Validating a quality of life rating scale for idiopathic parkinsonism: Parkinson's Impact Scale (PIMS)

Quality of Life in Patients With Parkinson's Disease: A Cross-Sectional Study

Patients with Parkinson's disease (PD) suffer from a range of physical, psychological, and social problems. The disease affects the quality of life (QOL) of the affected person. Several factors contribute to QOL, and these factors should be examined to develop appropriate strategies. This study aimed to determine the factors related to QOL in patients with PD. A cross-sectional, descriptive study was conducted using a tool with strong validity and reliability (39-Item Parkinson's Disease Questionnaire (PDQ-39)) to assess the quality of life. Descriptive statistics were used to analyze the data, and non-parametric chi-square tests were applied to evaluate the relationship between QOL and the variables. Frequent hospital admissions, level of education, and marital status were among the factors that affected QOL. The ability to perform Ramadan fasting correlated with the degree of QOL. The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the quality of life due to changes in access to medical care and medications. To improve QOL in patients with PD, a comprehensive approach is required in many healthcare domains that includes physiotherapy together with the conventional pharmacotherapy, other treatments, and psychological support.

The distorted body: The perception of the relative proportions of the body is preserved in Parkinson's disease

Given humans' ubiquitous visual experience of their own body, one reasonable assumption is that one's perceptions of the lengths of their body parts should be accurate. However, recent research has shown that large systematic distortions of the length of body parts are present in healthy younger adults. These distortions appear to be linked to tactile sensitivity such that individuals overestimate the length of body parts of low tactile sensitivity to a greater extent than body parts of high tactile sensitivity. There are certain conditions featuring reduced tactile sensitivity, such as Parkinson's disease (PD) and healthy older ageing. However, the effect of these circumstances on individuals' perceptions of the lengths of their body parts remains unknown. In this study, participants visually estimated the length of their body parts using their hand as a metric. We show that despite the reductions in tactile sensitivity, and potential alterations in the cortical presentation of body parts that may occur in PD and healthy older ageing, individuals with mild-moderate PD and older adults of comparable age experience body size distortions comparable to healthy younger controls. These findings demonstrate that the ability to perceive the length of one's body parts is well preserved in mild-moderate PD.

A holistic approach to evaluating Parkinson's disease, using the Delphi method: a linear evaluation index

BACKGROUND

Parkinson's disease (PD) is a chronic disease that presents a multitude of symptoms, with symptoms of both motor and nonmotor nature. The Delphi method is widely used to create consensuses among experts in a field of knowledge.

OBJECTIVE

In order to reach a consensus on the values that should be assigned to the different motor and nonmotor manifestations of Parkinson's disease, a linear evaluation index (LEI) was created. Subsequently, the metric properties of this index were studied.

METHODS

120 consecutive patients with a Parkinson's diagnosis were chosen in accordance with the UKPDSBB criteria. The Delphi method was used to reach a consensus among experts regarding the values of each of the manifestations included. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability, in terms of internal consistency, reliability index, Cronbach's alpha and standard error of measurement; and validity, in terms of convergent validity and validity for known groups.

RESULTS

Twenty-five experts participated. The importance factor did not differ between the first round and the second round (chi-square test). We analyzed the responses that assigned percentage values to the 10 dimensions of the LEI. Both in the first and in the second round, the values of the scattering coefficient Vr were always close to 0. The homogeneity index was 0.36; the corrected-item total correlation values ranged from 0.02 to 0.7; Cronbach's α was 0.69; and the SEM was 4.23 (55.1%).

CONCLUSIONS

The LEI was obtained through rigorous recommended methodology. The results showed adequate metric properties.

How far can I reach? The perception of upper body action capabilities in Parkinson's disease

Successful interaction within the environment is contingent upon one’s ability to accurately perceive the extent over which they can successfully perform actions, known as action boundaries. Healthy young adults are accurate in estimating their action boundaries and can flexibly update them to accommodate stable changes in their action capabilities. However, there are conditions in which motor abilities are subject to variability over time such as in Parkinson’s disease (PD). PD impairs the ability to perform actions and can lead to variability in perceptual-motor experience, but the effect on the perceptions of their action boundaries remains unknown. This study investigated the influence of altered perceptual-motor experience during PD, on the perceptions of action boundaries for reaching, grasping, and aperture passing. Thirty participants with mild-to-moderate idiopathic PD and 26 healthy older adults provided estimates of their reaching, grasping, and aperture-passing ability. Participants’ estimates were compared with their actual capabilities. There was no evidence that individuals with PD’s perceptions were less accurate than those of healthy controls. Furthermore, there was some evidence for more conservative estimates than seen in young healthy adults in reaching (both groups) and aperture passing (PD group). This suggests that the ability to judge action capabilities is preserved in mild to moderate PD.

Parkinson's Disease Gravity Index: A Method by means of Optimal Scaling

Objective

This study has been designed with the aim of using optimal scaling to perform the allocation of scores and to be able to construct an indicator of the Parkinson's Disease Gravity Index. Scores were assigned to interrelated dimensions that share information about the patient's situation, to have an objective, holistic tool which integrates scores so that doctors can have a comprehensive idea of the patient's situation. Patients and Methods. 120 consecutive patients with Parkinson's diagnosis were chosen according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. Subsequently, all the chosen dimensions were transformed into interval variables for which the formula proposed by Sturges was used. Once the dimensions were transformed into interval variables, optimal scaling was carried out. Subsequently, the following attributes were analyzed: quality and acceptability of the data; reliability: internal consistency, reliability index, Cronbach's alpha, and standard error of measurement; finally, validity: convergent validity and validity for known groups.

