-Fuller
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Monica L Gordillo
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
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O' Shea E, Rukundo A, Foley G, Wilkinson T, Timmons S. Experiences of health service access: A qualitative interview study of people living with Parkinson's disease in Ireland. Health Expect 2024; 27:e13901. [PMID: 37926923 PMCID: PMC10726277 DOI: 10.1111/hex.13901] [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: 07/28/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. AIM To explore experiences of PD service access for people living with PD, using a qualitative approach. METHODS Purposive maximum variation sampling was used. Semi-structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. RESULTS The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two-tiered and under-resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. CONCLUSIONS These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under-provision and under-resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology-enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. PATIENT OR PUBLIC CONTRIBUTION The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co-researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper.
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Affiliation(s)
- Emma O' Shea
- Centre for Gerontology and Rehabilitation, School of MedicineUniversity College CorkCorkIreland
| | - Aphie Rukundo
- Centre for Gerontology and Rehabilitation, School of MedicineUniversity College CorkCorkIreland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of MedicineTrinity College DublinDublinIreland
| | - Tony Wilkinson
- Cork Parkinson's AssociationParkinson's Association of IrelandDublinIreland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of MedicineUniversity College CorkCorkIreland
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Mathur S, Mathur S. Patient Empowerment for Those Living with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S173-S180. [PMID: 39121135 PMCID: PMC11380282 DOI: 10.3233/jpd-230235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
Parkinson's disease (PD) poses a number of challenges for individuals, affecting them physically, mentally, emotionally, and socially. The complex nature of PD necessitates empowering patients to address their unique needs and challenges, fostering improved health outcomes and a better quality of life. Patient empowerment is a multifaceted concept crucial to enhancing healthcare outcomes, particularly in chronic conditions such as PD. However, defining patient empowerment presents challenges due to its varied interpretations across disciplines and individuals. Essential components include access to information, development of self-care skills, and fostering a supportive environment. Strategies for patient empowerment encompass health literacy, education, and shared decision-making within a trusted healthcare provider-patient relationship. In PD, patient empowerment is crucial due to the disease's phenotypic variability and subjective impact on quality of life. Patients must navigate individualized treatment plans and advocate for their needs, given the absence of objective markers of disease progression. Empowerment facilitates shared decision-making and enables patients to communicate their unique experiences and management goals effectively. This paper provides a comprehensive overview of the dimensions and strategies associated with patient empowerment, its definition and the facilitators that are necessary, emphasizing its critical importance and relevance in Parkinson's management. At the end of this review is a personal perspective as one of the authors is a person with lived experience.
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Affiliation(s)
- Soania Mathur
- The Global Alliance to End Parkinson's Disease (PD Avengers), Vancouver, BC, Canada
- UnshakeableMD, Oshawa, ON, Canada
| | - Sarika Mathur
- The Global Alliance to End Parkinson's Disease (PD Avengers), Vancouver, BC, Canada
- Queens University, Kingston, ON, Canada
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Kehagia AA, Chowienczyk S, Helena van Velthoven M, King E, North T, Shenton D, Abraham J, Langley J, Partridge R, Ankeny U, Gorst T, Edwards E, Whipps S, Batup M, Rideout J, Swabey M, Inches J, Bentley S, Gilbert G, Carroll C. Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative. JOURNAL OF PARKINSON'S DISEASE 2024; 14:197-208. [PMID: 38250784 PMCID: PMC10836560 DOI: 10.3233/jpd-230205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed. OBJECTIVE To evaluate feasibility, acceptability and safety of Home Based Care. METHODS We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews. RESULTS Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment. CONCLUSIONS We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.
