Mobility, mood and site of care impact health related quality of life in Parkinson's disease

J G Nutt; A D Siderowf; M Guttman; P N Schmidt; J I Zamudio; S S Wu; M S Okun; T Simuni; S A Parashos; N A Dahodwala; T L Davis; N Giladi; T Gurevich; R A Hauser; J Jankovic; K E Lyons; L Marsh; J M Miyasaki; J C Morgan; A J Santiago; D Tarsy; Z Mari; I A Malaty; E C Nelson; National Parkinson Foundation Quality Improvement Initiative Investigators

doi:10.1016/j.parkreldis.2013.10.004

Mobility, mood and site of care impact health related quality of life in Parkinson's disease

Parkinsonism Relat Disord. 2014 Mar;20(3):274-9. doi: 10.1016/j.parkreldis.2013.10.004. Epub 2013 Oct 16.

Authors

J G Nutt¹, A D Siderowf², M Guttman³, P N Schmidt⁴, J I Zamudio⁴, S S Wu⁵, M S Okun⁶, T Simuni⁷, S A Parashos⁸, N A Dahodwala², T L Davis⁹, N Giladi¹⁰, T Gurevich¹⁰, R A Hauser¹¹, J Jankovic¹², K E Lyons¹³, L Marsh¹⁴, J M Miyasaki¹⁵, J C Morgan¹⁶, A J Santiago¹⁷, D Tarsy¹⁸, Z Mari¹⁹, I A Malaty⁵, E C Nelson²⁰; National Parkinson Foundation Quality Improvement Initiative Investigators

Affiliations

¹ Oregon Health & Science University, USA. Electronic address: nuttj@ohsu.edu.
² University of Pennsylvania, USA.
³ University of Toronto, USA.
⁴ National Parkinson Foundation, USA.
⁵ University of Florida, USA.
⁶ National Parkinson Foundation, USA; University of Florida, USA.
⁷ Northwestern University, USA.
⁸ Struthers Parkinson Center, USA.
⁹ Vanderbilt University, USA.
¹⁰ Tel Aviv Sourasky Medical Center, USA.
¹¹ University of South Florida, USA.
¹² Baylor College of Medicine, USA.
¹³ University of Kansas, USA.
¹⁴ DeBakey Veterans Affairs Medical Center, USA.
¹⁵ Toronto Western University, USA.
¹⁶ Georgia Regents University, USA.
¹⁷ Muhammad Ali Parkinson Center, USA; Barrow Neurological Institute, USA.
¹⁸ Beth Israel Medical Center, USA.
¹⁹ Johns Hopkins Medical Center, USA.
²⁰ Dartmouth-Hitchcock Medical Center, USA.

PMID: 24182524
DOI: 10.1016/j.parkreldis.2013.10.004

Abstract

Objective: Examine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs).

Background: Improving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery.

Methods: This cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL.

Results: The variability in the PDQ-39 summary index score correlated with H&Y stage (R(2) = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL.

Conclusions: We confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices.

Keywords: Best practices; Health related quality of life; Parkinson's disease; Quality improvement.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Affect*
Aged
Aged, 80 and over
Female
Humans
Internationality
Male
Middle Aged
Mobility Limitation*
Outpatient Clinics, Hospital* / standards
Parkinson Disease / diagnosis
Parkinson Disease / epidemiology*
Parkinson Disease / psychology*
Quality of Life / psychology*