Results

There were no missing data. An appropriate Cronbach's alpha value of 0.71 was gathered, and all items were found to be pertinent to the scale. The item homogeneity index was 0.36. Precision evaluated with the standard error of measurement was 7.8. The Parkinson's Disease Gravity Index discriminant validity (validity for known groups), assessed among the different stages of Hoehn and Yahr scale by the Kruskal–Wallis test, showed major significance (X² = 32.7, p ≤ 0.001).

Conclusions

The Parkinson's Disease Gravity Index has shown adequate metric properties.

Quality of life in Parkinson's disease: Italian validation of the Parkinson's Disease Questionnaire (PDQ-39-IT)

Translation and cross-cultural adaptation of the 39-item Parkinson's Disease Questionnaire (PDQ-39) to the Italian culture was performed by Oxford University Innovation in 2008, but this version has never been validated. Therefore, we performed the process of validation of the Italian version of the PDQ-39 (PDQ-39-IT) following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. The translated PDQ-39-IT was tested with 104 patients diagnosed with Parkinson's disease (PD) who were recruited between June and October 2017. The mean age of the participants was 65.7 ± 10.2 years, and the mean duration of symptoms was 7.4 ± 5.3 years. The internal consistency of the PDQ-39-IT was assessed by Cronbach's alpha and ranged from 0.69 to 0.92. In an assessment of test-retest reliability in 35 of the 104 patients, the infraclass correlation coefficient (ICC) ranged from 0.85 to 0.96 for the various subitems of the PDQ-39-IT (all p < 0.01). Spearman's rank correlation coefficient for the validity of the PDQ-39-IT and the Italian version of the 36-Item Short Form (SF-36) was - 0.50 (p < 0.01). The results show that the PDQ-39-IT is a reliable and valid tool to assess the impact of PD on functioning and well-being. Thus, the PDQ-39-IT can be used in clinical and research practice to assess this construct and to evaluate the overall effect of different treatments in Italian PD patients.

The Impact of Living with Parkinson's Disease: Balancing within a Web of Needs and Demands

This study explores the impact of living with Parkinson's disease (PD). Nineteen persons (11 women) aged 55–84 diagnosed with PD 3–27 years ago participated. Data were collected through semistructured interviews, which were recorded, transcribed verbatim, and analysed by qualitative content analysis. Four categories represented the impact of living with PD: “Changed prerequisites for managing day-to-day demands,” “Loss of identity and dignity,” “Compromised social participation,” and “The use of practical and psychological strategies.” There was a shift from an internal to an external locus of control in managing, control, competence, relatedness, and autonomy. According to self-determination theory, a shift towards extrinsically motivated behaviours may occur when these basic needs are thwarted, leading to compensatory strategies or needs substitutes with negative consequences on health and well-being. We suggest a needs-based approach as an important starting point to better understand the consequences of living with PD and to explore the means for people with PD to acquire an improved quality of life on their own terms. In conclusion, our findings suggest for a shift in focus, from a biomedical to a needs-based approach to understand the impact of living with PD and facilitate more person-centred care and person-centred outcome measurement.

Validity and Reliability of the Turkish Version of the 8-Item Parkinson's Disease Questionnaire

Introduction

Symptomatic control and improvement of health-related quality of life (HRQoL) is a key feature of the management of patients with Parkinson's disease (PD). The 39-item Parkinson's Disease Questionnaire (PDQ) and its short version, PDQ-8, validated disease-specific patient-reported instruments, have been highly recommended to use for assessing HRQoL in patients with PD. The aim of this study was to assess the reliability and validity of the Turkish version of the PDQ-8.

Methods

Eighty-three patients with PD were recruited for this methodological and cross-sectional study. The PDQ-8 was repeated to assess the test-retest reliability after one-week interval. The participants completed the 36-Item Short Form Health Survey (SF-36) as a generic HRQoL previously validated in Turkey. The Hoehn & Yahr stages of the patients were also determined. The SF-36 and Hoehn & Yahr stages were used to assess the convergent validity of the PDQ-8.

Results

The Cronbach's alpha coefficient was 0.78 (95% CI: 0.70-0.84, p<0.001) for PDQ-8. The test-retest reliability was very high as the intra-class correlation coefficient was 0.97 (95% CI: 0.93-0.99, p<0.001). The PDQ-8 had significant correlations with the physical and mental component scores of SF-36 (ρ=-0.52, p<0.001 and ρ=-0.64, p<0.001, respectively) and Hoehn & Yahr stages (ρ=0.56, p<0.001). There was no evidence of floor or ceiling effects.

Conclusion

The results of this study suggest that the Turkish version of the PDQ-8 is a reliable, valid, less time-consuming, and brief disease-specific instrument to assess HRQoL in patients with Parkinson's disease.

Fatigue in Parkinson's disease: Metric properties of the fatigue impact scale for daily use (D-FIS), and its impact on quality of life

OBJECTIVE

In Parkinson's disease patients, fatigue is a disabling non-motor symptom whose prevalence ranges from 28% to 58%. The Fatigue Impact Scale for Daily Use (D-FIS), one of the various scales for quantifying fatigue. The aim of our study was to analyze the metric properties of the D-FIS in PD subjects and assess the impact of fatigue on their quality of life.

