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Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis

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Abstract

Purpose

To identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson’s disease (PD).

Method

Two hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson’s Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model.

Results

The two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p < 0.05), while limitations in functional mobility had the largest contribution in Model 2 (β = −0.31; p < 0.0005). Self-reported history of falls was also found to have a significant and direct relationship with HRQOL in both models (Model 1 β = −0.11; p < 0.05; Model 2 β = −0.21; p < 0.05).

Conclusions

Health-related quality of life in PD is associated with self-care limitations, mobility limitations, self-reported history of falls and disease duration. Understanding how these factors are inter-related may assist clinicians focus their assessments and develop strategies that aim to minimize the negative functional and social sequelae of this debilitating disease.

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Abbreviations

ADL:

Activities of daily living

AIC:

Akaike Information Criteria

CFI:

Comparative fit index

FOG-Q:

Freezing of Gait questionnaire

CI :

Confidence interval

CNS:

Central Nervous System

df :

degrees of freedom

HBSMS:

Heuristic Best Significant Model Search

HRQOL:

Health-related quality of life

HY:

Hoehn and Yahr

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

ICF:

International Classification of Functioning, Disability and Health

MDRS:

Modified Dyskinesia Rating Scale

MMSE:

Mini-Mental State Examination

PD:

Parkinson’s disease

PDQ-39:

Parkinson’s Disease Questionnaire-39

PDQ-39 SI:

Parkinson’s Disease Questionnaire-39 Summary Index

RCT:

Randomized controlled trial

RMSEA:

Root mean square error of approximation

SD:

Standard deviation

SEM:

Structural equation modeling

SRMR:

Standardized root mean square residual

TUGT:

Timed “Up and Go Test”

UPDRS:

Unified Parkinson’s Disease Rating Scale

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Acknowledgments

This project has been funded by a Michael J Fox Foundation (US) Clinical Discovery Grant 2006. SS was provided with financial support by the Australian Postgraduate Award and The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences Scholarship. The authors would also like to acknowledge the contribution of Dr. Sue Finch for her statistical advice. Sze-Ee Soh was provided with financial support to write this manuscript by the Alfred Physiotherapy Research Fellowship.

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Soh, SE., McGinley, J.L., Watts, J.J. et al. