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.

[1]  D. Murphy,et al.  Validating a quality of life rating scale for idiopathic parkinsonism: Parkinson's Impact Scale (PIMS). , 1996, Parkinsonism & related disorders.

[2]  Marjan Jahanshahi,et al.  What contributes to quality of life in patients with Parkinson's disease? , 2000, Journal of neurology, neurosurgery, and psychiatry.

[3]  S. Walker,et al.  Quality of Life Assessment: Key Issues in the 1990s , 1993, Springer Netherlands.

[4]  A. Dobson,et al.  A comparison of two quality-of-life questionnaires for cancer clinical trials: the functional living index--cancer (FLIC) and the quality of life questionnaire core module (QLQ-C30). , 1996, Journal of clinical epidemiology.

[5]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[6]  D. Gold,et al.  Quality of life and Parkinson's disease. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  B. Spilker,et al.  Quality of life and pharmacoeconomics in clinical trials , 1996 .

[8]  H. Fukunaga,et al.  Clinical findings, status of care, comprehensive quality of life, daily life therapy and treatment at home in patients with Parkinson's disease. , 1997, European neurology.

[9]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[10]  P Sandercock,et al.  Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. , 1998, Stroke.

[11]  S. Fahn Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale , 1987 .

[12]  J. Ware SF-36 health survey: Manual and interpretation guide , 2003 .

[13]  Myfanwy Morgan,et al.  Health Status and Health Policy: Allocating Resources to Health Care , 1994 .

[14]  R. Klein,et al.  Self-rated health and mortality in people with diabetes. , 1994, American journal of public health.

[15]  R. Fitzpatrick,et al.  The PDQ-8: Development and validation of a short-form parkinson's disease questionnaire , 1997 .

[16]  J. Larsen,et al.  Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease , 1999, Journal of neurology, neurosurgery, and psychiatry.

[17]  J. Stradling,et al.  How should we evaluate health status? A comparison of three methods in patients presenting with obstructive sleep apnoea , 1998, Quality of Life Research.

[18]  A Schrag,et al.  The EQ-5D—a generic quality of life measure—is a useful instrument to measure quality of life in patients with Parkinson's disease , 2000, Journal of neurology, neurosurgery, and psychiatry.

[19]  J. Speelman,et al.  Quality of life in patients with Parkinson's disease: development of a questionnaire. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[20]  R. Fitzpatrick,et al.  Health‐related quality of life in parkinson's disease: A study of outpatient clinic attenders , 1997, Movement disorders : official journal of the Movement Disorder Society.

[21]  W. Longstreth,et al.  Utility of the Sickness Impact Profile in Parkinson's Disease , 1992, Journal of geriatric psychiatry and neurology.

[22]  Michael H. Kutner Applied Linear Statistical Models , 1974 .

[23]  K. Lohr Applications of health status assessment measures in clinical practice. Overview of the third conference on advances in health status assessment. , 1992, Medical care.

[24]  L. Berkman,et al.  Two Shorter Forms of the CES-D Depression Symptoms Index , 1993 .

[25]  R. Fitzpatrick,et al.  Self-reported health status and access to health services in a community sample with Parkinson's disease. , 1997, Disability and rehabilitation.

[26]  C. Marsden,et al.  Recent Developments in Parkinson's Disease , 1986 .

[27]  R. Deyo,et al.  Measuring Functional Outcomes in Chronic Disease: A Comparison of Traditional Scales and a Self- Administered Health Status Questionnaire in Patients With Rheumatoid Arthritis , 1983, Medical care.

[28]  A. Damiano,et al.  A review of health-related quality-of-life concepts and measures for Parkinson's disease , 1999, Quality of Life Research.

[29]  R. Wallace,et al.  The Usefulness of the Functional Status Questionnaire and Medical Outcomes Study Short Form in Parkinson's Disease Research , 1998, Quality of Life Research.

[30]  A. Williams EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[31]  Richard A. Johnson,et al.  Applied Multivariate Statistical Analysis , 1983 .

[32]  J. Sørensen,et al.  Large-scale health outcomes evaluation: how should quality of life be measured? Part II--Questionnaire validation in a cohort of patients with advanced cancer. , 1995, Journal of clinical epidemiology.

