Caregiver strain in Parkinson's disease: National Parkinson Foundation Quality Initiative Study
Caregiver strain in Parkinson's disease: National Parkinson Foundation Quality Initiative Study
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DOI：
10.1016/j.parkreldis.2013.06.015
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发表时间：
2013-11-01
影响因子：
4.1
通讯作者：
Simuni, T.
中科院分区：
文献类型：
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作者：
Oguh, O.;Kwasny, M.;Simuni, T.
背景：国家帕金森基金会质量改进倡议(NPF-QII)是帕金森病(PD)中第一个大规模的数据驱动倡议，旨在确定预测最佳护理模式和结果的变量。目的：探讨帕金森病患者照顾者的心理压力与帕金森病患者残疾程度、人口统计学和患者生活质量的关系。数据集包括疾病严重程度、卫生保健利用、PD生活质量问卷-39(PDQ-39)和多维照顾者压力问卷(MCSI)的多维测量。结果：与高照顾者压力相关的单一最佳因素是pdq-39总分(连续变量的c统计量=0.792，p<；0.001)，其次是pdq-活动性分分数(c=0.776，p<；0.001)。PDQ-39>；=47是与高照顾者菌株相关的最佳分界值，其敏感度=83%，特异度=%。逐步选择的多元Logistic回归模型显示，除了PDQ-39&>=47(OR和95%可信区间=5.13.2，8.2%)外，下列受试者特征与高照顾者压力有关：(模型P<；0.001，c=0.838)：Hoehn和Yahr分期>；3(2.0(1.3，3.1))，有抗抑郁药物(2.1(1.5，3.1))和抗精神病药物(2.5(1.5，4.2))，社会工作者来访(1.6(1.2，2.1))，男性(2.3(1.5，3.5))，言语流畅性差(0.95(0.92，0.98))。PDQ-39总分与高水平的照顾者压力有最强的相关性。这些结果可以指导临床医生对处于危险中的照顾者进行评估。(C)2013爱思唯尔有限公司。保留所有权利，
Background: National Parkinson Foundation Quality Improvement Initiatives (NPF-QII) is the first large scale data-driven initiative in Parkinson's disease (PD) aimed at identifying variables predicting best care models and outcomes. Objective: To determine what measures of PD disability, demographics, and patient quality of life are associated with caregiver strain among caregivers of patients with PD.Methods: All PD patients at 18 participating sites are eligible for enrollment into the NPF-QII registry. Dataset includes multidimensional measures of disease severity, health care utilization, PD quality of life questionnaire-39 (PDQ-39) and multidimensional caregiver strain inventory (MCSI). A univariate as well as an adjusted analysis was performed to examine the relationship between caregiver strain and variables of PD disability.Results: The single best factor associated with high caregiver strain was the PDQ-39 total score (c-statistic of continuous variable = 0.792, p < 0.001) followed by the PDQ-mobility subscore (c = 0.776, p < 0.001). PDQ-39 >= 47 was the optimal cut off associated with a high caregiver strain with a sensitivity = 83% and specificity = 64%. A multiple logistic regression model with stepwise selection showed that in addition to PDQ-39 >= 47 (OR and 95% confidence interval = 5.1 (3.2, 8.2), the following subject characteristics were associated with high caregiver strain: (model p < 0.001, c = 0.838): Hoehn and Yahr stage > 3 (2.0 (1.3, 3.1)), presence of concomitant medications such as antidepressants (2.1 (1.5, 3.1)) and antipsychotics (2.5 (1.5, 4.2)), social worker visits (1.6 (1.2, 2.1)), male gender (2.3 (1.5, 3.5)), and decreased verbal fluency (0.95 (0.92, 0.98)).Conclusions: There is a high prevalence of caregiver strain in PD. PDQ-39 total score has the strongest association with high levels of caregiver strain. These results could guide clinicians in the assessment of caregivers at risk. (C) 2013 Elsevier Ltd. All rights reserved,