Which features of postural sway are effective in distinguishing Parkinson's disease from controls? A systematic review

Background Postural sway may be useful as an objective measure of Parkinson's disease (PD). Existing studies have analyzed many different features of sway using different experimental paradigms. We aimed to determine what features have been used to measure sway and then to assess which feature(s) best differentiate PD patients from controls. We also aimed to determine whether any refinements might improve discriminative power and so assist in standardizing experimental conditions and analysis of data.Methods In this systematic review of the literature, effect size (ES) was calculated for every feature reported by each article and then collapsed across articles where appropriate. The influence of clinical medication status, visual state, and sampling rate on ES was also assessed.Results Four hundred and forty-three papers were retrieved. 25 contained enough information for further analysis. The most commonly used features were not the most effective (e.g., PathLength, used 14 times, had ES of 0.47, while TotalEnergy, used only once, had ES of 1.78). Increased sampling rate was associated with increased ES (PathLength ES increased to 1.12 at 100 Hz from 0.40 at 10 Hz). Measurement during "OFF" clinical status was associated with increased ES (PathLength ES was 0.83 OFF compared to 0.21 ON).Conclusions This review identified promising features for analysis of postural sway in PD, recommending a sampling rate of 100 Hz and studying patients when OFF to maximize ES. ES complements statistical significance as it is clinically relevant and is easily compared across experiments. We suggest that machine learning is a promising tool for the future analysis of postural sway in PD

Self-Management: Parkinson’s as a Chronic Condition

Setting Parkinson’s is cited as a chronic disease which is a “disease… of long duration and generally slow progression”. The burden of chronic, neurodegenerative diseases, including Parkinson’s, is a growing problem worldwide, and it is necessary to find ways to support People Living with Parkinson’s (PlwP) and their carers world-wide. Objective This poster presents the results of a systematic review of the existing literature relating to selfmanagement in PlwP. Methods The Cochrane Database of Systematic Reviews, PsycINFO, CINAHL and Embase were used to identify evidence such as randomised controlled trials and original literature, as well as evidence-based guidelines, evidence-based review articles and meta-analysis relevant to the topics reviewed. 3532 studies were found in total, of which 49 were appropriate for review. Selection was based on quality of evidence and relevance to the topic (table 1). Five studies were judged as meeting the inclusion criteria and included in the initial review. Data was extracted, summarised, coded and critiqued. Findings Five studies provided evidence related to the effectiveness of self-management. Four of the studies demonstrated beneficial impact but one study showed negative impact, namely worsening in fatigue scores. Emerging Themes Experience of illness: Three areas emerged from the evidence as particularly impacting on selfmanagement. Pain and fatigue was an area that was improved by CDSMP involvement. Deterioration and acceptance of loss of physical and mental function was a large issue for people living with the fluctuating nature of the disorder. Depression was positively impacted by the CDSMP, with increased sense of self-efficacy and reduced stress levels. Ways of coping: Relaxation was a key theme throughout the literature, which responded positively to mindfulness exercises. Self-tailoring was shown to be highly beneficial to participants, and was a particular focus for the young onset PlwP. Use of Health Services: Many of the studies found no impact on health service use, with only one finding any reduction in emergency room visits. It was noted that the participants had appropriate use of health services at baseline but developed better collaborative relationships with their healthcare teams. Self Efficacy: Self-efficacy was measured in the majority of studies and found to be worthwhile in most, with benefits sustained for one year. Overall Self-management improves self-efficacy, despite the progressive, fluctuating nature of Parkinson’s. It is limited by the health systems in which it is attempted, requiring a collaborative, flexible approach from Health Professionals. In the medical model, this becomes a source of frustration and conflict. Additionally, younger PlwP seem to have a higher desire to engage in self-management and collaborative medicine, requiring increased access and responsiveness from the services they are engaged with, a flexibility that is not possible in the current model of care. Conclusion Self-management is a valuable tool in the overall management for PlwP. Self-management also requires that the health system be accessible, reactive and collaborative, rather than a medical model system focussed on acute issues, and that healthcare professionals acknowledge the PlwP as someone knowledgeable about their condition and able to play an expert role in their own care. Many healthcare professionals would require support and education around this manner of working. A Parkinson's Disease Nurse Specialist is wellplaced to oversee and contribute a supervisory role for healthcare staff and PlwP as an element of a larger overall service for people living with the conditio