[33]  G. Grimby,et al.  Endurance training effect on individuals with postpoliomyelitis. , 1996, Archives of physical medicine and rehabilitation.

[34]  Robert G. Holloway,et al.  Cost Effectiveness of Pramipexole in Parkinson’s Disease in the US , 1998, PharmacoEconomics.

[35]  K. Marder,et al.  A controlled trial of piracetam in intellectually impaired patients with Parkinson's disease , 1990, Movement disorders : official journal of the Movement Disorder Society.

[36]  Mona L. Martin,et al.  Quality of life and parkinson's disease: Translation and validation of the US Parkinson's Disease Questionnaire (PDQ-39) , 1999, Quality of Life Research.

[37]  I. Wilson,et al.  Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. , 1995, JAMA.

[38]  P. Martínez-Martín,et al.  Unified Parkinson's disease rating scale characteristics and structure , 1994, Movement disorders : official journal of the Movement Disorder Society.

[39]  R. Hays,et al.  Benefits and obstacles of health status assessment in ambulatory settings. The clinician's point of view. The Dartmouth Primary Care COOP Project. , 1992, Medical care.

[40]  R. Meara,et al.  Is the SF-36 health survey questionnaire suitable as a self-report measure of the health status of older adults with Parkinson's disease? , 1997, Quality of Life Research.

[41]  J. Parkes,et al.  Measuring the quality of life of patients with Parkinson’s disease , 1993 .

[42]  G. Bonsel,et al.  Test-retest reliability of health state valuations collected with the EuroQol questionnaire. , 1994, Social science & medicine.

[43]  M. Liang,et al.  Comparative Measurement Sensitivity of Short and Longer Health Status Instruments , 1992, Medical care.

[44]  L. Radloff The CES-D Scale , 1977 .

[45]  R. Wallace,et al.  Depression among the Rural Elderly A Study of Prevalence and Correlates , 1985, The Journal of nervous and mental disease.

[46]  A. Jacobson,et al.  The Evaluation of Two Measures of Quality of Life in Patients With Type I and Type II Diabetes , 1994, Diabetes Care.

[47]  G. Bonsel,et al.  The Impact of Migraine on Health Status , 1995, Headache.

[48]  D. Jette,et al.  The disablement process in patients with pulmonary disease. , 1997, Physical therapy.

[49]  S. Fahn Unified Parkinson's Disease Rating Scale , 1987 .

[50]  R. Fitzpatrick,et al.  Self-reported functioning and well-being in patients with Parkinson's disease: comparison of the short-form health survey (SF-36) and the Parkinson's Disease Questionnaire (PDQ-39) , 1995, Age and ageing.

[51]  B Fitzsimmons,et al.  Parkinson's disease. Quality of life issues. , 1993, The Nursing clinics of North America.

[52]  G. Smith Measuring Health: a Practical Approach , 1988 .

[53]  P. Yarnold,et al.  Cross-Sectional Psychometric Assessment of the Functional Status Questionnaire: Use with Geriatric versus Nongeriatric Ambulatory Medical Patients , 1995, International journal of psychiatry in medicine.

[54]  K Whetten-Goldstein,et al.  The Burden of Parkinson's Disease on Society, Family, and the Individual , 1997, Journal of the American Geriatrics Society.

[55]  R. Fitzpatrick,et al.  The Parkinson's Disease Questionnaire (PDQ-39): development and validation of a Parkinson's disease summary index score. , 1997, Age and ageing.

[56]  W H Rogers,et al.  Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. , 1995, Medical care.

[57]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[58]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[59]  A. Jette,et al.  Functional disability assessment. , 1987, Physical therapy.

[60]  L. D. Frazier,et al.  Coping with disease-related stressors in Parkinson's disease. , 2000, The Gerontologist.

[61]  R B Wallace,et al.  The health burdens of Parkinson's disease , 1998, Movement disorders : official journal of the Movement Disorder Society.

[62]  J. Larsen,et al.  Health related quality of life in Parkinson's disease: a prospective longitudinal study , 2000, Journal of neurology, neurosurgery, and psychiatry.