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Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data

Rafferty, Miriam R; Schmidt, Peter N; Luo, Sheng T; Li, Kan; Marras, Connie; Davis, Thomas L; Guttman, Mark; Cubillos, Fernando; Simuni, Tanya
BACKGROUND:Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson's disease (PD). OBJECTIVE:To examine whether exercise habits were associated with changes in HRQL and mobility over two years. METHODS:We identified a cohort of National Parkinson Foundation Quality Improvement Initiative (NPF-QII) participants with three visits. HRQL and mobility were measured with the Parkinson's Disease Questionnaire (PDQ-39) and Timed Up and Go (TUG). We compared self-reported regular exercisers (≥2.5 hours/week) with people who did not exercise 2.5 hours/week. Then we quantified changes in HRQL and mobility associated with 30-minute increases in exercise, across PD severity, using mixed effects regression models. RESULTS:Participants with three observational study visits (n = 3408) were younger, with milder PD, than participants with fewer visits. After 2 years, consistent exercisers and people who started to exercise regularly after their baseline visit had smaller declines in HRQL and mobility than non-exercisers (p < 0.05). Non-exercisers worsened by 1.37 points on the PDQ-39 and a 0.47 seconds on the TUG per year. Increasing exercise by 30 minutes/week was associated with slower declines in HRQL (-0.16 points) and mobility (-0.04 sec). The benefit of exercise on HRQL was greater in advanced PD (-0.41 points) than mild PD (-0.14 points; p < 0.02). CONCLUSIONS:Consistently exercising and starting regular exercise after baseline were associated with small but significant positive effects on HRQL and mobility changes over two years. The greater association of exercise with HRQL in advanced PD supports improving encouragement and facilitation of exercise in advanced PD.
PMID: 27858719
ISSN: 1877-718x
CID: 3123742

Hospital care for mental health and substance abuse conditions in Parkinson's disease

Willis, Allison W; Thibault, Dylan P; Schmidt, Peter N; Dorsey, E Ray; Weintraub, Daniel
OBJECTIVE:The objective of this study was to examine mental health conditions among hospitalized individuals with Parkinson's disease in the United States. METHODS:This was a serial cross-sectional study of hospitalizations of individuals aged ≥60 identified in the Nationwide Inpatient Sample dataset from 2000 to 2010. We identified all hospitalizations with a diagnosis of PD, alcohol abuse, anxiety, bipolar disorder, depression, impulse control disorders, mania, psychosis, substance abuse, and attempted suicide/suicidal ideation. National estimates of each mental health condition were compared between hospitalized individuals with and without PD. Hierarchical logistic regression models determined which inpatient mental health diagnoses were associated with PD, adjusting for demographic, payer, geographic, and hospital characteristics. RESULTS:We identified 3,918,703 mental health and substance abuse hospitalizations. Of these, 2.8% (n = 104, 437) involved a person also diagnosed with PD. The majority of mental health and substance abuse patients were white (86.9% of PD vs 83.3% of non-PD). Women were more common than men in both groups (male:female prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34), psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse control disorders (adjusted odds ratio 1.51, 1.31-1.75), and mania (adjusted odds ratio 1.43, 1.18-1.74) were more likely among PD patients, alcohol abuse was less likely (adjusted odds ratio 0.26, 0.25-0.27). We found no PD-associated difference in suicide-related care. CONCLUSIONS:PD patients have unique patterns of acute care for mental health and substance abuse. Research is needed to guide PD treatment in individuals with pre-existing psychiatric illnesses, determine cross provider reliability of psychiatric diagnoses in PD patients, and inform efforts to improve psychiatric outcomes. © 2016 International Parkinson and Movement Disorder Society.
PMID: 27943472
ISSN: 1531-8257
CID: 3123752

National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers

Dorsey, E Ray; Achey, Meredith A; Beck, Christopher A; Beran, Denise B; Biglan, Kevin M; Boyd, Cynthia M; Schmidt, Peter N; Simone, Richard; Willis, Allison W; Galifianakis, Nicholas B; Katz, Maya; Tanner, Caroline M; Dodenhoff, Kristen; Ziman, Nathan; Aldred, Jason; Carter, Julie; Jimenez-Shahed, Joohi; Hunter, Christine; Spindler, Meredith; Mari, Zoltan; Morgan, John C; McLane, Dedi; Hickey, Patrick; Gauger, Lisa; Richard, Irene Hegeman; Bull, Michael T; Mejia, Nicte I; Bwala, Grace; Nance, Martha; Shih, Ludy; Anderson, Lauren; Singer, Carlos; Zadikoff, Cindy; Okon, Natalia; Feigin, Andrew; Ayan, Jean; Vaughan, Christina; Pahwa, Rajesh; Cooper, Jessica; Webb, Sydney; Dhall, Rohit; Hassan, Anhar; Weis, Delana; DeMello, Steven; Riggare, Sara S; Wicks, Paul; Smith, Joseph; Keenan, H Tait; Korn, Ryan; Schwarz, Heidi; Sharma, Saloni; Stevenson, E Anna; Zhu, William
BACKGROUND:Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. MATERIALS AND METHODS:Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. RESULTS:During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. CONCLUSIONS:Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.
PMID: 26886406
ISSN: 1556-3669
CID: 3123732