Self-Management: Parkinson’s as a Chronic Condition

Setting Parkinson’s is cited as a chronic disease which is a “disease… of long duration and generally slow progression”. The burden of chronic, neurodegenerative diseases, including Parkinson’s, is a growing problem worldwide, and it is necessary to find ways to support People Living with Parkinson’s (PlwP) and their carers world-wide. Objective This poster presents the results of a systematic review of the existing literature relating to selfmanagement in PlwP. Methods The Cochrane Database of Systematic Reviews, PsycINFO, CINAHL and Embase were used to identify evidence such as randomised controlled trials and original literature, as well as evidence-based guidelines, evidence-based review articles and meta-analysis relevant to the topics reviewed. 3532 studies were found in total, of which 49 were appropriate for review. Selection was based on quality of evidence and relevance to the topic (table 1). Five studies were judged as meeting the inclusion criteria and included in the initial review. Data was extracted, summarised, coded and critiqued. Findings Five studies provided evidence related to the effectiveness of self-management. Four of the studies demonstrated beneficial impact but one study showed negative impact, namely worsening in fatigue scores. Emerging Themes Experience of illness: Three areas emerged from the evidence as particularly impacting on selfmanagement. Pain and fatigue was an area that was improved by CDSMP involvement. Deterioration and acceptance of loss of physical and mental function was a large issue for people living with the fluctuating nature of the disorder. Depression was positively impacted by the CDSMP, with increased sense of self-efficacy and reduced stress levels. Ways of coping: Relaxation was a key theme throughout the literature, which responded positively to mindfulness exercises. Self-tailoring was shown to be highly beneficial to participants, and was a particular focus for the young onset PlwP. Use of Health Services: Many of the studies found no impact on health service use, with only one finding any reduction in emergency room visits. It was noted that the participants had appropriate use of health services at baseline but developed better collaborative relationships with their healthcare teams. Self Efficacy: Self-efficacy was measured in the majority of studies and found to be worthwhile in most, with benefits sustained for one year. Overall Self-management improves self-efficacy, despite the progressive, fluctuating nature of Parkinson’s. It is limited by the health systems in which it is attempted, requiring a collaborative, flexible approach from Health Professionals. In the medical model, this becomes a source of frustration and conflict. Additionally, younger PlwP seem to have a higher desire to engage in self-management and collaborative medicine, requiring increased access and responsiveness from the services they are engaged with, a flexibility that is not possible in the current model of care. Conclusion Self-management is a valuable tool in the overall management for PlwP. Self-management also requires that the health system be accessible, reactive and collaborative, rather than a medical model system focussed on acute issues, and that healthcare professionals acknowledge the PlwP as someone knowledgeable about their condition and able to play an expert role in their own care. Many healthcare professionals would require support and education around this manner of working. A Parkinson's Disease Nurse Specialist is wellplaced to oversee and contribute a supervisory role for healthcare staff and PlwP as an element of a larger overall service for people living with the conditio

