Letting nature take its course: A qualitative exploration of the illness and adjustment experiences of Hong Kong Chinese people with Parkinson's disease

Palliative Care Need and Quality of Life Mediated by Psychological Distress in Neurologic Diseases

CONTEXT

Patients with progressive neurologic diseases (PNDs) face a prolonged and fluctuating course of illness marked by increasing disability and a range of nonmotor symptoms. However, the impacts of nonmotor symptoms and unmet care needs remain underexplored. Palliative care needs arise from the multifaceted sufferings associated with PNDs, encompassing not only physical pain but also psychological, social, and spiritual distress. Despite recommendations for early palliative care for PNDs to address these multidimensional sufferings, access to such supportive care is often restricted to advanced stages of the disease.

OBJECTIVES

This cross-sectional study aimed to examine palliative care needs, psychological distress, health-related quality of life, and the mediating effects of psychological distress on palliative care needs and health-related quality of life among patients with PNDs.

METHODS

A total of 210 patients with PNDs (Parkinson's disease or multiple sclerosis) were recruited using convenience sampling from regional neurology outpatient clinics and patient support groups in Hong Kong. Participants responded to Palliative Care Outcome Scale (POS), Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L surveys.

RESULTS

Most respondents (59.0%) walked without aid, whereas 26.2% required assistance and 14.8% were wheelchair-restricted. The most prevalent palliative care needs were physical symptoms other than pain, psychosocial support, and spiritual burden. A significant portion of participants exhibited possible anxiety (41.1%) or depression (48.6%). Hierarchical regression analysis indicated that mobility, palliative care needs, anxiety, and depression were significantly associated with the health-related quality of life. Anxiety and depression partially mediated the relationship between palliative care needs and quality of life.

CONCLUSION

Given the chronic, fluctuating illness trajectory, early recognition and management of emerging palliative care needs, particularly psychospiritual distress, is crucial for enhancing health-related quality of life for patients with PNDs.

Multicomponent Intervention for Distressed Informal Caregivers of People With Dementia: A Randomized Clinical Trial

Importance

Multicomponent interventions for informal caregivers of people with dementia are urgently needed, but evidence regarding which components are most effective is lacking.

Objective

To apply a multiphase optimization strategy to examine the effects of 5 psychosocial components of an intervention designed to support informal caregivers of people with dementia.

Design, Setting, and Participants

In this assessor-blinded randomized clinical trial with a fractional factorial design, Chinese community-dwelling adults (aged ≥18 years) who were informal family caregivers of people with dementia were screened between July 2 and December 28, 2022, in Hong Kong. Eligible participants with elevated depression or caregiving burden were included and randomized to 1 of 16 experimental conditions. Assessments were conducted at baseline, 6 months, and 12 months. The last 12-month follow-up assessment was conducted on February 26, 2024.

Interventions

The intervention involved a core component (dementia caregiving education) and 5 tested psychosocial components (self-care skills [SC], behavioral problem management [BPM], behavioral activation [BA], mindfulness-based intervention [MBI], and support group [SG]).

Main Outcomes and Measures

Primary outcomes for each tested psychosocial component were physical health (12-item Short-Form Health Survey), caregiver burden (12-item Zarit Burden Interview) and stress (10-item Perceived Stress Scale), psychological well-being (Ryff Psychological Well-Being Scale), anxiety (Hospital Anxiety and Depression Scale-Anxiety Subscale), depressive symptoms (9-item Patient Health Questionnaire), and social support (20-item Medical Outcomes Study Social Support Survey). Multiple linear regression models were used to analyze score changes from baseline to 6 months and from baseline to 12 months for primary and proximal outcomes across the 5 components.

Results

This trial included 250 caregivers (mean [SD] age, 48.9 [13.8] years); most (171 [68.4%]) were female. The MBI component significantly improved multiple caregiver outcomes, with reduced depressive symptoms (β = -2.13 [95% CI, -2.85 to -1.38]; P < .001) and increased mindfulness (β = 4.23 [95% CI, 2.27-6.36]; P < .001), perceived social support (β = 4.76 [95% CI, 1.28-8.15]; P = .007), and active dementia care management (β = 3.70 [95% CI, 1.80-5.66]; P < .001) at 12 months. The SG component significantly improved perceived social support (β = 4.63 [95% CI, 1.32-7.85]; P = .006) at 12 months. BPM had mixed effects; that is, it initially increased caregiver anxiety (β = 1.43 [95% CI, 0.43-2.42]; P = .005) and self-care risk (β = -1.12 [95% CI, -1.82 to -0.43]; P = .002) at 6 months but improved dementia care strategies in terms of encouragement (β = 2.49 [95% CI, 0.74-4.22]; P = .005), active management (β = 5.99 [95% CI, 4.12-7.84]; P < .001), and psychological well-being (β = 3.52 [95% CI, 0.92-6.08]; P = .008) at 12 months. Interaction effects were observed, with the MBI component enhancing the benefits of SC (β = -1.70 [95% CI, -3.05 to -0.35]; P = .01) and BPM (β = -1.40 [95% CI, -2.76 to -0.05]; P = .04) on depression; meanwhile, the MBI and SG components synergistically improved perceived social support (β = 7.58 [95% CI, 0.90-14.26]; P = .03).