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Affiliation(s)
- Angie A. Kehagia
- School of Biomedical Engineering and Imaging Sciences, King’s Technology Evaluation Centre, King’s College London, UK
- University of Plymouth, Plymouth, UK
| | | | | | - Emma King
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | | | | | | | | | - Terry Gorst
- South West Academic Health Science Network, Exeter, UK
| | | | | | | | | | - Mat Swabey
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jemma Inches
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sue Bentley
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Camille Carroll
- University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
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De Pandis MF, Torti M, Rotondo R, Iodice L, Levi Della Vida M, Casali M, Vacca L, Viselli F, Servodidio V, Proietti S, Stocchi F. Therapeutic education for empowerment and engagement in patients with Parkinson's disease: A non-pharmacological, interventional, multicentric, randomized controlled trial. Front Neurol 2023; 14:1167685. [PMID: 37144003 PMCID: PMC10151770 DOI: 10.3389/fneur.2023.1167685] [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: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background In 1997 the European Parkinson's Disease Associations launched the Charter for People with Parkinson's disease that stated the right of patients to be informed and trained on the disease, its course, and treatments available. To date, few data analyzed the effectiveness of education program on motor and non-motor symptoms of PD. Objective The aim of this study was to evaluate the efficacy of an education program as it was a pharmacological treatment, thus choosing as the primary endpoint the change in daily OFF hours, the most widely used outcome in pharmaceutical clinical trials on PD patients with motor fluctuations. Secondary outcomes were change in motor and non-motor symptoms, quality of life and social functioning. The long-term efficacy of the education therapy was also evaluated by analyzing data collected at 12- and 24-weeks follow-up outpatient visits. Methods One hundred and twenty advanced patients and their caregivers were assigned to the intervention or control group in a single-blind, multicentric, prospective, randomized study evaluating an education program structured in individual and group sessions over a 6-weeks period.At the end of study, the intervention group showed a significant reduction in daily OFF hours compared to control patients (-1.07 ± 0.78 vs. 0.09 ± 0.35, p < 0.0001) and a significant improvement was also reported in most secondary outcomes. Patients retained significant medication adherence and daily OFF hours reduction at 12- and 24-weeks follow-up. Conclusion The results obtained demonstrated that education programs may translate in a notable improvement in motor fluctuations and non-motor symptoms in advanced PD patients.Clinical Trial Registration:Clinicaltrials.gov, identifier NCT04378127.
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Affiliation(s)
| | | | | | - Lanfranco Iodice
- Health Management, University Hospital “Federico II”, Naples, Italy
- Italian Health Ministry c/o USMAF Campania, Naples, Italy
| | | | | | | | | | | | | | - Fabrizio Stocchi
- IRCCS San Raffaele Roma, Rome, Italy
- San Raffaele University, Rome, Italy
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Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
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Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Wannheden C, Revenäs Å. How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study. J Med Internet Res 2020; 22:e19195. [PMID: 32955448 PMCID: PMC7536604 DOI: 10.2196/19195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/04/2020] [Accepted: 07/26/2020] [Indexed: 01/26/2023] Open
Abstract
Background Worldwide, the number of people with Parkinson’s disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs. Objective This study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care. Methods Principles of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported. Results The qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86% to 97% per functionality). Conclusions This study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care. International Registered Report Identifier (IRRID) RR2-10.2196/11278
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Affiliation(s)
- Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Åsa Revenäs
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden.,School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
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Mancini F, van Halteren AD, Carta T, Thomas S, Bloem BR, Darweesh SKL. Personalized care management for persons with Parkinson's disease: A telenursing solution. Clin Park Relat Disord 2020; 3:100070. [PMID: 32844158 PMCID: PMC7437514 DOI: 10.1016/j.prdoa.2020.100070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 08/12/2020] [Indexed: 11/24/2022] Open
Abstract
Poor recognition and inadequate treatment of motor and non-motor symptoms negatively impact on the quality of life of persons with Parkinson's Disease (PD). Furthermore, failure to incorporate timely detection and management of symptoms increases the risk of partially avoidable complications. A promising approach to overcome these pitfalls is telenursing, which entails proactive care delivery by a PD Nurse Specialist (PDNS) through telephone contacts. We hypothesized that adding telenursing to usual care could fill a gap in currently available services, including offering patients easy accessibility to a nurse with specific expertise in PD. We explored this hypothesis by prospectively assessing the effects of a telenursing intervention on motor and non-motor symptoms in a patient with PD. During a threemonth intervention period which comprised 13 telephone contacts, the patient reported a remarkable reduction in number of falls, from 99 falls per three months to 3 falls per three months; and a reduction in non-motor symptoms. The main working mechanism was presumably rather indirect and mediated via alleviation of anxiety, achieved by the individually tailored information and problem-solving strategies provided by the PDNS. Our observations should encourage large-scale evaluations to assess the long-term effectiveness and cost-effectiveness of telenursing interventions in persons with PD. Proactive care delivery through telenursing has potential to improve motor and non-motor symptoms in Parkinson's Disease. Observation of a marked reduction in falls and lower impact of hallucinations on quality of life. Main working mechanisms presumably indirect and mediated via alleviation of anxiety.