Self-Management: Parkinson’s as a Chronic Condition

Setting Parkinson’s is cited as a chronic disease which is a “disease… of long duration and generally slow progression”. The burden of chronic, neurodegenerative diseases, including Parkinson’s, is a growing problem worldwide, and it is necessary to find ways to support People Living with Parkinson’s (PlwP) and their carers world-wide. Objective This poster presents the results of a systematic review of the existing literature relating to selfmanagement in PlwP. Methods The Cochrane Database of Systematic Reviews, PsycINFO, CINAHL and Embase were used to identify evidence such as randomised controlled trials and original literature, as well as evidence-based guidelines, evidence-based review articles and meta-analysis relevant to the topics reviewed. 3532 studies were found in total, of which 49 were appropriate for review. Selection was based on quality of evidence and relevance to the topic (table 1). Five studies were judged as meeting the inclusion criteria and included in the initial review. Data was extracted, summarised, coded and critiqued. Findings Five studies provided evidence related to the effectiveness of self-management. Four of the studies demonstrated beneficial impact but one study showed negative impact, namely worsening in fatigue scores. Emerging Themes Experience of illness: Three areas emerged from the evidence as particularly impacting on selfmanagement. Pain and fatigue was an area that was improved by CDSMP involvement. Deterioration and acceptance of loss of physical and mental function was a large issue for people living with the fluctuating nature of the disorder. Depression was positively impacted by the CDSMP, with increased sense of self-efficacy and reduced stress levels. Ways of coping: Relaxation was a key theme throughout the literature, which responded positively to mindfulness exercises. Self-tailoring was shown to be highly beneficial to participants, and was a particular focus for the young onset PlwP. Use of Health Services: Many of the studies found no impact on health service use, with only one finding any reduction in emergency room visits. It was noted that the participants had appropriate use of health services at baseline but developed better collaborative relationships with their healthcare teams. Self Efficacy: Self-efficacy was measured in the majority of studies and found to be worthwhile in most, with benefits sustained for one year. Overall Self-management improves self-efficacy, despite the progressive, fluctuating nature of Parkinson’s. It is limited by the health systems in which it is attempted, requiring a collaborative, flexible approach from Health Professionals. In the medical model, this becomes a source of frustration and conflict. Additionally, younger PlwP seem to have a higher desire to engage in self-management and collaborative medicine, requiring increased access and responsiveness from the services they are engaged with, a flexibility that is not possible in the current model of care. Conclusion Self-management is a valuable tool in the overall management for PlwP. Self-management also requires that the health system be accessible, reactive and collaborative, rather than a medical model system focussed on acute issues, and that healthcare professionals acknowledge the PlwP as someone knowledgeable about their condition and able to play an expert role in their own care. Many healthcare professionals would require support and education around this manner of working. A Parkinson's Disease Nurse Specialist is wellplaced to oversee and contribute a supervisory role for healthcare staff and PlwP as an element of a larger overall service for people living with the conditio

The Use of Event-Related Potentials and Machine Learning to Improve Diagnostic Testing and Prediction of Disease Progression in Parkinson's Disease

Current tests of disease status in Parkinson's disease suffer from high variability, limiting their ability to determine disease severity and prognosis. Event-related potentials, in conjunction with machine learning, may provide a more objective assessment. In this study, we will use event-related potentials to develop machine learning models, aiming to provide an objective way to assess disease status and predict disease progression in Parkinson's disease