Erratum To: Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial [Correction]

Achey, Meredith A; Beck, Christopher A; Beran, Denise B; Boyd, Cynthia M; Schmidt, Peter N; Willis, Allison W; Riggare, Sara S; Simone, Richard B; Biglan, Kevin M; Dorsey, E Ray
PMID: 26733455
ISSN: 1745-6215
CID: 3123722

From local partnership to national network: The growth of a medically connected, community based Parkinson's wellness program model [Meeting Abstract]

Lemen, A; Schmidt, P; Hagestuen, R; Edelson, V; Sweeney, M; Di, Rocco A
Objective: To increase the scale of a medical and community partnership model for the delivery of comprehensive Parkinson's Wellness programming. Background: In 2007, the Fresco Institute for Parkinson's and Movement Disorders at NYU Langone Medical Center launched a novel initiative with Jewish Community Center Manhattan to develop a comprehensive wellness program model designed specifically for the needs of individuals, care partners and families living with Parkinson's disease (PD). The program has been in high demand since its inception and has proven popular with patients, families and providers. Methods: An interdisciplinary team of medical and community professionals was formed to expand the scale of the program nationally. Top PD specialized clinics and high capacity Jewish Community Centers from around the USA were selected and evaluated for participation in program expansion. Multidisciplinary teams comprised of medical and community professionals from the selected locations participated in program training in New York. The program model is comprised of three group-based components- exercise, support, and education-designed to provide proactive tools to enhance well-being, improve quality of life and complement specialized medical care. These tools are provided within a PD educated, community hub with collaborative support from an expert PD clinic. The benefits of exercise and support are well established in Parkinson's disease and have been previously described. Results: The New York program was adapted first in Boston, MA, and in Rockville, MD, followed by Tampa, FL, and Chicago, IL, in partnership with an expert PD clinic and Jewish Community Center in each location. Enrollment, satisfaction with the program, and impact on social domains of the patients' and caregivers' quality of life are being tracked. Sufficient data on enrollment and impact of the programs are not yet available, but initial feedback is positive. Discussion: The program model offers multiple domains of potential benefit in the areas of physical and psychosocial health for patients, care partners and families. Preliminary data suggests that the program model is effective in fostering motivation for participation in programs that aid in physical and psychosocial adaptation to PD. Potential further study and expansion of the program is being considered. This poster will demonstrate in graphics and narrative the development and growth of this program model
ISSN: 1877-718x
CID: 3194192

What Engineering Technology Could Do for Quality of Life in Parkinson's Disease: A Review of Current Needs and Opportunities

Stamford, Jonathan A; Schmidt, Peter N; Friedl, Karl E
Parkinson's disease (PD) involves well-known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait, but there are also nonlocomotory motor symptoms (e.g., changes in handwriting and speech) and even nonmotor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity-based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring and also provide information that could be shared with a healthcare provider to help better manage treatment. Until recently, nonmotor symptoms ("soft signs") had been generally overlooked in clinical management, yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits make better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self-correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease-related challenges are examples of other near-term technology solutions to PD problems. Ultimately, a sensor technology is not good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near-term gratifying benefits.
PMID: 26259205
ISSN: 2168-2208
CID: 3123712

Initiating Regular Exercise is Associated with Slower Quality of Life Decline in Parkinson's Disease (National Parkinson Foundation Quality Improvement Initiative Data) [Meeting Abstract]

Rafferty, Miriam R.; Schmidt, Peter N.; Cubillos, Fernando; Marras, Connie; Guttman, Mark; Nelson, Eugene C.; Simuni, Tanya
ISSN: 0364-5134
CID: 3123792

Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial

Achey, Meredith A; Beck, Christopher A; Beran, Denise B; Boyd, Cynthia M; Schmidt, Peter N; Willis, Allison W; Riggare, Sara S; Simone, Richard B; Biglan, Kevin M; Dorsey, E Ray
BACKGROUND:Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. METHODS/DESIGN/METHODS:We are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely.The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson's Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden. DISCUSSION/CONCLUSIONS:Connect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a model for increasing access and delivering patient-centered care at home for individuals with chronic conditions. TRIAL REGISTRATION/BACKGROUND:This trial was registered on on January 8, 2014 [NCT02038959].
PMID: 25431346
ISSN: 1745-6215
CID: 3123702

Recognition and treatment of depressive symptoms in Parkinson's disease: the NPF dataset

Bega, Danny; Wu, Sam S; Pei, Qinglin; Schmidt, Peter N; Simuni, Tanya
Depression is a major determinant of Health Related Quality of Life in PD, but there is limited data on physician recognition of depression and treatment efficacy. We used data obtained from the QII dataset of the National Parkinson's Foundation database to determine whether there was an association between depressive symptoms and utilization of antidepressants and/or mental health services (MHS) in a large cohort of PD patients. We found that prevalence of depressive symptoms remained high in the PD population despite improved physician recognition and treatment initiation.
PMID: 25035310
ISSN: 1877-718x
CID: 3123692