Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach
Identifieur interne : 000005 ( Main/Exploration ); précédent : 000004; suivant : 000006Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach
Auteurs : Franziska Maier [Allemagne] ; Catharine J. Lewis [Allemagne] ; Nina Horstkoetter [Allemagne] ; Carsten Eggers [Allemagne] ; Elke Kalbe [Allemagne] ; Mohammad Maarouf [Allemagne] ; Jens Kuhn [Allemagne] ; Mateusz Zurowski [Canada] ; Elena Moro [France] ; Christiane Woopen [Allemagne] ; Lars Timmermann [Allemagne]Source :
- 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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xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne</wicri:regionArea><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Cologne</wicri:noRegion></affiliation></author><author><name sortKey="Kuhn, Jens" sort="Kuhn, Jens" uniqKey="Kuhn J" first="Jens" last="Kuhn">Jens Kuhn</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Cologne, Cologne</wicri:regionArea><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Cologne</wicri:noRegion></affiliation></author><author><name sortKey="Zurowski, Mateusz" sort="Zurowski, Mateusz" uniqKey="Zurowski M" first="Mateusz" last="Zurowski">Mateusz Zurowski</name><affiliation wicri:level="4"><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, 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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><affiliations><list><country><li>Allemagne</li><li>Canada</li><li>France</li></country><region><li>Ontario</li></region><settlement><li>Grenoble</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Allemagne"><noRegion><name sortKey="Maier, Franziska" sort="Maier, Franziska" uniqKey="Maier F" first="Franziska" last="Maier">Franziska Maier</name></noRegion><name sortKey="Eggers, Carsten" sort="Eggers, Carsten" uniqKey="Eggers C" first="Carsten" last="Eggers">Carsten Eggers</name><name sortKey="Horstkoetter, Nina" sort="Horstkoetter, Nina" uniqKey="Horstkoetter N" first="Nina" last="Horstkoetter">Nina Horstkoetter</name><name sortKey="Kalbe, Elke" sort="Kalbe, Elke" uniqKey="Kalbe E" first="Elke" last="Kalbe">Elke Kalbe</name><name sortKey="Kalbe, Elke" sort="Kalbe, Elke" uniqKey="Kalbe E" first="Elke" last="Kalbe">Elke Kalbe</name><name sortKey="Kuhn, Jens" sort="Kuhn, Jens" uniqKey="Kuhn J" first="Jens" last="Kuhn">Jens Kuhn</name><name sortKey="Lewis, Catharine J" sort="Lewis, Catharine J" uniqKey="Lewis C" first="Catharine J" last="Lewis">Catharine J. Lewis</name><name sortKey="Maarouf, Mohammad" sort="Maarouf, Mohammad" uniqKey="Maarouf M" first="Mohammad" last="Maarouf">Mohammad Maarouf</name><name sortKey="Timmermann, Lars" sort="Timmermann, Lars" uniqKey="Timmermann L" first="Lars" last="Timmermann">Lars Timmermann</name><name sortKey="Woopen, Christiane" sort="Woopen, Christiane" uniqKey="Woopen C" first="Christiane" last="Woopen">Christiane Woopen</name></country><country name="Canada"><region name="Ontario"><name sortKey="Zurowski, Mateusz" sort="Zurowski, Mateusz" uniqKey="Zurowski M" first="Mateusz" last="Zurowski">Mateusz Zurowski</name></region></country><country name="France"><noRegion><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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