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Affiliation(s)
- Francesca Mancini
- UO Neurology and Stroke Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.,CareApt, Bresso, Italy
| | - Angelika D van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | | | - Sue Thomas
- Parkinson's Academy Faculty, Sheffield, United Kingdom
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care. Lancet Neurol 2020; 19:623-634. [DOI: 10.1016/s1474-4422(20)30064-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
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10
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Rastgardani T, Armstrong MJ, Gagliardi AR, Grabovsky A, Marras C. Communication About OFF Periods in Parkinson's Disease: A Survey of Physicians, Patients, and Carepartners. Front Neurol 2019; 10:892. [PMID: 31481924 PMCID: PMC6709650 DOI: 10.3389/fneur.2019.00892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022] Open
Abstract
Background: OFF periods impair quality of life in Parkinson's disease and are often amenable to treatment. Optimal treatment decisions rely on effective communication between physicians, patients and carepartners regarding this highly variable and complex phenomenon. Little is published in the literature about communication about OFF periods. Methods: Informed by interviews with physicians, patients and carepartners we designed questionnaires for each group. We surveyed these parties using an online platform to investigate the frequency, content and ease of communication about OFF periods and barriers and facilitators of communication with physicians. Results: Fifty movement disorder neurologists, 50 general neurologists, 442 patients and 97 carepartners participated. A free-flowing dialogue is the mainstay of communication according to all parties. Motor aspects of OFF periods are discussed more frequently than non-motor aspects (90 vs. <50% according to both general neurologists and movement disorder neurologists). The most common physician-reported barriers to communication are patient cognitive impairment, patient difficulty recognizing OFF periods and poor patient understanding of OFF periods' relationship to medication timing. The barriers most commonly cited as major by patients were that they perceived OFF periods to be part of the disease (i.e., not a clinical aspect that could be improved by a physician), variability of symptoms, and difficulty in describing symptoms. The most commonly described facilitator (by physicians) was the input of a caregiver. Positively viewed but less commonly used facilitators included pre-visit questionnaires or diaries, digital apps and wearable devices to monitor fluctuations. The majority of patients and carepartners identified a free-flowing dialogue with their physicians and having an agenda as helpful facilitators of communication about OFF periods which they already use. The majority of both groups felt that keeping a diary and pre-visit questionnaires were potentially helpful facilitators that were not currently in use. Conclusions: Perceived barriers and facilitators to communication about OFF periods are different between health care providers and receivers of health care. Modifiable barriers and facilitators that could be implemented were identified by both groups. Future research should develop and test strategies based on this input to optimize communication and thus clinical care for this common and debilitating problem.
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Affiliation(s)
- Tara Rastgardani
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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11
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Rastgardani T, Armstrong MJ, Marras C, Gagliardi AR. Improving patient-centred care for persons with Parkinson's: Qualitative interviews with care partners about their engagement in discussions of "off" periods. Health Expect 2019; 22:555-564. [PMID: 30977262 PMCID: PMC6543149 DOI: 10.1111/hex.12884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This study explored how care partners (CPs) of persons with Parkinson's (PwP) are engaged in discussions of "off" symptoms. METHODS During qualitative interviews, CPs of PwP sampled by convenience through the Michael J Fox Foundation online clinical trial matching service were asked to describe their familiarity with "off" symptoms, how "off" symptoms were discussed with clinicians, and the impact of "off" symptoms on them. Data were analysed using constant comparative technique by all members of the research team. RESULTS A total of 20 CPs were interviewed. Compared with PwP, they were more likely to describe "off" symptoms to clinicians. CPs identified important aspects of patient-centred care for PD: establishing a therapeutic relationship, soliciting and actively listening to information about symptoms, and providing self-management support to both PwP and CPs. CPs said that clinicians did not always engage CPs, ask about "off" symptoms or provide self-management guidance, limiting their ability to function as caregivers. CONCLUSION By not engaging and educating CPs, "off" symptoms may not be identified or addressed, leading to suboptimal medical management and quality of life for PwP. These findings must be confirmed on a broader scale through ongoing research but suggest the potential need for interventions targeted at clinicians and at CPs to promote patient-centred care for PwP.