PATIENTS AND METHODS

The cohort in this study was comprised of 211 consecutive patients with a PD diagnosis regularly followed up at the Movement Disorders Unit of the Neurology Department at Carlos Andrade Marín Hospital (HCAM) in Quito, Ecuador, according to the United Kingdom PD Society Brain Bank criteria. Data Quality, Acceptability, Reliability, Stability (test-retest), Validity and Multiple linear regression analysis were determined.

RESULTS

The final sample consisted of 138 men (65.4%) and 73 women. Forty-six percent of these (98 patients) were in stage II of H&Y. We obtained a Cronbach's α value of 0.912 and an ICC value of 0.79. D-FIS was strongly correlated with depression (Spearman rho [Srho] 0.60), anxiety (Srho 0.59), quality of life (Srho 0.67), and non-motor symptoms (Srho 0.66). The scale's discriminant validity, assessed among the different stages of H&Y by the Kruskal-Wallis test, showed major significance (X² = 23.183, p ≤ 0.001). In the Multiple linear regression study, the resulting model proves that fatigue has a determining effect on quality of life.

CONCLUSIONS

The D-FIS has good metric properties and demonstrates that fatigue significantly affects PD patients' quality of life and that its impact is independent from that of anxiety, depression, and sleep disorders.

Clinical Assessments in Parkinson's Disease: Scales and Monitoring

Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.

Validation of the Parkinson's Disease-Cognitive Rating Scale Applying the Movement Disorder Society Task Force Criteria for Dementia Associated with Parkinson's Disease

BACKGROUND

The authors studied the measurement properties of the Parkinson's Disease-Cognitive Rating Scale (PD-CRS) compared with Movement Disorders Society Task Force (MDS-TF) criteria for the diagnosis of dementia in patients with Parkinson's disease.

METHODS

The sample consisted of 223 patients who were diagnosed in accordance with the United Kingdom Parkinson's Disease Society Brain Bank who were assessed with both the MDS-TF and the PD-CRS criteria (in addition to other instruments) without the assessors' knowledge of previous results. Internal consistency was studied (homogeneity of the items and Guttmann's λ values were obtained) in addition to convergent, divergent, and discriminative validity. The receiver operating characteristic curve was obtained, and the cutoff point at which the PD-CRS had the greatest efficiency was analyzed.

RESULTS

The internal consistency was shown to be adequate, with a λ value of 0.821. A floor effect was observed in 4 of the items (Sustained Attention, Working Memory, Immediate Verbal Memory, and Alternating Verbal Fluency), and 1 item showed a ceiling effect (Clock Copying). The scale adequately discriminated patients with and without dementia (Kruskal-Wallis; P ≤ 0.000). The area under the curve was 0.899. With a cutoff score of 62 (from a possible score of 134), the scale achieved 94% sensitivity and 99% specificity.

CONCLUSIONS

The PD-CRS has adequate measurement properties and is a valid tool for studying the presence of dementia in patients with Parkinson's disease.

Strategies to maintain quality of life among people with Parkinson's disease: what works?

Among chronic neurodegenerative disorders, Parkinson's disease (PD) is one of the most difficult and challenging to tackle as several motor and nonmotor features influence the patients' quality of life (QoL) and daily activities. Assessing patients QoL with valid instruments and gathering knowledge about the determinants that affect QoL in individuals with PD are the basis of an efficient caring strategy. In addition to the known motor symptoms, nonmotor disorders must also be comprehensively tracked and targeted for treatment to enhance QoL. A holistic strategy to maintain QoL in people with PD should consist of a multidisciplinary, personalized and patient-centered approach with timely administration of palliative care and efficient involvement of caregivers and family members.

What Should Constitute a Health Related Quality of Life Scale for Parkinson's Disease?

INTRODUCTION

Health Related Quality of Life (HRQoL) in Parkinson's Disease (PD) lacks universally agreed definition and its components. A conceptual framework helps in understanding the essential domains and their inter-relationship while developing patient reported outcome measure.

AIM

To construct a conceptual framework for developing HRQoL scale in PD.

MATERIALS AND METHODS

A panel of 7 experts extracted 6 major domains for measuring HRQoL in PD from literature review including 8 disease specific scales for PD, 2 books on quality of life, 5 websites, relevant articles; and content analysis of semi-structured interviews of stakeholders (28 persons with PD, 6 caregivers and 9 clinicians). Extracted domains were subjected to consensus of stakeholders (7 persons with PD, 7 caregivers and 7 clinicians) on 7 point Likert scale. The panel constructed a conceptual framework and a definition of HRQoL in PD in context of available guidelines for developing patient reported outcome measures.

RESULTS

The extracted domains were physical, non motor symptom, psychological, family/social, finance and treatment domains. Median of all six domains on 7 point Likert scale was 7 and inter-quartile distance was <1 in consensus agreement. The conceptual framework consisted of indicator domains and causal domains. Indicator domains (physical, psychological, and social and family) estimate the influence of causal domains (motor symptoms, non motor symptoms, finance and treatment) on quality of life. The definition emphasizes upon the person's perception of their symptoms and its impact on their lives.

CONCLUSION

This study defined and developed a conceptual framework for HRQoL scale for PD.

