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Parkinsonism Relat Disord. 2018 Nov;56:93-97. doi: 10.1016/j.parkreldis.2018.06.034. Epub 2018 Jul 2.

Predictors of clinically meaningful change in PDQ-39 in Parkinson's disease.

Author information

1
Department of Neurology, Northwestern University, 303 East Chicago Avenue Ward 12-140, Chicago, IL, 60611, USA. Electronic address: margola@ccf.org.
2
National Parkinson Foundation, 200 SE 1st Street, Suite 800, Miami, FL, 33131, USA. Electronic address: fcubillos@parkinson.org.
3
Department of Mathematics, Clarkson University, 8 Clarkson Avenue, Potsdam, NY, 13699, USA. Electronic address: yhe@clarkson.edu.
4
Department of Biostatistics, University of Florida, 2004 Mowry Road, 5th Floor CTRB P.O. Box 117450, Gainesville, FL, 32611, USA. Electronic address: sw45@ufl.edu.
5
National Parkinson Foundation, 200 SE 1st Street, Suite 800, Miami, FL, 33131, USA. Electronic address: pschmidt@parkinson.org.
6
Department of Neurology, Northwestern University, 303 East Chicago Avenue Ward 12-140, Chicago, IL, 60611, USA. Electronic address: tsimuni@nmff.org.

Abstract

OBJECTIVE:

To determine predictors of clinically meaningful change in Health-Related Quality of Life (HRQL) in patients with Parkinson's disease (PD).

BACKGROUND:

There is limited literature on longitudinal predictors of change in HRQL in PD.

METHODS:

Data were collected from the National Parkinson Foundation Quality Improvement Initiative (NPF-QII) registry, a multicenter, longitudinal observational study. HRQL is measured by the Parkinson's Disease Questionnaire-39 (PDQ-39). We calculated the PDQ-39 change between every two consecutive visits and generated binary outcomes using the threshold for clinically meaningful change (previously determined to be 1.6). We used chi-squared tests for discrete and t-test for continuous variables for baseline characteristic comparison between patient groups of interest. Generalized linear mixed models with repeated measures were used for identifying the predictors of whether PDQ-39 outcomes worsen over time.

RESULTS:

Of 8041 subjects enrolled, 5250 had at least one follow-up visit and were included in the analysis. Subjects were separated into two groups, "worse" and "not worse" based on PDQ-39 change >1.6 across consecutive visits. The "worse" group was more likely to be older (p = 0.001), to have motor fluctuations (p = 0.011), be on cognitive enhancers (p = 0.01), and to have more impaired immediate five-word recall (p = 0.04). The "non-worse" group was more likely to have rest tremor (p = 0.003), and to utilize social work/counseling (p = 0.046).

CONCLUSIONS:

The majority of predictors of worsening of HRQL are baseline disease and demographic characteristics that are difficult to modify. The positive effect of social service/counseling is intriguing and important to further explore in controlled interventional studies.

KEYWORDS:

Health-related quality of life; National Parkinson foundation quality improvement initiatives; PDQ-39; Parkinson's disease; Quality of life

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