Participant characteristics.

<p>Data reflect means (standard deviation between brackets). N; number of subjects, NS; not significant, UPDRS; Unified Parkinson’s Disease Rating Scale, L: Left side most affected H&Y Hoehn & Yahr, FAB; Frontal Assessment Battery. NFoG-Q; new freezing of gait questionnaire.</p>†<p>Mann-Whitney U test.</p><p>Patients were assessed during the OFF state. There were no significant differences between patients and controls, or between freezers and non-freezers.</p

Experimental set-up.

<p>Participants stood on the dual forceplate (A), with their arms crossed over their chest, embedded in the movable platform (B). Two independent perturbations in the forward-backward direction were applied simultaneously using both the movable platform (B) and the pusher (C). Interaction forces between the pusher (C) and the participant were measured with a force sensor (D). Actual falls were prevented by the safety harness (E), which did not provide any support or directional cues. Reflective spherical markers (F) measured movements of the participant.</p

Timeseries and powerspectrum of the two perturbation signals.

<p>The left panels represent the platform perturbation; the right panels the pusher perturbation.</p

Clinical asymmetry, weight-bearing and balance-control contribution of the left (lower bar) and right leg (upper bar) of the individual PD patients.

<p>The absolute and relative value and the most affected side of the clinical asymmetry is shown above the bar graphs. The upper panel indicates the dynamical weight bearing (DWB), the middle panel the dynamic-balance contribution of the ankle joint (DBC_Ank), and the lower panel is of the hip joint (DBC_Hip). The group is separated in non-freezers (the first 11 patients, indicated by the solid bars) and freezers (patient 12 through 20, indicated by the dashed bars). There were no significant differences in asymmetry of WB, DBC_Ank nor DBC_Hip between non-freezers and freezers. The dashed line indicate the 99-percent confidence intervals of the healthy controls for the WB, DBC_Ank, and DBC_Hip. The asterisk (*) denotes balance contributions outside the respective confidence intervals. For WB, 14 patients were outside the 99 percent CI. This number increased to 15 considering DBC_Ank and to 16 for DBC_Hip. ns = not significant. The clinically most affected side coincided in most cases with weight-bearing and balance-control asymmetry. However, there were no significant correlations between clinical asymmetry and balance asymmetry (WB, p = 0.32; DBC_Ank, p = 0.37 and DBC_Hip, p = 0.75).</p

Comparison of clinical outcome measures between patients with (ASYM) and without (SYM) asymmetrical weight bearing or asymmetric balance control, based on the 99 percent CI of weight bearing, the ankle joint or the hip joint contributions of the healthy controls.

<p>Data reflect means with the standard deviation (between brackets). N, number of subjects, UPDRS Unified Parkinson’s Disease Rating Scale; H&Y Hoehn & Yahr; PIGD; Postural Instability and Gait Difficulty; TMT; Ten Meter walk Test, TUG; Timed-Up-and-go-Test; ASYM = asymmetrical patients. SYM = symmetrical patients.</p><p>Due the small sample we used non-parametric tests (Mann Whitney U test) or χ2 tests indicated with (∼).</p><p><i>p</i> values are not corrected for multiple comparisons, but the significance level reduced 0.005 due to Bonferoni correction.</p><p>There were no significant differences in clinical outcome measures between patients with and without asymmetrical weight bearing or balance control.</p

Involving Patients in Weighting Benefits and Harms of Treatment in Parkinson's Disease

<div><p>Introduction</p><p>Little is known about how patients weigh benefits and harms of available treatments for Parkinson’s Disease (oral medication, deep brain stimulation, infusion therapy). In this study we have (1) elicited patient preferences for benefits, side effects and process characteristics of treatments and (2) measured patients’ preferred and perceived involvement in decision-making about treatment.</p><p>Methods</p><p>Preferences were elicited using a best-worst scaling case 2 experiment. Attributes were selected based on 18 patient-interviews: treatment modality, tremor, slowness of movement, posture and balance problems, drowsiness, dizziness, and dyskinesia. Subsequently, a questionnaire was distributed in which patients were asked to indicate the most and least desirable attribute in nine possible treatment scenarios. Conditional logistic analysis and latent class analysis were used to estimate preference weights and identify subgroups. Patients also indicated their preferred and perceived degree of involvement in treatment decision-making (ranging from active to collaborative to passive).</p><p>Results</p><p>Two preference patterns were found in the patient sample (N = 192). One class of patients focused largely on optimising the process of care, while the other class focused more on controlling motor-symptoms. Patients who had experienced advanced treatments, had a shorter disease duration, or were still employed were more likely to belong to the latter class. For both classes, the benefits of treatment were more influential than the described side effects. Furthermore, many patients (45%) preferred to take the lead in treatment decisions, however 10.8% perceived a more passive or collaborative role instead.</p><p>Discussion</p><p>Patients weighted the benefits and side effects of treatment differently, indicating there is no “one-size-fits-all” approach to choosing treatments. Moreover, many patients preferred an active role in decision-making about treatment. Both results stress the need for physicians to know what is important to patients and to share treatment decisions to ensure that patients receive the treatment that aligns with their preferences.</p></div

Background, socio-demographic and clinical characteristics (N = 229).

<p>Background, socio-demographic and clinical characteristics (N = 229).</p

Treatment desirability in Parkinson’s Disease based on conditional logit analysis and latent class analysis (N = 192).

<p>Treatment desirability in Parkinson’s Disease based on conditional logit analysis and latent class analysis (N = 192).</p

Questions and answer-categories used to assess patient’s preferred and perceived decision role in treatment decision making.

<p>Questions and answer-categories used to assess patient’s preferred and perceived decision role in treatment decision making.</p

Importance weights of the attributes estimated from the conditional logit analysis and latent class analysis.

<p>Importance weights of the attributes estimated from the conditional logit analysis and latent class analysis.</p