Validity, Reliability, and Insights from Applying the McGill Quality of Life Questionnaire to People Living with Parkinson's Disease (MQoL-PD)

Existing quality-of-life instruments for Parkinson's disease (PD) may not fully assess quality of life (QoL) for people with PD in a holistic and multidimensional manner. This study examines the subscale structure, validity, and internal-consistency reliability of the McGill Quality of Life (MQoL) Questionnaire in a sample of people with PD. This cross-sectional study evaluates the MQoL-PD by using Cronbach's alpha and principal components analysis. A total of 81 consenting people with PD from a tertiary care outpatient clinic were studied. Scores were tabulated for the motor Unified Parkinson's Disease Rating Scale (mUPDRS), the Short Form Health Survey (SF-36), the Parkinson's Disease Questionnaire (PDQ-39), the MQoL Single-Item Scale (MQoL-SIS), and the MQoL Questionnaire (MQoL). Cronbach's alpha for the MQoL-PD was: physical symptoms, 0.83; psychological symptoms, 0.59; and existential/support symptoms, 0.76. Important contributors to QoL in PD include mobility, bowel and bladder function, fatigue, and pain. The MQoL Questionnaire is a valid and reliable measure of physical, psychological, and existential/support symptoms for people with PD.

Health-related quality of life as an outcome variable in Parkinson's disease

In the past three decades, health-related quality of life (HRQoL) has become an outcome variable in Parkinson's disease clinical trials. This review considers the measuring tools that have been developed, suitability of data reporting, complexity of outcome interpretation, and clinical application to provide evidence regarding available therapeutic interventions to date. In the introduction, different terms regarding quality of life are clearly defined. The methodology section offers an overview of generic, disease specific, and recommended HRQoL scales in Parkinson's disease and the most important psychometric attributes a scale should meet. The interpretation of HRQoL outcomes is complex and not intuitive. Thus, appropriate reporting of data is crucial in order to calculate relative change, a result that facilitates understanding to what extent an intervention is beneficial. The concept of minimally important change/difference is explained as well as the different approaches to its calculation (anchor-based and distribution-based methods). In the results section, a brief overview of the impact on HRQoL of currently available treatments in Parkinson's disease is provided. Special emphasis is given to data assessment, highlighting reports that helped understanding of the clinical significance of the intervention and therefore aided in making therapeutic decisions. The discussion section emphasizes the need for more clinical trials with HRQoL as a primary outcome and standardized reporting in order to further our understanding of the complexity of treatment effects and make evidence-based clinical decisions regarding HRQoL in patients with Parkinson's disease.

Psychometric attributes of the rating scale for gait evaluation in Parkinson's disease

BACKGROUND

The RSGE-PD-V2.0 is a specific measure for evaluation of gait impairment in PD.

OBJECTIVE

To check the RSGE-PD-V2.0 metrics attributes.

METHODS

In addition to demographic and historical data of PD, applied assessments were: Hoehn and Yahr staging (H&Y); impact in daily activities with Schwab and England scale (S&E); SCOPA Motor; mental status with Short portable mental status questionnaire (SPMSQ); quality of life with Parkinson's impact scale (PIMS), the Hamilton Depression Rating Scale-6 items (HDRS-6); and, the Clinical Impression of Severity Index-PD (CISI-PD).

RESULTS

151 PD patients were included (n = 102 (67.5%) were male). Most patients were in H&Y stage 3 (n = 78 (51.6%)). Mean of age and duration of disease was 68.4 and 7.6 years respectively. Mean values of L-Dopa doses was 652.6 mg/day. Mean values of SCOPA Motor were 29.1; SPMSQ: 1.8; HADS-6: 9.2; PIMS: 18.7;RSGE-PD-V2.0: 25.4; and, CISI-PD were 10.8. Full computable scores were 100%; Guttman's lambda, 0.954; and the item-total correlation, 0.408-0.830. Correlation coefficients (Spearman's rho) between RSGE-PD-V2.0 and H&Y, S&E, SCOPA Motor, PIMS and CISI-PD, were: 0.62; -0.75; 0.74; 0.46; and, 0.78 respectively. RSGE-PD-V2.0 scale significantly discriminated among PD severity levels (based on H&Y staging) Kruskal-Wallis (p < 0.000).

CONCLUSIONS

Metric attributes of the RSGE-PD-V2.0 in this sample of study resulted in has sufficient and suitable satisfactory. We, therefore, believe that RSGE-PD-V2.0 is easy and a useful and recommendable specific tool for measuring gait disease in PD patients.

The impact of levodopa on quality of life in patients with Parkinson disease

BACKGROUND

Parkinson disease (PD) is associated with a progressive decline in patient quality of life (QoL), because of motor and nonmotor manifestations of PD and treatment-related side effects.

REVIEW SUMMARY

Treatment with carbidopa/levodopa-the current gold standard therapy-improves QoL in the short term, but gains are not maintained over a long term. Long-term treatment is associated with symptom re-emergence (end-of-dose "wearing off") and development of dyskinesia, which may have an adverse impact on QoL.

CONCLUSIONS

Levodopa (LD; combined with carbidopa) remains the gold standard for symptomatic treatment of PD, but long-term treatment is associated with complications that may adversely affect QoL. Recent studies have suggested that the addition of a catechol-O-methyltransferase inhibitor may improve QoL through the reduction of some of the motor complications of LD therapy. Further studies are required to determine the full effects of this as well as other treatments that are used to manage LD-associated complications on QoL.

Quality of life in Parkinson's disease patients following adjunctive tolcapone therapy: results of an open-label, multicenter, community-based trial

OBJECTIVE

To examine changes in quality of life (QOL) and global clinical status after 30 days of adjunctive treatment with tolcapone, a revers-ible inhibitor of catechol-O-methyltransferase, in patients with fluctuating Parkinson's disease.

