Moving Mindfully: A MBSR-Centered Approach to Freezing in Parkinson Disease

摘要 这一规划赠款申请是对由国家补充和综合健康中心(NCCIH)赞助的R34资助机会的回应，题为NCCIH高优先级研究主题的心理和身体干预可行性临床试验，PAR-18-417。在这里，我们将修改和评估正念干预在患有帕金森病(PD)和步态冻结(FOG)的患者中的可行性。雾是一种严重的运动障碍，会阻碍人们正常行走，并与焦虑、沮丧、久坐不动、生活质量下降和摔倒有关。基于正念的减压(MBSR)是一种基于证据的实践，它创造了一种文化，通过增加意识和自我同情来减少压力和焦虑。在这项研究中，我们建议开发一种基于正念的步行干预，以解决构成雾的心理健康和行动挑战。 该R34包括三个目标，以允许在帕金森病患者中开发一种针对雾的身心方法。在目标1中，我们将组成一个由研究团队成员、物理治疗师、正念导师和患者利益相关者组成的咨询小组。该咨询小组将对目前的MBSR计划进行调整，以开发和提供一种以正念为基础的治疗方法，强调步行冥想，对患有帕金森病和雾气的人来说是安全和适用的。在目标2中，我们开始试点修改后的项目，基于正念的步行疗法(MBWT)。MBWT将根据讲师和学员的反馈进行修改。AIM 2的最终结果将是一个标准化的MBWT计划。在目标3中，我们将在个人随机分组治疗试验中试行标准化的MBWT计划。经历雾的人将被随机分配到接受MBWT或常规护理。常规护理将包括有关冻结步态的医疗管理和教育。将在目标2和目标3期间收集符合有关招募、随机化、保留、满意度、实施干预措施、遵守情况和结果负担等基准的可行性参数。

ABSTRACT This planning grant application is in response to the R34 funding opportunity sponsored by the National Center for Complementary and Integrative Health (NCCIH) titled Feasibility Clinical Trials of Mind and Body Interventions for NCCIH High Priority Research Topics, PAR-18-417. Here we will modify and evaluate the feasibility of a mindfulness intervention among people living with Parkinson disease (PD) and freezing of gait (FOG). FOG is a severe motor disturbance that prevents people from stepping normally and is associated with anxiety, frustration, sedentary behaviors, poorer quality of life, and falls. Mindfulness-Based Stress Reduction (MBSR) is an evidence-based practice that creates a culture to reduce stress and anxiety by increasing conscious awareness and self-compassion. In this study, we propose developing a mindfulness-based walking intervention to address both mental health and mobility challenges that constitute FOG. This R34 includes three aims to permit the development of a mind and body approach for FOG among people living with PD. In Aim 1 we will form an advisory group of study team members, physical therapists, mindfulness instructors, and patient stakeholders. The advisory group will adapt the current MBSR Program to develop and deliver a mindfulness-based treatment that emphasizes walking meditations and is safe and applicable for people living with PD and FOG. In Aim 2 we open pilot the modified program, Mindfulness-Based Walking Therapy (MBWT). MBWT will be modified per feedback from instructors and participants. The end result of Aim 2 will be a standardized MBWT program. In Aim 3 we will pilot the standardized MBWT program in an individually randomized group treatment trial. People who experience FOG will be randomized to receive MBWT or usual care. Usual care will include medical management and education regarding freezing of gait. Feasibility parameters to meet benchmarks regarding recruitment, randomization, retention, satisfaction, delivery of intervention, adherence, and burden of outcomes will be collected during both Aim 2 and Aim 3.