Conclusions and Relevance

In this clinical trial of informal caregivers of people with dementia, synergistic interaction effects were noted for MBI, which enhanced the benefits of SC and BPM on depression. The combination of the MBI and SG components also synergistically improved social support. Integrating MBI with SC, SG, or BPM components was an effective multicomponent approach to support caregivers in this study, although ongoing support was needed to mitigate potential short-term risks. Further research is required to validate the efficacy of this optimized intervention package.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2300071235.

Progress and prospects of Parkinson's disease with depression research: A global bibliometric analysis based on CiteSpace

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative disorder marked by motor impairments such as stiffness, involuntary shaking, and slowed movement. In addition, PD patients frequently experience nonmotor symptoms, especially depression. This study uses a mixed-methods scientometric analysis to review global research trends and advancements in PD and depression. This analysis is vital for clinicians, researchers, and policymakers, identifying knowledge gaps and directing future research efforts.

METHODS

We conducted a comprehensive literature review on PD and depression using the Web of Science database from 2004 to 2023, facilitated by CiteSpace 6.1.R6. Our analysis examined collaborations among authors, institutions, countries, and keywords, incorporating insights from RCTs and qualitative studies. We calculated effect sizes and confidence intervals with precision. Ethical approval was not required as the study used publicly available data without personal information.

RESULTS

Our analysis included 3048 research papers and 915 reviews, involving 17,927 authors and 12,466 institutions. The United States and the University of Toronto led in publications. Studies revealed significant effect sizes with narrow confidence intervals, particularly on the prevalence and impact of depression in PD patients. High-frequency keywords included "Parkinson's disease," "depression," "quality of life," "non-motor symptom," and "dementia." Visual mapping identified critical research nodes and future directions.

CONCLUSION

Over the past 2 decades, research on the PD-depression link has accelerated. Our analysis highlights prevailing trends and critical areas, providing evidence-based recommendations for therapeutic strategies. This study offers valuable insights for clinicians and researchers, emphasizing future research priorities to improve patient outcomes.

The palliative care needs and experiences of patients with advanced Parkinson's disease: a qualitative scoping review

Aim

To determine the experiences and needs of palliative care in patients with advanced Parkinson's disease (PD).

Methods

A scoping literature review methodology, as described by the Joanna Briggs Institute, was employed to search for relevant literature. An electronic search of studies published in English was conducted across five databases from inception to 10 September 2023.

Results

The search yielded a total of 1,205 articles, with 20 meeting the inclusion criteria. The findings were organized into four themes: (1) unmet emotional and informational needs; (2) needs for effective coordination of care; (3) planning for the future; and (4) symptom management. This scoping review highlights the intricate nature of palliative care for patients with PD and sheds light on issues within current palliative care healthcare systems. The findings emphasize the necessity for individualized interventions and services to address the diverse unmet palliative care needs of people with PD.

Conclusion

The study reveals the complex landscape of palliative care for individuals with advanced PD, emphasizing the inadequacies within existing healthcare systems. The identified themes underscore the importance of tailored interventions to address the varied unmet palliative care needs of this population.

A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol

BACKGROUND

Between 40 and 50% of patients with Parkinson's disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants' experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management.

METHODS

We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews.

DISCUSSION

The study would also generate important insights to enhance the patients' adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services.

TRIAL REGISTRATION

WHO Primary Registry - Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 ( https://www.chictr.org.cn/showproj.html?proj=125878 ).

Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong

AIM

This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong.

DESIGN

The study adopted a qualitative descriptive design with thematic analysis.

METHODS

Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach.

RESULTS

Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence - 'it has nothing to do with me' and (4) dilemma towards sexual violence prevention.

CONCLUSION

The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence.

IMPACTS

This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.

Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis

OBJECTIVES

To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes.

DESIGN

Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies.

SETTING AND PARTICIPANTS

Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers.

METHODS

MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model.

RESULTS

Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), -0.34 (95% Cl, -0.59 to -0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, -0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, -0.09 (95% Cl, -0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, -0.07 to 0.44)] were observed.

CONCLUSIONS AND IMPLICATIONS

Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.