METHODS

This 30-day, multicenter, open-label, community-based study enrolled fluctuating Parkinson's disease patients to receive tolcapone 100 mg TID as an adjunct to levodopa/carbidopa. The primary end point was QOL change assessed using the Parkinson's Disease Questionnaire (PDQ)-8. Clinical change was assessed using the investigator-rated Clinical Global Impression of Improvement Scale (CGI-I).

RESULTS

Fifty-six physicians enrolled 202 patients; 138 (68%) were > or = 65 years of age and 116 (57%) had Parkinson's disease for > or = 5 years. The mean PDQ-8 total score improved from 42.1 to 34.8 after 30 days of tolcapone (P<.0001). Sixty-nine percent of patients improved on the CGI-I. Physicians planned to continue tolcapone beyond the 30 days in 72%, most commonly because of positive changes in motor function and overall general improvement. No patient discontinued because of liver adverse events.

CONCLUSIONS

Adjunctive tolcapone treatment was associated with statistically significant improvement in QOL in fluctuating Parkinson's disease patients. A majority of patients experienced clinical benefits and continued treatment beyond the end of this study. No liver-related adverse events were reported.

Quality of life scale in parkinson's disease PDQ-39 - (Brazilian Portuguese version) to assess patients with and without levodopa motor fluctuation

Quality of life (QoL) is an important treatment outcome indicator in Parkinson's disease (PD). The aim of this study is to assess the usefulness of the Parkinson's disease questionnaire - PDQ-39 (Brazilian Portuguese Version) in measuring QoL of PD patients with or without motor fluctuations. Fifty-six PD patients with mean disease duration of 7.4 years were assessed and 41 of them (73.3%) had motor fluctuations. The PDQ-39 has eight dimensions ranging from 0 to 100; being the higher the score, the worse the QoL. Comparing groups with and without motor fluctuations showed that the dimensions mobility, activities of daily living (ADL), communication and bodily discomfort scored higher in the fluctuating group. There was a tendency to see that the higher the Hoehn and Yahr (HY) scale stages, the higher the PDQ-39 scores. Patients suffering from the disease for more than five years had worse PDQ-39 scores only in the items ADL and communication, when compared with those with the disease for < 5 years. The PDQ-39 is an instrument that detects decrease in QoL of PD patients and the presence of motor fluctuations predicts QoL reduction.

The suitability of patient‐based measures in the field of Parkinson's disease: A systematic review

The aim of this study is to appraise the suitability of current quality of life (QOL) questionnaires for use in the field of Parkinson's disease (PD). Computerized bibliographic databases were screened for publications from 1960 to December 2006. Predefined selection criteria were used to identify QOL questionnaires in PD studies. Two investigators independently assessed and, subsequently, agreed on a set of multidimensional generic and PD-specific QOL questionnaires. Data were extracted concerning the internal structure, reliability, validity, and responsiveness of the included questionnaires. Sixteen-questionnaires were found, of which 14 questionnaires were included (six generic measures and eight PD-specific). In general, the psychometrics of all the questionnaires were adequately described. Sensitivity to change, however, has been reported for only a limited number of instruments. Almost all included questionnaires used QOL as a keyword, but only two questionnaires fitted the broad QOL definition used in this review. Considering the few "real " QOL questionnaires, we conclude that there is a strong need for such instruments.

Quality of life and related concepts in Parkinson's disease: A systematic review

Several studies have investigated the quality of life (QOL) of patients with Parkinson's disease (PD). The purpose of this study was to review the conceptual and methodological quality of quality of life (QOL) studies among patients with PD and to identify factors associated with poor (HR)QOL. Computerized bibliographic databases were screened for publications from 1960 to January 2007. According to a list of predefined criteria, the methodological quality of the 61 studies, was moderate. The term 'QOL' was often used inappropriately. In fact, almost all studies in this review actually assessed health status (HS) instead of QOL. The functioning of patients with PD on physical, social, and emotional domains is affected by PD. Their HS seems to be lower when compared to healthy persons or patients with other chronic diseases. HS studies augment the insight in self-perceived functioning. Therefore, HS is conceived as a valuable construct. However, QOL is also an important factor in health care. Attention towards QOL is needed in order to draw valid conclusions regarding a person's subjective experience of well-being in a broad sense. In order to accomplish this, future studies should apply the QOL concept with more rigor, should use an adequate operational definition, and should employ sound measures.

Cross-cultural evaluation of the short form 8-item Parkinson's Disease Questionnaire (PDQ-8): results from America, Canada, Japan, Italy and Spain

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of a short form health survey, the Parkinson's Disease Questionnaire (PDQ-8), cross-culturally, by comparing results gained from this instrument to the original longer form instrument-the PDQ-39.

DESIGN

Data are from the Global Parkinson's Disease Survey.

OUTCOMES

The 8-item Parkinson's Disease Questionnaire Single Index Score (PDQ-8-SI). In this study, we evaluate response rate, scaling assumptions, and data quality, in terms of comparability of results with the parent form from which the PDQ-8 was derived, of the instrument in the USA, Canada, Spain, Italy and Japan.

RESULTS

The PDQ-8 was found to produce results that were very similar to the parent form across all five countries. However, it should be borne in mind that the PDQ-8 was nested within the PDQ-39, and results may be influenced by this.

CONCLUSIONS

Results suggest that the PDQ-8 is a valid and reliable measure that can be appropriately and meaningfully used in cross-cultural studies.

