Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach
Identifieur interne : 002454 ( Istex/Corpus ); précédent : 002453; suivant : 002455Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach
Auteurs : Franziska Maier ; Catharine J. Lewis ; Nina Horstkoetter ; Carsten Eggers ; Elke Kalbe ; Mohammad Maarouf ; Jens Kuhn ; Mateusz Zurowski ; Elena Moro ; Christiane Woopen ; Lars TimmermannSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2013-11.
Abstract
Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD). Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests. Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified. Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).
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DOI: 10.1136/jnnp-2012-303670
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Lewis</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Horstkoetter, Nina" sort="Horstkoetter, Nina" uniqKey="Horstkoetter N" first="Nina" last="Horstkoetter">Nina Horstkoetter</name><affiliation><mods:affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Eggers, Carsten" sort="Eggers, Carsten" uniqKey="Eggers C" first="Carsten" last="Eggers">Carsten Eggers</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kalbe, Elke" sort="Kalbe, Elke" uniqKey="Kalbe E" first="Elke" last="Kalbe">Elke Kalbe</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute for Gerontology, University of Vechta, Vechta, Germany</mods:affiliation></affiliation></author><author><name sortKey="Maarouf, Mohammad" sort="Maarouf, Mohammad" uniqKey="Maarouf M" first="Mohammad" last="Maarouf">Mohammad Maarouf</name><affiliation><mods:affiliation>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kuhn, Jens" sort="Kuhn, Jens" uniqKey="Kuhn J" first="Jens" last="Kuhn">Jens Kuhn</name><affiliation><mods:affiliation>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Zurowski, Mateusz" sort="Zurowski, Mateusz" uniqKey="Zurowski M" first="Mateusz" last="Zurowski">Mateusz Zurowski</name><affiliation><mods:affiliation>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Woopen, Christiane" sort="Woopen, Christiane" uniqKey="Woopen C" first="Christiane" last="Woopen">Christiane Woopen</name><affiliation><mods:affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Timmermann, Lars" sort="Timmermann, Lars" uniqKey="Timmermann L" first="Lars" last="Timmermann">Lars Timmermann</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:436610088435E9614BE05D633E7A803476F69355</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/jnnp-2012-303670</idno><idno type="url">https://api.istex.fr/document/436610088435E9614BE05D633E7A803476F69355/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002454</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002454</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title><author><name sortKey="Maier, Franziska" sort="Maier, Franziska" uniqKey="Maier F" first="Franziska" last="Maier">Franziska Maier</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Lewis, Catharine J" sort="Lewis, Catharine J" uniqKey="Lewis C" first="Catharine J" last="Lewis">Catharine J. Lewis</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Horstkoetter, Nina" sort="Horstkoetter, Nina" uniqKey="Horstkoetter N" first="Nina" last="Horstkoetter">Nina Horstkoetter</name><affiliation><mods:affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Eggers, Carsten" sort="Eggers, Carsten" uniqKey="Eggers C" first="Carsten" last="Eggers">Carsten Eggers</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kalbe, Elke" sort="Kalbe, Elke" uniqKey="Kalbe E" first="Elke" last="Kalbe">Elke Kalbe</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute for Gerontology, University of Vechta, Vechta, Germany</mods:affiliation></affiliation></author><author><name sortKey="Maarouf, Mohammad" sort="Maarouf, Mohammad" uniqKey="Maarouf M" first="Mohammad" last="Maarouf">Mohammad Maarouf</name><affiliation><mods:affiliation>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kuhn, Jens" sort="Kuhn, Jens" uniqKey="Kuhn J" first="Jens" last="Kuhn">Jens Kuhn</name><affiliation><mods:affiliation>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Zurowski, Mateusz" sort="Zurowski, Mateusz" uniqKey="Zurowski M" first="Mateusz" last="Zurowski">Mateusz Zurowski</name><affiliation><mods:affiliation>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Woopen, Christiane" sort="Woopen, Christiane" uniqKey="Woopen C" first="Christiane" last="Woopen">Christiane Woopen</name><affiliation><mods:affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Timmermann, Lars" sort="Timmermann, Lars" uniqKey="Timmermann L" first="Lars" last="Timmermann">Lars Timmermann</name><affiliation><mods:affiliation>Department of Neurology, University of Cologne, Cologne, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-11">2013-11</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1273">1273</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">436610088435E9614BE05D633E7A803476F69355</idno><idno type="DOI">10.1136/jnnp-2012-303670</idno><idno type="href">jnnp-84-1273.pdf</idno><idno type="ArticleID">jnnp-2012-303670</idno><idno type="PMID">23715910</idno><idno type="local">jnnp;84/11/1273</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD). Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests. Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified. Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Franziska Maier</name><affiliations><json:string>Department of Neurology, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Catharine J Lewis</name><affiliations><json:string>Department of Neurology, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Nina Horstkoetter</name><affiliations><json:string>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Carsten Eggers</name><affiliations><json:string>Department of Neurology, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Elke Kalbe</name><affiliations><json:string>Department of Neurology, University of Cologne, Cologne, Germany</json:string><json:string>Institute for Gerontology, University of Vechta, Vechta, Germany</json:string></affiliations></json:item><json:item><name>Mohammad Maarouf</name><affiliations><json:string>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Jens Kuhn</name><affiliations><json:string>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Mateusz Zurowski</name><affiliations><json:string>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Elena Moro</name><affiliations><json:string>Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Christiane Woopen</name><affiliations><json:string>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</json:string></affiliations></json:item><json:item><name>Lars Timmermann</name><affiliations><json:string>Department of Neurology, University of Cologne, Cologne, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>JNNP Patients' choice</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PARKINSON'S DISEASE</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>NEUROPSYCHIATRY</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>NEUROPSYCHOLOGY</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>QUALITY OF LIFE</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STEREOTAXIC SURGERY</value></json:item></subject><articleId><json:string>jnnp-2012-303670</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD). Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests. Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified. Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).</abstract><qualityIndicators><score>10</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>6</keywordCount><abstractCharCount>1968</abstractCharCount><pdfWordCount>5545</pdfWordCount><pdfCharCount>39719</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>252</abstractWordCount></qualityIndicators><title>Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title><pmid><json:string>23715910</json:string></pmid><refBibs><json:item><author><json:item><name>G Deuschl</name></json:item><json:item><name>C Schade-Brittinger</name></json:item><json:item><name>P Krack</name></json:item></author><host><volume>355</volume><pages><last>908</last><first>896</first></pages><author></author><title>N Engl J Med</title></host><title>A randomized trial of deep-brain stimulation for 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framework for outcome assessment in psychiatric DBS</title></json:item></refBibs><genre><json:string>research-article</json:string></genre><host><volume>84</volume><publisherId><json:string>jnnp</json:string></publisherId><pages><first>1273</first></pages><issn><json:string>0022-3050</json:string></issn><issue>11</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><categories><wos><json:string>social science</json:string><json:string>psychiatry</json:string><json:string>science</json:string><json:string>surgery</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>neurology & neurosurgery</json:string></scienceMetrix></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/jnnp-2012-303670</json:string></doi><id>436610088435E9614BE05D633E7A803476F69355</id><score>0.13863026</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/436610088435E9614BE05D633E7A803476F69355/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/436610088435E9614BE05D633E7A803476F69355/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/436610088435E9614BE05D633E7A803476F69355/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</p></availability><date>2013-05-28</date></publicationStmt><notesStmt><note>FM and CJL contributed equally.