Linking clinical variables to health-related quality of life in Parkinson's disease.
ABSTRACT Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).
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.
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.
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.
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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ABSTRACT: Purpose: To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson's disease (PD). Method: Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson's Disease Questionnaire (PDQ-39) which includes eight domains of functioning. Results: Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e. g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment. Conclusions: The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically.Disability and Rehabilitation 02/2014; 36(23). DOI:10.3109/09638288.2014.883442 · 1.84 Impact Factor
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ABSTRACT: To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease. Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability. Cross-sectional. Socio-demographic and clinical data of the patients (n = 176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation. Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator. Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life. Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease.Journal of Clinical Nursing 12/2013; 23(13-14). DOI:10.1111/jocn.12442 · 1.23 Impact Factor
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ABSTRACT: Enhanced recovery pathways (ERPs) aim to improve patient recovery. However, validated outcome measures to evaluate this complex process are lacking. The objective of this review was to identify how recovery is measured in ERP studies and to provide recommendations for the design of future studies. A systematic search of MEDLINE, Embase and Cochrane databases was conducted. Prospective studies evaluating ERPs compared with traditional care in abdominal surgery published between 2000 and 2013 were included. All reported outcomes were classified into categories: biological and physiological variables, symptom status, functional status, general health perceptions and quality of life (QoL). The phase of recovery measured was defined as baseline, intermediate (in hospital) and late (following discharge). A total of 38 studies were included based on the systematic review criteria. Biological or physiological variables other than postoperative complications were reported in 30 studies, and included return of gastrointestinal function (25 studies), pulmonary function (5) and physical strength (3). Patient-reported symptoms, including pain (16 studies) and fatigue (9), were reported less commonly. Reporting of functional status outcomes, including mobilization (16 studies) and ability to perform activities of daily living (4), was similarly uncommon. Health aspects of QoL were reported in only seven studies. Length of follow-up was generally short, with 24 studies reporting outcomes within 30 days or less. All studies documented in-hospital outcomes (intermediate phase), but only 17 reported postdischarge outcomes (late phase) other than complications or readmission. Patient-reported outcomes, particularly postdischarge functional status, were not commonly reported. Future studies of the effectiveness of ERPs should include validated, patient-reported outcomes to estimate better their impact on recovery, particularly after discharge from hospital.British Journal of Surgery 02/2014; 101(3):159-71. DOI:10.1002/bjs.9324 · 5.21 Impact Factor