A randomized clinical trial of mindfulness meditation versus exercise in Parkinson's disease during social unrest

Clinical practice guidelines support resilience training and exercise for patients with Parkinson's disease (PD). This assessor-blinded, randomized clinical trial aimed to compare the effects of a modified mindfulness meditation program versus stretching and resistance training exercise (SRTE) in patients with mild-to-moderate PD. A total of 126 potential participants were enrolled via convenience sampling, of which 68 eligible participants were randomized 1:1 to receive eight weekly 90-min sessions of mindfulness meditation or SRTE. Compared to the SRTE group, generalized estimating equation analyses revealed that the mindfulness group had significantly better improvement in outcomes, particularly for improving depressive symptoms (d, -1.66; 95% CI, -3.31 to -0.02) at week 8 and maintaining emotional non-reactivity at week 20 (d, 2.08; 95% CI, 0.59 to 3.56). Both groups demonstrated significant immediate, small-moderate effects on cognition (effect size [d] = 0.36-0.37, p = 0.006-0.011). Compared with the SRTE, mindfulness meditation appeared to be a feasible and promising strategy for managing depressive symptoms and maintaining emotional stability, with comparable benefits on cognitive performance. To combat the psychospiritual and cognitive sequelae of social unrest and COVID-19 pandemic, the integration of mindfulness training into motor-oriented PD rehabilitation protocols is recommended to strengthen the resilience and minimize the psycho-cognitive comorbidities among patients with mild-to-moderate PD.Trial Registration: HKU Clinical Trials Registry identifier: HKUCTR-2681.

Living with Parkinson’s disease: disease and medication experiences of patients and caregivers

Purpose

Symptoms and medication use in patients with Parkinson’s disease (PD) affect the quality of life of patients and caregivers, yet prior research seldom focused on their experiences with medications. This study explored comprehensive living and medication experience from patients with PD and their caregivers.

Methods

Patients diagnosed with PD for ≥2 years, with or without their caregivers, were recruited from an outpatient clinic in Taiwan. Semi-structured in-depth interviews were conducted based on the Common Sense Model. A qualitative content analysis was used to identify salient themes from verbatim transcripts.

Results

In total, 15 patients and eight caregivers were interviewed. Five themes were derived: (1) symptoms and help-seeking behaviours before a diagnosis, (2) emotional impacts and life adaptations after a PD diagnosis, (3) life affected by medications, (4) experiences of caregivers in taking care of PD patients, and (5) communication between doctors and patients.

Conclusions

Patients frequently adjusted their daily schedules to live with PD and the medication side effects. Caregivers struggle to overcome caring burdens and to stay positive to support patients. More attention on providing medication information, mental support, and communication between stakeholders is needed to improve the quality of life of patients and caregivers.

Adjusting to living with Parkinson's disease; a meta-ethnography of qualitative research

PURPOSE

Parkinson's disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question "how do individuals adjust to PD?"

METHOD

A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach.

RESULTS

After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: "maintaining a coherent sense of self", "feeling in control" and "holding a positive mindset". Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing.

CONCLUSION

The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson's disease and supporting future wellbeing.IMPLICATIONS FOR REHABILITATIONIndividual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson's disease.Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual's understanding and experience of the disease.

Effects of Mindfulness Yoga Versus Conventional Physical Exercises on Symptom Experiences and Health-related Quality of Life in People with Parkinson's Disease: The Potential Mediating Roles of Anxiety and Depression

BACKGROUND

Although several studies have reported positive effects of mind-body exercises on symptom management and health-related quality of life (HRQOL) of people living with Parkinson's disease (PD), it is not known whether these effects are attributable to a change in anxiety and depression.

PURPOSE

To compare the effects of mindfulness yoga to conventional stretching exercises in a randomized controlled trial while examining potentially mediating effects of anxiety and depression.

METHODS

138 adults with PD were randomized to eight weekly yoga (n = 71) or stretching (n = 67) sessions. Symptom experiences, anxiety and depression, and HRQOL outcomes were assessed at baseline, immediate post-intervention, and 3-month post-intervention.

RESULTS

Generalized estimating equation analyses revealed that, compared to stretching, yoga significantly improved patients' nonmotor (time-by-group interaction, T1:β = -1.99, p = .008; T2:β = -2.86, p < .001) and motor (time-by-group interaction, T1:β = -1.77, p = .03) symptom experiences. The mediation analysis found that the changes in anxiety and depression were the mediators in the associations between non-motor experience and HRQOL; while only the changes in depression were found to be the mediator in the relationship between motor experience and HRQOL.