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12
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Hurt CS, Rixon L, Chaudhuri KR, Moss-Morris R, Samuel M, Brown RG. Barriers to reporting non-motor symptoms to health-care providers in people with Parkinson's. Parkinsonism Relat Disord 2019; 64:220-225. [PMID: 31036430 DOI: 10.1016/j.parkreldis.2019.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Non-motor symptoms (NMS) are common in Parkinson's disease (PD) and cause significant distress. A high rate of non-declaration of NMS by patients to healthcare providers (HCP) means that many NMS remain untreated. Current understanding of the factors preventing disclosure of NMS to HCPs is limited. The present study aimed to i) further assess the prevalence of NMS and associated distress, ii) establish current rates of NMS reporting across a range of sources, and iii) explore overall and any symptom specific barriers to help-seeking for NMS. METHODS 358 PD patients completed a cross-sectional survey of NMS severity, reporting and barriers to help-seeking. A series of Generalised Estimating Equations were used to determine whether barriers were symptom specific. RESULTS A mean of 10.5 NMS were reported by each patient. Rates of non-reporting of NMS ranged from 15 to 72% of those experiencing distressing symptoms. The most commonly reported barriers to help-seeking were acceptance of symptoms; lack of awareness that a symptom was associated with PD, and belief that no effective treatments were available. Symptom specific barriers were found for sexual dysfunction (embarrassment), unexplained pain and urinary problems (belief about lack of treatment availability). CONCLUSION A diverse range of barriers prevent PD patients reporting NMS to HCPs and these barriers differ between NMS. The study provides the foundations for developing interventions to increase reporting by targeting individual NMS. Increasing rates of help-seeking for NMS by patients to their Parkinson's healthcare providers will increase appropriate clinical care which may improve quality of life and well-being.
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Affiliation(s)
- Catherine S Hurt
- Centre for Health Services Research, School of Health Sciences, City, University of London, EC1R 1UW, London, UK.
| | - Lorna Rixon
- Centre for Health Services Research, School of Health Sciences, City, University of London, EC1R 1UW, London, UK.
| | - K Ray Chaudhuri
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK; King's College Hospital NHS Foundation Trust, National Parkinson's Foundation International Centre of Excellence, Denmark Hill, London, SE5 9RS, UK.
| | - Rona Moss-Morris
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK.
| | - Mike Samuel
- King's College Hospital NHS Foundation Trust, National Parkinson's Foundation International Centre of Excellence, Denmark Hill, London, SE5 9RS, UK; East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, TN24 0LZ, UK.
| | - Richard G Brown
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK; South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK.
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13
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Armstrong MJ, Rastgardani T, Gagliardi AR, Marras C. Barriers and facilitators of communication about off periods in Parkinson's disease: Qualitative analysis of patient, carepartner, and physician Interviews. PLoS One 2019; 14:e0215384. [PMID: 30998707 PMCID: PMC6472878 DOI: 10.1371/journal.pone.0215384] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Successful patient-physician communication is critical for improving health outcomes, but research regarding optimal communication practices in Parkinson’s disease is limited. The objective of the current study was to investigate barriers and facilitators of communication between persons with Parkinson’s disease, carepartners, and physicians, specifically in the setting of off periods, with the goal of identifying ways to improve patient-carepartner-physician communication. Method We interviewed persons with Parkinson’s, carepartners, and physicians (specialists and non-specialists) using a semi-structured questionnaire to identify and describe experiences, barriers, and facilitators relating to communication about off periods in Parkinson’s disease. We used a qualitative descriptive approach to analyze interview transcripts and compare themes between participating groups. Results Twenty persons with Parkinson’s and their carepartners and 20 physicians (10 specialists, 10 non-specialists) participated in interviews. Identified communication barriers included patient-level (e.g. cognitive impairment, reluctance to discuss symptoms), caregiver-level (e.g. caregiver absence), and physician-level (e.g. distraction by technology, lack of appreciation of the burden of off periods) factors. Other barriers included the challenging nature of off periods themselves. Positive physician characteristics such as empathy, respect, and taking time to listen were major facilitators of communication regarding off periods. Persons with Parkinson’s, carepartners, and physicians described using various tools (e.g. home diaries, questionnaires, mobile phone videos) to aid communication regarding off periods but participants identified a need for more formal educational materials. Conclusions Physicians caring for persons with Parkinson’s can improve communication through more patient-centered practice but there is a need for improved educational tools regarding off periods. Further research is needed to identify optimal strategies for communication about off periods and preferred approaches for off period education.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
