Influence of Functional Movement Rehabilitation on Quality of Life in People with Parkinson’s Disease

[Purpose] Parkinson’s disease is one of the most frequent diseases of the central nervous system. Thorough knowledge of reasons for movement defects may contribute to the ability to quality of life at a good level as far as motor abilities are concerned. The aim of the study was to evaluate the influence of functional movement rehabilitation on the degree of intensity of movement symptoms in Parkinson’s disease. [Subjects] The research was carried out in people diagnosed with stage III Parkinson’s disease, according to the Hoehn and Yahr scale classification. [Methods] In order to establish the clinical state of patients, parts I, II, and III of the Unified Parkinson’s Disease Rating Scale, the Schwab and England Activities of Daily Living scale, and the quality of life in Parkinson’s disease questionnaire were applied. The intervention group took part in 60 minutes of functional movement rehabilitation twice a week for a period of 15 weeks. The main emphasis was placed on the ability to cope with everyday activities. [Results] A significant difference in scores for the given scales between before and after research the intervention period was observed in the intervention group. [Conclusion] The obtained results revealed positive that the influence of applied rehabilitation program had a positive influence on the degree of intensity of movement symptoms in people with Parkinson’s disease.Key words: Parkinson’s disease, Functional movement rehabilitation, Quality of life     

Effect of Muscle Vibration on Spatiotemporal Gait Parameters in Patients with Parkinson’s Disease

[Purpose] The purpose of this study was to investigate the effect of muscle vibration in the lower extremities in patients with Parkinson’s disease (PD) during walking. [Subjects] Nine patients with PD participated in this study and were tested with and without vibration (vibration at 60 Hz). [Methods] Eight oscillators of vibration were attached to the muscle bellies (tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris) on both sides of the lower extremities with adhesive tape in this study. Spatiotemporal gait parameters were measured using a motion analysis system. [Results] Stride length and walking speed with vibration were significantly increased compared with those without vibration in PD patients. [Conclusion] These results suggest that the application of vibration to lower extremity muscles in patients with PD may improve the parkinsonian gait pattern.Key words: Parkinson’s disease, Muscle vibration, Spatiotemporal gait parameter     

Effect of Protective Cover on the Quality of Life of Patients With Tracheostomy—A Quasi-Experimental Study

PurposePatients with tracheostomy experience problems such as the inability to speak, swallowing disorders, and impairment of body image. These problems adversely affect patients' quality of life (QoL). This study aimed to investigate the effect of discharge training and the use of a protective cover on the QoL of patients with tracheostomy and the problems experienced after discharge.DesignA quasi-experimental study.MethodsAll patients (n = 24) were followed for 3 months after the preoperative period. Patients in the control group (CG) received routine care after surgery, whereas patients in the intervention group (IG) received routine care, discharge training, and a protective stoma cover.FindingsThe 90th postdischarge day QoL scores between the CG and IG were statistically significant. Respiratory problems were the most common postdischarge problems in both groups. Patients in the CG significantly experienced more problems than those in the IG during the postdischarge period.ConclusionsThis study provides that patients can benefit from discharge training and protective cover and that health care professionals become aware of the cover for future use.     

Effects of Exercise on Non-motor Symptoms in Parkinson’s Disease

Patients with Parkinson’s disease experience disabling non-motor symptoms, including autonomic dysfunction, cognitive decline, and sleep disorders. Pharmacologic treatments for these symptoms are often ineffective or have intolerable side effects. Therefore, non-pharmacologic interventions are an attractive alternative. Exercise in particular has the potential to alleviate the progressive impairment related to these non-motor symptoms. In this commentary, we explore available research that addresses the impact of exercise and physical activity on autonomic dysfunction, cognitive impairment, and sleep disorders in Parkinson’s disease and suggest areas in need of further study. Many gaps remain in our understanding of the most effective exercise intervention for these symptoms, the mechanisms underlying exercise-induced changes, and the best way to monitor response to therapy. However, available research suggests that exercise is a promising approach to improve non-motor symptoms in patients with Parkinson’s disease.     