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title><author xml:id="author-1"><persName><forename type="first">Franziska</forename><surname>Maier</surname></persName><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-2"><persName><forename type="first">Catharine J</forename><surname>Lewis</surname></persName><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-3"><persName><forename type="first">Nina</forename><surname>Horstkoetter</surname></persName><affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-4"><persName><forename type="first">Carsten</forename><surname>Eggers</surname></persName><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-5"><persName><forename type="first">Elke</forename><surname>Kalbe</surname></persName><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><affiliation>Institute for Gerontology, University of Vechta, Vechta, Germany</affiliation></author><author xml:id="author-6"><persName><forename type="first">Mohammad</forename><surname>Maarouf</surname></persName><affiliation>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-7"><persName><forename type="first">Jens</forename><surname>Kuhn</surname></persName><affiliation>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-8"><persName><forename type="first">Mateusz</forename><surname>Zurowski</surname></persName><affiliation>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada</affiliation></author><author xml:id="author-9"><persName><forename type="first">Elena</forename><surname>Moro</surname></persName><affiliation>Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France</affiliation></author><author xml:id="author-10"><persName><forename type="first">Christiane</forename><surname>Woopen</surname></persName><affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</affiliation></author><author xml:id="author-11"><persName><forename type="first">Lars</forename><surname>Timmermann</surname></persName><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-11"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1273">1273</biblScope></imprint></monogr><idno type="istex">436610088435E9614BE05D633E7A803476F69355</idno><idno type="DOI">10.1136/jnnp-2012-303670</idno><idno type="href">jnnp-84-1273.pdf</idno><idno type="ArticleID">jnnp-2012-303670</idno><idno type="PMID">23715910</idno><idno type="local">jnnp;84/11/1273</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-05-28</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD). Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests. Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified. Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>JNNP Patients' choice</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>PARKINSON'S DISEASE</term></item><item><term>NEUROPSYCHIATRY</term></item><item><term>NEUROPSYCHOLOGY</term></item><item><term>QUALITY OF LIFE</term></item><item><term>STEREOTAXIC SURGERY</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-05-28">Created</change><change when="2013-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/436610088435E9614BE05D633E7A803476F69355/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-303670</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-303670</article-id><article-id pub-id-type="other">jnnp;84/11/1273</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-303670</article-id><article-id pub-id-type="pmid">23715910</article-id><article-id pub-id-type="other">1273</article-id><article-id pub-id-type="other">jnnp-2012-303670</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>JNNP Patients' choice</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Maier</surname><given-names>Franziska</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lewis</surname><given-names>Catharine J</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Horstkoetter</surname><given-names>Nina</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Eggers</surname><given-names>Carsten</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kalbe</surname><given-names>Elke</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Maarouf</surname><given-names>Mohammad</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Kuhn</surname><given-names>Jens</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Zurowski</surname><given-names>Mateusz</given-names></name><xref ref-type="aff" rid="af6">6</xref></contrib><contrib contrib-type="author"><name><surname>Moro</surname><given-names>Elena</given-names></name><xref ref-type="aff" rid="af7">7</xref></contrib><contrib contrib-type="author"><name><surname>Woopen</surname><given-names>Christiane</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Timmermann</surname><given-names>Lars</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Neurology</addr-line>, <institution>University of Cologne</institution>, <addr-line>Cologne</addr-line>, <country>Germany</country></aff><aff id="af2"><label>2</label><addr-line>Research Unit Ethics</addr-line>, <institution>Institute for the History of Medicine and Medical Ethics, University of Cologne</institution>, <addr-line>Cologne</addr-line>, <country>Germany</country></aff><aff id="af3"><label>3</label><institution>Institute for Gerontology, University of Vechta</institution>, <addr-line>Vechta</addr-line>, <country>Germany</country></aff><aff id="af4"><label>4</label><addr-line>Department of Stereotaxy and Functional Neurosurgery</addr-line>, <institution>University of Cologne</institution>, <addr-line>Cologne</addr-line>, <country>Germany</country></aff><aff id="af5"><label>5</label><addr-line>Department of Psychiatry and Psychotherapy</addr-line>, <institution>University