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14
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van der Steen JT, Lennaerts H, Hommel D, Augustijn B, Groot M, Hasselaar J, Bloem BR, Koopmans RTCM. Dementia and Parkinson's Disease: Similar and Divergent Challenges in Providing Palliative Care. Front Neurol 2019; 10:54. [PMID: 30915012 PMCID: PMC6421983 DOI: 10.3389/fneur.2019.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/16/2019] [Indexed: 12/29/2022] Open
Abstract
Dementia and Parkinson's disease are incurable neurological conditions. Patients often experience specific, complex, and varying needs along their disease trajectory. Current management typically employs a multidisciplinary team approach. Recognition is growing that this team approach should also address palliative care issues to optimize quality of life for patient and family caregivers, but it remains unclear how palliative care is best delivered. To inspire future service development and research, we compare the trajectories and conceptualization of palliative care between dementia and Parkinson's disease. Both Parkinson's disease and dementia are characterized by a protracted course, with progressive but fairly insidious development of disability. However, patients with Parkinson's disease may experience relatively stable periods initially but with time, a wide range of debilitating symptoms develops, many of which do not respond well to treatment. Eventually, dementia develops in most Parkinson patients, while motor disability develops in many dementia patients. In both diseases, symptoms such as pain, apathy, sleeping problems, falls, and a high caregiver burden are prevalent. Advance care planning has benefits in terms of being prepared before the disease progresses into a stage with communication problems or severe cognitive impairment. However, for both conditions, the protracted disease trajectories complicate conceptualization of palliative care through different stages of the disease, with pertinent questions such as when to offer what interventions pro-actively. Given the similarities and differences, we should develop palliative approaches that are partially generic and partially disease-specific. These should be integrated seamlessly with disease-specific care. Substantial research is already being performed on dementia palliative care. This may also inform the further development of palliative care for Parkinson's disease, including an evaluation of palliative interventions and services.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
| | - Herma Lennaerts
- Departments of Neurology and Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Danny Hommel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, Netherlands
- Groenhuysen Organisation, Roosendaal, Netherlands
| | | | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care/Expertise Center for Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Care/Expertise Center for Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, Netherlands
| | - Raymond T. C. M. Koopmans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Radboudumc Alzheimer Center, Nijmegen, Netherlands
- De Waalboog “Joachim en Anna, ” Center for Specialized Geriatric Care, Nijmegen, Netherlands
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15
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Vlaanderen FP, Rompen L, Munneke M, Stoffer M, Bloem BR, Faber MJ. The Voice of the Parkinson Customer. JOURNAL OF PARKINSONS DISEASE 2019; 9:197-201. [DOI: 10.3233/jpd-181431] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Floris P. Vlaanderen
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Lonneke Rompen
- Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marije Stoffer
- Consultancy Group Process Improvement and Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marjan J. Faber
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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16
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Schrag A, Khan K, Hotham S, Merritt R, Rascol O, Graham L. Experience of care for Parkinson's disease in European countries: a survey by the European Parkinson's Disease Association. Eur J Neurol 2018; 25:1410-e120. [DOI: 10.1111/ene.13738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Schrag
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - K. Khan
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - S. Hotham
- Centre for Health Services Studies; University of Kent; Canterbury UK
| | - R. Merritt
- Centre for Health Services Studies; University of Kent; Canterbury UK
- University of Surrey; Guildford UK
| | - O. Rascol
- Départements de Pharmacologie Clinique et de Neurosciences; Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436; Centre Expert Parkinson, NeuroToul COEN Centre of Excellence in Neurodegeneration; Université de Toulouse; Toulouse France