Impact of Primary Care�CBased Disease Management on the Health-Related Quality of Life in Patients With Type 2 Diabetes and Comorbidity

OBJECTIVE

This study examined the effectiveness of the German diabetes disease management program (DMP) for patients with varying numbers of other medical conditions with respect to their health-related quality of life (HRQoL).

RESEARCH DESIGN AND METHODS

A questionnaire, including the HRQoL-measured EQ-5D, was mailed to a random sample of 3,546 patients with type 2 diabetes (59.3% female). The EQ-5D score was analyzed by grouping patients according to those on a DMP and those receiving routine care.

RESULTS

The analysis showed that participation in the DMP (P < 0.001), the number of other medical conditions (P < 0.001), and the interaction between the DMP and the number of other conditions (P < 0.05) had a significant impact on the EQ-5D score.

CONCLUSIONS

Our findings suggest that the number of other medical conditions may have a negative impact on the HRQoL of patients with type 2 diabetes. The results demonstrate that the German DMP for type 2 diabetes may help counterbalance this effect.Previous research showed that the presence of other medical conditions had a negative impact on health-related quality of life (HRQoL) for patients with type 2 diabetes (1,2,3). In Germany, a special disease management program (DMP) has been in place throughout the country since 2003, aiming to better structure and coordinate the care of patients with type 2 diabetes. This primary care–based continuous program comprises elements of the Chronic Care Model and is accessible for all patients with type 2 diabetes (4,5). This study aimed to examine the effectiveness of the German diabetes DMP for patients with varying numbers of other medical conditions with respect to their HRQoL.     

Measuring the Psychosocial Dimensions of Quality of Life in Patients With Advanced Cancer: Psychometrics of the German Quality of Life at the End of Life-Cancer-Psychosocial Questionnaire

Context

Quality of life (QoL) is a central focus of care in advanced cancer. Specialized instruments, such as the Quality of Life at the End of Life-Cancer (QUAL-EC), may be useful to assess psychosocial issues associated with QoL unique to this population.

Effects of Home Exercise on Physical Function and Activity in Home Care Patients with Parkinson’s Disease

[Purpose] The aim of this study was to clarify the effects of guidance in home exercise on physical function and the amount of activity in home care patients with Parkinson’s disease (PD). [Subjects and Methods] A 2-month home exercise intervention consisting of self-administered exercise by patients (self-exercise) and home visit exercise therapy guided by a physical therapist (home visit exercise) was conducted in 10 home care patients with PD to compare changes in physical function, activities of daily living, and postural status between before and after the intervention. [Results] A decreased number of chief complaints and alleviation of fear of falling were observed after the intervention. In terms of physical function, a significant increase in flexibility and muscle strength were observed, although no significant changes were found in activities of daily living, gait, and balance. Although there was no significant change in the total amount of daily physical activity, the analysis of daily posture changes revealed a significant reduction in the percentage of time spent lying down and a significant increase in the percentage of time spent sitting after the intervention. [Conclusion] Guidance in home exercise in home care patients with PD can be effective in making self-exercise a habit, improving range of motion and muscle strength, and reducing the time spent in a supine position.Key words: Exercise therapy, Home care patients with Parkinson’s disease, Physical activity     

The Effects of Mindfulness Meditation-Based Complex Exercise Program on Motor and Nonmotor Symptoms and Quality of Life in Patients with Parkinson's Disease

Purpose

The present study was to examine the effect of a meditation-based exercise program on the motor and non-motor symptoms of Parkinson’s disease (PD).

Effect of Muscle Vibration on Postural Balance of Parkinson’s Diseases Patients in Bipedal Quiet Standing