of Cologne</institution>, <addr-line>Cologne</addr-line>, <country>Germany</country></aff><aff id="af6"><label>6</label><addr-line>Department of Psychiatry, Department of Medicine</addr-line>, <institution>University of Toronto, University Health Network</institution>, <addr-line>Toronto, Ontario</addr-line>, <country>Canada</country></aff><aff id="af7"><label>7</label><addr-line>Movement Disorders Unit, Department of Psychiatry and Neurology</addr-line>, <institution>University Hospital Center (CHU) of Grenoble</institution>, <addr-line>Grenoble</addr-line>, <country>France</country></aff><author-notes><corresp><label>Correspondence to</label> Franziska Maier, Department of Neurology, University Hospital Cologne, Kerpener Str. 62, Cologne D-50937, Germany; <email>franziska.maier@uk-koeln.de</email></corresp><fn><p>FM and CJL contributed equally.</p></fn></author-notes><pub-date pub-type="ppub"><month>11</month><year>2013</year></pub-date><pub-date pub-type="epub-original"><day>28</day><month>5</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>28</day><month>5</month><year>2013</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>11</issue><issue-id pub-id-type="other">jnnp;84/11</issue-id><issue-id pub-id-type="other">11</issue-id><issue-id pub-id-type="other">84/11</issue-id><fpage>1273</fpage><history><date date-type="received"><day>13</day><month>7</month><year>2012</year></date><date date-type="rev-recd"><day>2</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>1</day><month>5</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-84-1273.pdf"></self-uri><abstract><sec><title>Objective</title><p>To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD).</p></sec><sec><title>Methods</title><p>PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests.</p></sec><sec><title>Results</title><p>Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified.</p></sec><sec><title>Conclusions</title><p>The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).</p></sec></abstract><kwd-group><kwd>PARKINSON'S DISEASE</kwd><kwd>NEUROPSYCHIATRY</kwd><kwd>NEUROPSYCHOLOGY</kwd><kwd>QUALITY OF LIFE</kwd><kwd>STEREOTAXIC SURGERY</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title><partName>Research paper</partName></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach</title><partName>Research paper</partName></titleInfo><name type="personal"><namePart type="given">Franziska</namePart><namePart type="family">Maier</namePart><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Catharine J</namePart><namePart type="family">Lewis</namePart><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nina</namePart><namePart type="family">Horstkoetter</namePart><affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carsten</namePart><namePart type="family">Eggers</namePart><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elke</namePart><namePart type="family">Kalbe</namePart><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><affiliation>Institute for Gerontology, University of Vechta, Vechta, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mohammad</namePart><namePart type="family">Maarouf</namePart><affiliation>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jens</namePart><namePart type="family">Kuhn</namePart><affiliation>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mateusz</namePart><namePart type="family">Zurowski</namePart><affiliation>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elena</namePart><namePart type="family">Moro</namePart><affiliation>Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Christiane</namePart><namePart type="family">Woopen</namePart><affiliation>Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lars</namePart><namePart type="family">Timmermann</namePart><affiliation>Department of Neurology, University of Cologne, Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>JNNP Patients' choice</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-11</dateIssued><dateCreated encoding="w3cdtf">2013-05-28</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD). Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests. Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified. Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).</abstract><note type="footnotes">FM and CJL contributed equally.</note><subject><genre>keywords</genre><topic>PARKINSON'S DISEASE</topic><topic>NEUROPSYCHIATRY</topic><topic>NEUROPSYCHOLOGY</topic><topic>QUALITY OF LIFE</topic><topic>STEREOTAXIC SURGERY</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>11</number></detail><extent unit="pages"><start>1273</start></extent></part></relatedItem><identifier type="istex">436610088435E9614BE05D633E7A803476F69355</identifier><identifier type="DOI">10.1136/jnnp-2012-303670</identifier><identifier type="href">jnnp-84-1273.pdf</identifier><identifier type="ArticleID">jnnp-2012-303670</identifier><identifier type="PMID">23715910</identifier><identifier type="local">jnnp;84/11/1273</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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