A Review of the Health-Related Quality of Life and Economic Impact of Parkinson??s Disease

Parkinson's disease (PD) is a chronic, neurodegenerative disease that places a substantial burden on patients, their families and carers, as well as on society as a whole. PD can severely affect the health-related quality of life (HR-QOL) of both patients and their carers and, as the disease progresses, HR-QOL deteriorates. This review aims to critically evaluate the literature on a number of important aspects that influence HR-QOL in relation to PD. Factors associated with a negative impact and ways to improve HR-QOL are highlighted, and tools for HR-QOL assessment reviewed. The economic impact of PD and related cost-effectiveness studies are also reviewed. Over the course of the disease, patients with PD experience changes in their HR-QOL that are affected by factors such as depression, motor complications, education and surgery. However, a lack of uniformity in the choice of HR-QOL tools used in studies makes comparison of results difficult. Research on motor fluctuations and dyskinesias has shown conflicting results, whereas it is clear from the available data that depression needs to be more clearly recognised and treated. Inequality in the numbers of men and women receiving surgery still needs to be addressed and, again, in this area there is a lack of uniformity with respect to assessment for surgery. Education programmes have been shown to be successful in improving HR-QOL, although more research is needed about how to introduce such programmes to all PD patients. In particular, there has been little detailed research into young-onset PD and juvenile patients to assess the true impact of the disease on their HR-QOL. The literature has also shown that PD can affect the HR-QOL of the carer, which may have a 'knock-on' effect for the patient. The HR-QOL of carers needs more attention because these individuals can significantly reduce the burden that would otherwise fall on the health services in terms of cost and care. Research shows that the economic costs of PD are high, particularly for patients in advanced stages of the disease and those with motor complications. Although carer burden is a major source of costs, this is not factored into cost-effectiveness analyses. Furthermore, because too few studies use quality-adjusted life years as their health outcome, particularly in studies of the costs of surgery, comparison of costs of treatments is difficult. The review highlights the need for HR-QOL tools such as the EuroQol-5D to be used together with disease-specific tools to provide the most comprehensive picture of the costs and impact of PD.A recent upsurge in published literature on PD resulting from increased interest in HR-QOL issues has led to an at times overwhelming amount of new information. The present review assembles the most important points relating to HR-QOL in PD raised in the literature, adds value to previously covered issues, and examines areas of HR-QOL in PD that have not previously been reviewed, such as education, carer burden and surgery, highlighting where more research is warranted.

Individualized assessment of quality of life in idiopathic Parkinson's disease

The purpose of this study was to assess quality of life (QoL) of patients with idiopathic Parkinson's disease (IPD). The Parkinson's Disease Questionnaire (PDQ-39) was compared with an individualized QoL tool: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW). One hundred twenty-three patients underwent interviews using these tools, together with the Mini Mental State examination, Beck Depression Inventory, a qualitative pain assessment, and the Palliative Care Assessment tool (for symptoms). The SEIQoL-DW was well tolerated and demonstrated that QoL not only was broad and highly individualistic but also was determined more by psychosocial than physical issues. Of the 87 domains nominated by patients, the most common were family (87.8%), health (52.8%), leisure activities (36.6%), marriage (35%), and friends (30.9%). The SEIQoL index score was predicted by depression but not by disease stage. However, the PDQ-39 was predicted by disease stage, the number of symptoms, and depression. Direct comparison of the tools confirmed that the SEIQoL index score was predicted by the PDQ-39 domains of social support, cognitive impairment, and emotion. The use of the SEIQoL-DW challenges current thinking within IPD research regarding QoL and its assessment using the PDQ-39.

Quality of life in patients with Parkinson's disease

We evaluated the quality of life (QoL) in 278 Indian patients with Parkinson's disease (PD) using PDQL questionnaire, with measures various aspects of health status in PD patients including parkinsonian symptoms, systemic symptoms, social and emotional functions. Apart from demographic and treatment details parkinsonian disability and stage was assessed by Hoehn and Yahr stage, Schwab and England scale and UPDRS scores. We conclude that female gender, presence of depression, low degree of independence, higher levodopa dose (>400 mg/day) and higher UPDRS activity of daily living score have the most detrimental impact on QoL in patients with Parkinson's disease. Depression was the most significant factor impairing the QoL and it needs to be treated.

Measuring outcomes for neurological disorders: a review of disease-specific health status instruments for three degenerative neurological conditions

Health-related quality-of-life measures have been increasingly used in research into neurological disorders in recent years. The aim of this paper is to provide an objective appraisal of the evidence in regard to disease-specific quality-of-life measures used in research on health interventions for three degenerative neurological disorders: multiple sclerosis, motor neurone disease/amyotrophic lateral sclerosis and Parkinson's disease. A comprehensive search strategy was developed to include nine relevant electronic databases. Only studies pertaining to patient-based outcome measurements in multiple sclerosis, motor neurone disease and Parkinson's disease were included. We identified 76 eligible studies. As studies consisted of descriptive and cross-sectional survey study designs, results were reported qualitatively rather than in the form of a meta-analysis. Four disease-specific measures were found for Parkinson's disease, 11 for multiple sclerosis and one for motor neurone disease. We conclude that health-related quality-of-life measures are useful in assessing the impact of treatments and interventions for neurological disorders. However, further research is needed on the development of instruments using psychometric methods and on the validation, utilization and responsiveness of instruments to change.

Validation and cross-cultural adjustment of PDQL-questionnaire, Spanish version (Ecuador) (PDQL-EV)

OBJECTIVE

To validate the Ecuadorian Spanish-language version of the Parkinson's Disease Quality of Life Questionnaire (PDQL-EV).