Self-Management: Parkinson’s as a Chronic Condition

Setting Parkinson’s is cited as a chronic disease which is a “disease… of long duration and generally slow progression”. The burden of chronic, neurodegenerative diseases, including Parkinson’s, is a growing problem worldwide, and it is necessary to find ways to support People Living with Parkinson’s (PlwP) and their carers world-wide. Objective This poster presents the results of a systematic review of the existing literature relating to selfmanagement in PlwP. Methods The Cochrane Database of Systematic Reviews, PsycINFO, CINAHL and Embase were used to identify evidence such as randomised controlled trials and original literature, as well as evidence-based guidelines, evidence-based review articles and meta-analysis relevant to the topics reviewed. 3532 studies were found in total, of which 49 were appropriate for review. Selection was based on quality of evidence and relevance to the topic (table 1). Five studies were judged as meeting the inclusion criteria and included in the initial review. Data was extracted, summarised, coded and critiqued. Findings Five studies provided evidence related to the effectiveness of self-management. Four of the studies demonstrated beneficial impact but one study showed negative impact, namely worsening in fatigue scores. Emerging Themes Experience of illness: Three areas emerged from the evidence as particularly impacting on selfmanagement. Pain and fatigue was an area that was improved by CDSMP involvement. Deterioration and acceptance of loss of physical and mental function was a large issue for people living with the fluctuating nature of the disorder. Depression was positively impacted by the CDSMP, with increased sense of self-efficacy and reduced stress levels. Ways of coping: Relaxation was a key theme throughout the literature, which responded positively to mindfulness exercises. Self-tailoring was shown to be highly beneficial to participants, and was a particular focus for the young onset PlwP. Use of Health Services: Many of the studies found no impact on health service use, with only one finding any reduction in emergency room visits. It was noted that the participants had appropriate use of health services at baseline but developed better collaborative relationships with their healthcare teams. Self Efficacy: Self-efficacy was measured in the majority of studies and found to be worthwhile in most, with benefits sustained for one year. Overall Self-management improves self-efficacy, despite the progressive, fluctuating nature of Parkinson’s. It is limited by the health systems in which it is attempted, requiring a collaborative, flexible approach from Health Professionals. In the medical model, this becomes a source of frustration and conflict. Additionally, younger PlwP seem to have a higher desire to engage in self-management and collaborative medicine, requiring increased access and responsiveness from the services they are engaged with, a flexibility that is not possible in the current model of care. Conclusion Self-management is a valuable tool in the overall management for PlwP. Self-management also requires that the health system be accessible, reactive and collaborative, rather than a medical model system focussed on acute issues, and that healthcare professionals acknowledge the PlwP as someone knowledgeable about their condition and able to play an expert role in their own care. Many healthcare professionals would require support and education around this manner of working. A Parkinson's Disease Nurse Specialist is wellplaced to oversee and contribute a supervisory role for healthcare staff and PlwP as an element of a larger overall service for people living with the conditio

Induced hypertension for preventing complications of delayed cerebral ischaemia in aneurysmal subarachnoid haemorrhage

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of induced hypertension in people with an aneurysmal subarachnoid haemorrhage, following treatment of the aneurysm (either surgical clipping, or intraluminal coiling), on favourable recovery, and recurrent haemorrhage

A Literature Review of Disease Education for People with Parkinson's Disease

Purpose Disease-specific research on the information needs of people with Parkinson's is non-existent but other diseases with a similar impact have been studied. This area of knowledge has a direct impact upon self-management of diseases as well as on quality of life. While Parkinson’s is not a life-threatening disease in the usual meaning of the words, it results in significant, increasing disability and receiving the diagnosis is a life-altering moment. The person may experience conflicting sentiments of relief and turmoil, described by some as “life-shattering” (Pinder, 1992). Methods Google Scholar, Cochrane and PubMed were searched to identify randomised controlled trials, evidence-based review articles and meta-analyses, as well as evidence-based guidelines. Only articles in English were studied. The search included articles published between January 1990 and February 2012 using the keywords and subjects: “Parkinson’s”, “information needs”, “patients”, “carers”, and “diagnosis”. Two review articles (Adams, Boulton and Watson, 2009; Kinnersley et al., 2008) and twenty studies (Wherry, 2012) were found and analysed Findings Two types of patients were noted within the literature. Type one (T1) was older, possibly had mild cognitive changes, had a lower level of educational attainment, and was likely to be retired or unemployed. Type two (T2), was younger, had a higher level of educational attainment and was likely to be still in employment (Kim et al., 2012). The typical T1 patient had a higher level of unmet information needs than T2 patients who were proactive in seeking information. Complex and rarely asked questions were more likely to be presented by T2 patients. Preferred sources of information for T1 patients included physicians and specialist nurses, whereas T2 patients supplemented the information from their care team by using external sources (Andreassen et al., 2005). Cultural behaviour in health had an impact, some patients exhibiting a higher reliance on medical teams for information and decision making than others (Wittman et al., 2011). Information needs changed over time and there was an obvious challenge to identify these needs when the patient was seen in a clinic setting (Kim et al., 2012). The level of information provided influenced help-seeking behaviour and a balance between inappropriate reassurance and overemphasis on complications was necessary (Wittman et al., 2011). Discussion Chronic care health professionals have begun to see patients from the Baby Boomer generation and can anticipate a rise in “technologically-savvy” T2 patients who demand high levels of communication and consultation with their care teams. The challenge remains to identify the specific information requirements and so meet patients’ needs in a personalised manner. In the light of this literature review, local practice has evolved to institute a nurse-led clinic and to provide patients with an information pack, specifically focused on the needs of newly-diagnosed patients. Given the prevalence and impact of Parkinson’s, the research base in this area is currently insufficient to inform policy and practice. Future research should explore the changes in information needs over the course of the disease, including the needs of the primary carers. A study identifying the best way to meet these needs is urgently required in order to ensure that best practice is informed by relevant and robust evidenc