| | - L. Graham
- European Parkinson's Disease Association; Sevenoaks UK
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17
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Bouça-Machado R, Lennaerts-Kats H, Bloem B, Ferreira JJ. Why Palliative Care Applies to Parkinson's Disease. Mov Disord 2018; 33:750-753. [DOI: 10.1002/mds.27309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular; Lisbon Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
| | - Herma Lennaerts-Kats
- Radboud University Medical Center, Department of Neurology, Department of Anaesthesiology, Pain and Palliative Care; Nijmegen The Netherlands
| | - Bastiaan Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology; Nijmegen The Netherlands
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular; Lisbon Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine; University of Lisbon; Portugal
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18
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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19
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Ambrosio L, Portillo MC, Rodriguez-Blazquez C, Martínez-Castrillo JC, Rodriguez-Violante M, Serrano-Dueñas M, Campos-Arillo V, Garretto NS, Arakaki T, Álvarez M, Pedroso-Ibáñez I, Carvajal A, Martinez-Martin P. Satisfaction with Life Scale (SLS-6): First validation study in Parkinson's disease population. Parkinsonism Relat Disord 2016; 25:52-7. [PMID: 26905015 DOI: 10.1016/j.parkreldis.2016.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/18/2016] [Accepted: 02/13/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To explore the psychometric attributes of a new Satisfaction with Life Scale (SLS-6) in a wide Spanish-speaking population with Parkinson's disease (PD). METHODS This was an international, cross-sectional study. Several rater-based and patient-reported outcomes measures for evaluation of PD (e.g., Scales for Outcomes in Parkinson's Disease-Motor) and other constructs (e.g., Duke-UNC Functional Social Support Questionnaire, Scale for Living with Chronic Illness) were applied together with the SLS-6. Acceptability, scaling assumptions, reliability, precision, and construct validity were tested. RESULTS The study included 324 patients from five countries, with age (mean ± standard deviation) 66.67 ± 10.68 years. None of the SLS-6 items had missing values and all acceptability parameters fulfilled the standard criteria. Scaling assumptions allowed the calculation of a summary index from items 2 to 6, complementary to the global evaluation (item 1). For these five items, Cronbach's alpha was 0.85; the corrected item-total correlation 0.53-0.73; inter-item correlation, 0.45-0.70, with an item homogeneity index of 0.55. The standard error of measurement, based on Cronbach's alpha for a single observation, was 3.48. SLS-6 correlations were moderate to strong (rs ≥ 0.35) with the patient-reported outcomes and weak to moderate with the rater-based assessments used in the study. The SLS-6 total score was significantly different according to PD severity levels established according to Hoehn and Yahr staging, Clinical Impression of Severity Index, and Patient-Based Global Impression of Severity scale. CONCLUSION The results suggest that SLS-6 is an easy, feasible, acceptable, consistent, precise and valid measure to evaluate satisfaction with life in PD patients.
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Affiliation(s)
- Leire Ambrosio
- Faculty of Nursing, University of Navarre, C/ Irunlarrea, s/n, Edificio de los Castaños, 31008 Pamplona, Navarre, Spain
| | - Mari Carmen Portillo
- Faculty of Health Sciences, University of Southampton, Building 67, Highfield Campus University Road, S0171BJ, Southampton, UK
| | - Carmen Rodriguez-Blazquez
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Av. Monforte de Lemos, 5, 28029 Madrid, Spain
| | | | - Mayela Rodriguez-Violante
- National Institute of Neurology and Neurosurgery, Movement Disorders Clinic, Insurgentes Sur 3877, Colonia La Fama, 14269 Mexico City, DF, Mexico
| | - Marcos Serrano-Dueñas
- Movement Disorder and Biostatistics Units, Neurological Service, Carlos Andrade Marín Hospital, Ayacucho s/n y Av. 18 de Septiembre, 170402 Quito, Ecuador
| | - Víctor Campos-Arillo
- Neuroscience Area, Vithas-Xanit International Hospital, Avenida de los Argonautas s/n, 29630 Benalmádena, Malaga, Spain
| | - Nelida Susana Garretto
- Department of Neurology, JM Ramos Mejia Hospital, Urquiza 609, 1221 Buenos Aires, Argentina
| | - Tomoko Arakaki
- Department of Neurology, JM Ramos Mejia Hospital, Urquiza 609, 1221 Buenos Aires, Argentina
| | - Mario Álvarez
- Department of Movement Disorders and Neurodegeneration, CIREN. Ave 25 # 15805, 11300 Cubanacán, Playa, La Habana, Cuba
| | - Ivonne Pedroso-Ibáñez
- Department of Movement Disorders and Neurodegeneration, CIREN. Ave 25 # 15805, 11300 Cubanacán, Playa, La Habana, Cuba
| | - Ana Carvajal
- Faculty of Nursing, University of Navarre, C/ Irunlarrea, s/n, Edificio de los Castaños, 31008 Pamplona, Navarre, Spain
| | - Pablo Martinez-Martin
- Faculty of Health Sciences, University of Southampton, Building 67, Highfield Campus University Road, S0171BJ, Southampton, UK.
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