METHOD

Cross-sectional study of patients with Parkinson's Disease attending a Movement Disorders Clinic. MEASURES APPLIED: Hoehn and Yahr (HY), Unified Parkinson's Disease Rating Scale (UPDRS-3.0), Schwab and England Scale (SES), Pfeiffer Questionnaire (SPMSQ), Hospital Anxiety and Depression Scale (HADS). PDQ-39 and PDQL-EV were applied, the latter after translation and back translation.

RESULTS

The study included 137 patients with an age range of 69.43 +/- 10.18 years (mean +/- SD), duration of illness 5.87 +/- 2.58 years, and HY 2.28 +/- 0.77. The PDQL-EV internal consistency (Cronbach's alpha) yielded: Parkinson's symptoms (PS) 0.85; systemic symptoms (SS) 0.69; social function (SF) 0.81; and emotional function (EF) 0.78. The correlation between measurements varied from 0.68 (PS-SS) to 0.46 (SS-EF), and total measurement correlation from 0.58 (EF) to 0.74 (PS) (altogether, p < 0.0001). The correlation of PDQL with clinical variables was: HY -0.62; UPDRS (subscales 1, 2 and 3) -0.55, -0.76, and -0.48, respectively; SES 0.65; SPMSQ -0.35; HADS-anxiety -0.55; HADS-depression -0.67; and PDQ-39 -0.91 (altogether p < 0.0001). PDQL-EV scores were significantly different (p < 0.0001) between moderate and advanced stages, for all domains except for EF (p = 0.006).

CONCLUSION

The PDQ-EV has satisfactory internal consistency, and converging and discriminating validity.

Validity and reliability of the PDQ-39 and the PDQ-8 in English-speaking Parkinson's disease patients in Singapore

The purpose of the study was to assess the validity and reliability of the Parkinson's disease questionnaire (PDQ-39, UK English version) as well as its briefer version (the PDQ-8) among Asian patients with Parkinson's disease (PD) in Singapore. Eighty-eight patients recruited from movement disorder clinics or patient support groups completed the PDQ-39 and EQ-5D, a generic health related quality of life questionnaire previously validated for use in Singapore. PDQ-39 items showed good convergent and discriminant validity. Construct validation against the EQ-5D showed strong correlation between these scales as hypothesised (Spearman's rho: 0.53-0.71, P<0.001 for all). Factor analysis yielded a component on which all eight PDQ-39 dimensions were substantially loaded (loading range: 0.50-0.79). The PDQ-39 also demonstrated acceptable internal consistency (Cronbach's alpha: 0.59-0.94) and test-retest reliability (intra-class correlation coefficient:0.67-0.87, n=68). Six of eight PDQ-8 items showed the strongest correlation with their PDQ-39 dimensions as hypothesised. PDQ-39 and PDQ-8 summary indexes were highly correlated (Pearson's r=0.96, ICC=0.95), and both were strongly correlated with the EQ-5D utility index and EQ-5D visual analogue scale (P<0.001). We conclude that the PDQ-39 and PDQ-8 are valid and reliable disease-specific HRQoL instruments for PD in Singapore.

Impact of the motor complications of Parkinson's disease on the quality of life

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.

Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers

BACKGROUND

The role of aging, disease, medications, and mood disturbances in sleep disturbances (SD) in patients with Parkinson's disease (PD) is poorly understood, and the impact of SD on the quality of life of their caregivers (CG) largely undocumented.

OBJECTIVES

To evaluate the pattern and determinants of disturbed sleep in PD patients complaining of SD, and in their primary CG.

METHODS

A prospective evaluation of 40 non-demented patients with PD complaining of SD and 23 of their primary CG (all were spouses) was conducted using Pittsburgh Sleep Quality Index, Zung's self-rating depression and anxiety scales, Parkinson's Impact Scale (PIMS) (only for PD), and an additional sleep questionnaire.

RESULTS

Eighty-four percent of patients were 'poor sleepers' with global sleep scores (GLSc) > 5. Other abnormalities were: excessive daytime sleepiness-57.5%, excessive daytime fatigue-72.5%, depression-51.5%, anxiety-63.1%, and abnormal PIMS score-83.8%. There was no correlation between the degree of sleep dysfunction and the age, severity, duration of PD or its treatment. Several component sleep scores correlated with anxiety scores, PIMS score with depression, and, subjects with GLSc > or = 10 had higher mean anxiety index. Daytime dysfunction (97.5%) was mainly associated with reduced enthusiasm, rather than excessive sleepiness. Among CG, 40% had a GLSc > 5, 21% had depression, and 10.5% had anxiety. Their depression, anxiety and sleep scores correlated with those of their spouses.

CONCLUSIONS

PD patients with significant SD may represent a subset of patients with early, progressive degeneration of sleep centres, rather than an enhanced aging process. They are more susceptible mood disturbances, which correlate with the severity of sleep dysfunction. Sleep and mood disturbances also adversely affect the quality of life of spousal caregivers.

Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery

OBJECTIVES

To investigate eventual differences between women and men with Parkinson's disease (PD) before and after surgery, with respect to clinical status, disability and health-related quality of life (HRQoL).

MATERIAL AND METHODS

Twenty-four men and 14 women with PD received a total of 46 surgical procedures (pallidotomy, thalamotomy and deep brain stimulation of the thalamus, pallidum or subthalamic nucleus). The impact of PD on disability and other aspects of HRQoL was analysed separately in men and women before and at a mean of 11 months after surgery, using the following assessment tools: The Unified Parkinson's Disease Rating Scale (UPDRS), the ADL Taxonomy, the Nottingham Health Profile, the Life Satisfaction Questionnaire and a Visual Analogue Scale.