[Purpose] The purpose of this study was to investigate the effect of muscle vibration applied to the lower extremities on static postural balance of patients with Parkinson’s disease (PD). [Subjects] Seven subjects with Parkinson’s disease participated in this study. [Methods] The oscillators of vibration were attached to the muscle bellies of the tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris on both sides of the lower extremities with adhesive tape. A vibration frequency of 60 Hz was used to induce static postural reactions. Subjects’ center of pressure (COP) sway and peak ground reaction force (GRF) were measured with their eyes open with and without vibration. COP sway and peak GRF (Fx, Fy, Fz) were measured using a force plate (AMTI, Newton, USA), which provides x, y and z coordinates of body movement. [Results] The area of COP sway with vibration was significantly smaller than that with no vibration, but the length of COP sway showed no difference between two conditions. Peak medial-lateral maximum force (Fy) with vibration was significantly higher than that with no vibration, but peak anterior-posterior force (Fx) and peak vertical force (Fz) showed no differences. [Conclusion] These results suggest that vibration applied to the lower extremities can help PD patients control postural balance during quiet standing.Key words: Vibration, Postural balance, Parkinson’s disease     

Correspondence Between the RAND–Negative Impact of Asthma on Quality of Life Item Bank and the Marks Asthma Quality of Life Questionnaire

Background

In many research and clinical settings in which patient-reported outcome (PRO) measures are used, it is often desirable to link scores across disparate measures or to use scores from 1 measure to describe scores on a separate measure. However, PRO measures are scored by using a variety of metrics, making such comparisons difficult.

Objective

The objective of this article was to provide an example of how to transform scores across disparate measures (the Marks Asthma Quality of Life Questionnaire [AQLQ-Marks] and the newly developed RAND–Negative Impact of Asthma on Quality of Life item bank [RAND-IAQL-Bank]) by using an item response theory (IRT)-based linking method.

Methods

Our sample of adults with asthma (N = 2032) completed 2 measures of asthma-specific quality of life: the AQLQ-Marks and the RAND-IAQL-Bank. We use IRT-based co-calibration of the 2 measures to provide a linkage, or a common metric, between the 2 measures. Co-calibration refers to the process of using IRT to estimate item parameters that describe the responses to the scales’ items according to a common metric; in this case, a normal distribution transformed to a T scale with a mean of 50 and an SD of 10.

Results

Respondents had an average age of 43 (15), were 60% female, and predominantly non-Hispanic White (56%), with 19% African American, 14% Hispanic, and 11% Asian. Most had at least some college education (83%), and 90% had experienced an asthma attack during the last 12 months. Our results indicate that the AQLQ-Marks and RAND-IAQL-Bank scales measured highly similar constructs and were sufficiently unidimensional for IRT co-calibration. Once linked, scores from the 2 measures were invariant across subgroups. A crosswalk is provided that allows researchers and clinicians using AQLQ-Marks to crosswalk to the RAND-IAQL toolkit.

Conclusions

The ability to translate scores from the RAND-IAQL toolkit to other “legacy” (ie, commonly used) measures increases the value of the new toolkit, aids in interpretation, and will hopefully facilitate adoption by asthma researchers and clinicians. More generally, the techniques we illustrate can be applied to other newly developed or existing measures in the PRO research field to obtain crosswalks with widely used traditional legacy instruments.     

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson’s Disease,Students and Clinical Educators

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson’s Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: “client-centredness”; “who am I/why am I here?”; “understanding interprofessional collaboration and development”; “personal and professional development, awareness of self and others”; “the environment - safety and support”. These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of “navigating interprofessional spaces” showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.     

Launch Delay of New Drugs in China and Effect on Patients’ Health

PurposeAlthough the launch delay of new drugs in China has been a deep concern during the past few years, research on this topic is scarce. The effect of recent regulatory efforts, such as initiating fast review channels to improve access to medical innovations, remains unclear. In this work, we measure the launch delay in China and study whether the fast channels contribute to shorter delays. We also offer an examination of the effect of launch delay on patients’ health.MethodsWe examined the launch delays of 40 new drugs engaged in the 3 national price negotiations in China. Launch delay was defined as the differences between the approval dates of the United States or the European Union and that of China and was measured according to approved indications of every specific drug. Thirty-four health impact models comparing the new drugs and their corresponding comparator therapies were populated with open data from published studies to assess the loss of health attributable to launch delay. The time horizon for each model was the specified delay time.FindingsA total of 40 new drugs with 54 approvals were studied. The median delay was 44.40 months (range, 7.30–196.24 months). For the 20 approvals granted with the fast channels, the median delay was 38.14 months, which was shorter than the 68.25 months of those 34 approvals on the track of standard procedure (P = 0.0276). Moreover, among the 34 health models for 27 new drugs, the largest loss of health was 5.76 life-years and 4.14 quality-adjusted life-years per potential patient, whereas the least loss was 0.006 life-years per head and 0.0035 quality-adjusted life-years per head, respectively.ImplicationsAccess to new drugs is delayed significantly in China, which may undermine patient benefit by causing loss of life-years and quality of life. The fast review procedures in China have appeared to mitigate the launch delay.     