A Literature Review of Disease Education for People with Parkinson's Disease

Purpose Disease-specific research on the information needs of people with Parkinson's is non-existent but other diseases with a similar impact have been studied. This area of knowledge has a direct impact upon self-management of diseases as well as on quality of life. While Parkinson’s is not a life-threatening disease in the usual meaning of the words, it results in significant, increasing disability and receiving the diagnosis is a life-altering moment. The person may experience conflicting sentiments of relief and turmoil, described by some as “life-shattering” (Pinder, 1992). Methods Google Scholar, Cochrane and PubMed were searched to identify randomised controlled trials, evidence-based review articles and meta-analyses, as well as evidence-based guidelines. Only articles in English were studied. The search included articles published between January 1990 and February 2012 using the keywords and subjects: “Parkinson’s”, “information needs”, “patients”, “carers”, and “diagnosis”. Two review articles (Adams, Boulton and Watson, 2009; Kinnersley et al., 2008) and twenty studies (Wherry, 2012) were found and analysed Findings Two types of patients were noted within the literature. Type one (T1) was older, possibly had mild cognitive changes, had a lower level of educational attainment, and was likely to be retired or unemployed. Type two (T2), was younger, had a higher level of educational attainment and was likely to be still in employment (Kim et al., 2012). The typical T1 patient had a higher level of unmet information needs than T2 patients who were proactive in seeking information. Complex and rarely asked questions were more likely to be presented by T2 patients. Preferred sources of information for T1 patients included physicians and specialist nurses, whereas T2 patients supplemented the information from their care team by using external sources (Andreassen et al., 2005). Cultural behaviour in health had an impact, some patients exhibiting a higher reliance on medical teams for information and decision making than others (Wittman et al., 2011). Information needs changed over time and there was an obvious challenge to identify these needs when the patient was seen in a clinic setting (Kim et al., 2012). The level of information provided influenced help-seeking behaviour and a balance between inappropriate reassurance and overemphasis on complications was necessary (Wittman et al., 2011). Discussion Chronic care health professionals have begun to see patients from the Baby Boomer generation and can anticipate a rise in “technologically-savvy” T2 patients who demand high levels of communication and consultation with their care teams. The challenge remains to identify the specific information requirements and so meet patients’ needs in a personalised manner. In the light of this literature review, local practice has evolved to institute a nurse-led clinic and to provide patients with an information pack, specifically focused on the needs of newly-diagnosed patients. Given the prevalence and impact of Parkinson’s, the research base in this area is currently insufficient to inform policy and practice. Future research should explore the changes in information needs over the course of the disease, including the needs of the primary carers. A study identifying the best way to meet these needs is urgently required in order to ensure that best practice is informed by relevant and robust evidenc