CONCLUSIONS

Yoga is superior to conventional stretching exercises in improving nonmotor and motor symptoms in daily living. Reduced anxiety and depression play a role in mediating the positive effects of the mindfulness yoga intervention. To optimize HRQOL, rehabilitation should reinforce psychological care in addition to pharmacological treatments and physical relief of PD symptoms. Future studies are needed to identify strategies for facilitating the implementation and sustainability of mind-body rehabilitation to enhance the quality of care for PD.

Tele-yoga for the management of Parkinson disease: A safety and feasibility trial

Objectives

Despite current standard treatments, persons with Parkinson disease (PD) still experience motor and non-motor symptoms that impact daily function and quality of life, warranting the investigation of additional interventions. Holistic complementary interventions such as yoga have been shown to be beneficial for persons with PD. However, there are multiple barriers to in-person interventions such as transportation difficulties and disease-related mobility impairments which may be mitigated by digital health applications. Therefore, this study’s purpose was to assess the safety and feasibility of a synchronous tele-yoga intervention for persons with PD.

Methods

Sixteen participants were enrolled in a single group safety and feasibility trial. The entire study was conducted remotely and consisted of a baseline assessment followed by a six-week waiting period, then a second assessment, a six-week tele-yoga intervention period, a post-intervention assessment, a six-week follow-up period, and lastly a follow-up assessment. During the tele-yoga period, participants completed two one-on-one 30-minute tele-yoga sessions weekly for a total of 12 sessions. Primary outcomes included adverse events, adherence, technological challenges, and usability. Secondary outcomes included enjoyment and clinically relevant outcome measures assessing both motor and non-motor symptoms.

Results

No severe adverse events were attributed to the intervention. Retention was 87.5%, assessment session adherence was 100%, and intervention session adherence was 97%. Technological challenges did not impact feasibility. The intervention was usable and enjoyable. While this study was not powered or designed to assess the efficacy of the intervention, preliminary improvements were shown for some of the clinically relevant outcome measures.

Conclusions

Overall, this study showed that the implementation of a synchronous one-on-one tele-yoga intervention was safe, feasible, usable, and enjoyable for persons with PD. Randomized control trials investigating its efficacy should be initiated. The study was registered with ClinicalTrials.gov (NCT04240899, https://clinicaltrials.gov/ct2/show/NCT04240899).

Coping Styles among People with Parkinson's Disease: A Three-Year Follow-Up Study

People with Parkinson’s disease (PD) experience a gradual loss of functional abilities that affects all facets of their daily life. There is a lack of longitudinal studies on coping styles in relation to the disease progression among people with PD. The aim of this study was to explore how coping styles in PD evolve over a 3-year period. Data from the longitudinal project “Home and Health in People Ageing with PD” was utilized (N = 158), including baseline and 3-year follow-up assessments. Coping was captured by ratings of 13 different coping styles. A factor analysis was conducted to analyse patterns of coping styles. Stability and change were analysed for each of the 13 styles with respect to the course of the disease. The factor analysis revealed four coping patterns: pessimistic, optimistic, persistent and support-seeking. The stability of each coping style over time ranged from 75.3% to 90.5%. Those who experienced a worsening of the disease were most inclined to change their coping style (p = 0.006). The results suggest that even when facing severe challenges due to PD in daily life, coping styles remain relatively stable over time. However, a worsening in PD severity appeared to trigger a certain re-evaluation of coping styles.

Effects of spiritual resilience on psychological distress and health-related quality of life in Chinese people with Parkinson's disease

PURPOSE

Health-related quality of life (HRQOL) is an increasingly critical outcome of chronic illness care. However, its disease-independent attributes, particularly its spiritual resilient indicators, for people with Parkinson's disease (PD) have not been explicitly examined. This study aimed to (i) assess the associations between psychological distress, spiritual resilience and HRQOL, and (ii) examine the mediating effects of spiritual resilience on psychological distress and HRQOL amongst individuals with PD.

METHODS

This is a secondary data analysis of the baseline data of a clinical trial that involved 138 individuals with PD. The subjects completed a structured questionnaire assessing psychological distress in terms of anxiety and depression, spiritual resilience in terms of perceived affliction and perceived equanimity, severity of motor symptoms and disease-specific HRQOL.

RESULTS

Analysis by independent t test suggested that distressed individuals with PD demonstrated less spiritual resilience and presented poorer HRQOL than non-distressed individuals with PD. Multiple linear regression models revealed that high emotional distress was associated with low spiritual resilience and poor HRQOL. The mediation analysis found that after simultaneously controlling for the degree of perceived affliction and perceived equanimity, a significant reduction was observed in the direct effect between psychological distress and HRQOL. This result indicated the partially mediating roles of perceived affliction and equanimity in the pathways between psychological distress and HRQOL.

CONCLUSION

In order to enhance HRQOL, PD interventions should address the spiritual resilience of patients in addition to providing psychological care and physical relief of symptoms.