Influence of fear of falling on gait and balance in Parkinson’s disease

Abstract

Purpose: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinson's disease (PD). Method: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22?±?8.93 years. The average time since diagnosis was 8.27?±?5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared. Results: Gait speed and stride length for forward walking (p?<?0.0005 for both) and backward walking (p?=?0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p?=?0.025), time to turn (p?<?0.0005), time to walk sideways (p?=?0.001), and time to complete the up and go test (p?=?0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p?=?0.001) and steps to walk sideways (p?=?0.002) were greater in those with a high level of FoF than in those with a low level FoF. Conclusions: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history.

• Implications for Rehabilitation

• The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD.

• Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

     

Effects of Balance and Gait Training on the Recovery of the Motor Function in an Animal Model of Parkinson’s Disease

[Purpose] This study was conducted to investigate the effect of balance and gait training on the recovery of the motor function in a Parkinson’s disease animal models. [Subjects and Methods] A total of 40 mice were randomly classified into four groups with 10 in each group: Group I-Normal; Group II-Parkinson’s disease and no training; Group III-Parkinson’s disease and balance training was performed; and Group IV-Parkinson’s disease and gait training. Parkinson’s disease was induced by administration of MPTP to animals in Groups II–IV. Groups III and IV did training once a day, five days a week, for four weeks. Neurobehavioral evaluation was performed through the pole and open-field tests. Immunological evaluation was performed via TH (tyrosine hydroxylase) protein expression, using western blot analysis. [Results] In the result of the pole test, Groups III and IV showed significantly greater motor function recovery than to Group II. The results of the open-field test also showed that Groups III and IV had significantly greater motor function recovery than to Group II, and Group IV showed significantly greater motor function recovery than to Group III. Using western blot analysis, we determined that the expression of TH protein in the corpus striatum was greatest in group I, followed by Groups III and IV, and that Group II had the lowest TH protein expression in the corpus striatum. [Conclusion] The results of this study showed that balance and gait training were effective at recovering the motor functions of a Parkinson’s disease animal models induced by MPTP, and that gait training was more effective than balance training.Key words: Parkinson’s disease, Balance training, Gait training     

Association of Metacognitive Beliefs,Obsessive Beliefs and Symptom Severity With Quality of Life in Obsessive–Compulsive Patients

The aim of this study was to evaluate the association of obsessive beliefs, obsessive–compulsive disorder severity and metacognitive beliefs to the quality of life in patients with obsessive–compulsive disorder (OCD). Sixty one adults with a principal diagnosis of OCD were recruited for the study. Participants were assessed by trained clinicians using an unstructured clinical interview, the Obsessive Beliefs Questionnaire, the Yale–Brown Obsessive–Compulsive Scale, the Metacognitive Beliefs Questionnaire and the WHO Quality of Life Questionnaire. Data were analyzed using Pearson's of correlation coefficients and multiple regression analyses. Findings indicate that obsessive beliefs, severity total OCD and metacognitive beliefs were associated with total quality of life scores. Regression analysis revealed that while OCD total severity explained 40.1% of the variance in total quality of life, obsessive beliefs (perfectionism/certainty domain) and metacognitions (cognitive self-consciousness and negative beliefs about thoughts in general) explained an additional 13.7%, 7.7% and 5.4% of the variance in QoL. Findings indicate that the metacognitive beliefs associated with OCD symptom severity are different from that associated with quality of life. The implications are that metacognitive therapy aimed at symptom reduction may not necessarily result in improved QoL in OCD patients.