RESULTS

At surgery, women had a significantly longer duration of disease than men (mean: 15 vs. 10 years, P < 0.01). They had a higher stage on the Hoehn and Yahr scale and worse scores on UPDRS parts II (ADL) and IV (complications), as well as on the Schwab and England scale and on the ADL Taxonomy. Following surgery, both men and women showed improvement, but women experienced greater benefit than men in ADL, in emotions, and in social life.

CONCLUSIONS

Perhaps women with PD should be offered surgery more often and earlier in the course of their disease.

Development and testing of the Parkinson's disease quality of life scale

We report on the development and results of preliminary psychometric testing of a disease specific health-related quality of life (HRQoL) scale intended for use in individuals diagnosed with idiopathic Parkinson's disease (PD). Results from an initial qualitative study provided content for item development and scale construction of the Parkinson's disease quality of life scale (PDQUALIF). The 33-item instrument includes seven domains: social/role function, self-image/sexuality, sleep, outlook, physical function, independence, and urinary function, plus one item of Global HRQoL. Initial psychometric testing of the instrument was conducted in 233 outpatient clinic attendees with physician-confirmed idiopathic PD. Factor structure, reliability and validity of the scale have been established in this cross-sectional study. Continuing development of the PDQUALIF will be directed at enhancing the psychometric properties, establishing responsiveness and determining appropriateness in culturally diverse samples.

The psychometric properties of the Parkinson's Impact Scale (PIMS) as a measure of quality of life in Parkinson's disease

We have previously designed and validated a 10-item bilingual questionnaire, the Parkinson's Impact Scale (PIMS), as a disease-specific instrument to measure the impact of Parkinson's disease (PD) on the quality of life of patients with PD. In this paper we extend the psychometric assessment of PIMS to a new set of patients, in the context of a cross-over trial by Hoffman-La Roche Ltd, comparing two doses of tolcapone in 116 PD patients who had developed wearing off effect on levodopa. Using data from this trial, we evaluate PIMS' test-retest reliability, construct validity, sensitivity and responsiveness to change. Validation is carried out by correlating the PIMS scores with corresponding UPDRS subscales and with the Schwab and England scale. We show that PIMS has excellent psychometric properties, and can therefore be used not only in clinical trials but also to identify quickly potential problems in major subjective areas of PD patients' lives, in order to refer them effectively to appropriate providers of assistance.

Psychosocial problems in Parkinson's disease: evaluation of a disease-specific questionnaire

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.

A short psychosocial questionnaire for patients with Parkinson's disease: the SCOPA-PS

The purpose of this study was to develop a short questionnaire for psychosocial functioning in patients with Parkinson's Disease (PD). The SCales for Outcomes in Parkinson's disease-PsychoSocial questionnaire (SCOPA-PS) was tested in a survey and compared with other instruments and with medical information. This survey was sent to 205 patents with idiopathic PD. Eighty-six percent of the questionnaires were returned. Cronbach's alpha was 0.83. Two-week test-retest reliability was 0.85 (intraclass correlation coefficient). Construct validity with other scales (Spearman's rho) was 0.82 for the Parkinson's Disease Questionnaire-39-item version (PDQ-39), 0.76 for the PDQ-8, 0.69 for the Hospital Anxiety and Depression Scale, -0.61 for the Euroqol, and -0.60 for a visual analogue scale evaluating Quality-of-Life. The summary index revealed a significant increase with increasing disease severity. The SCOPA-PS is a new, short psychosocial questionnaire for patients with PD with good clinimetric properties.

Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study

Sialorrhea is a relatively common symptom in idiopathic Parkinson's disease and related conditions for which most of the accepted treatments are either highly invasive or may cause substantial systemic side effects. This study describes an open-label pilot study of sublingual atropine drops for the treatment of sialorrhea in 7 patients (6 with Parkinson's disease, 1 with progressive supranuclear palsy). Participants demonstrated statistically significant declines in saliva production, both objectively and subjectively. Self-reported drooling severity showed a significant decline between baseline and 180 minutes, t(6) = 3.240 P < 0.025 (eta(2) = 0.636), and between baseline and 1 week, t(6) = 4.583 P < 0.005 (eta(2) = 0.778). Objectively measured saliva production decreased significantly between baseline and the 1-week follow-up, t(6) = 2.711 P < 0.05 (eta(2) = 0.551). Delirium occurred in 1 patient (concurrent with a urinary tract infection), and 2 patients experienced worsening of hallucinations (active hallucinosis was concealed by both individuals to allow participation in the trial). The remaining trial participants did not experience any anticholinergic side effects. This trial shows that, in selected patient populations, sublingual atropine is a simple and inexpensive treatment for sialorrhea associated with parkinsonism.

Quality of sexual life in Parkinson's disease

Ninety-one consecutive patients with Parkinson's disease (PD) were asked to grade their general satisfaction from life (GSL) and completed the PDQ-39 and the quality of sexual life questionnaire (QoSL-Q). The reliability of the QoSL-Q was 0.74. Satisfaction from sexual life as reflected by the QoSL-Q significantly decreased with aging (P<0.01) and advanced disease (P<0.05). No correlation was found between the PDQ-39 and the QoSL index. The correlation between the PDQ-39 and GSL (r=-0.334) improved by adding the QoSL-Q, as a 9th dimension to the PDQ-39 (r=-0.405). The QoSL-Q is a reliable tool assessed a unique and important dimension not evaluated by the PDQ-39.

Linking clinical variables to health-related quality of life in Parkinson's disease

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.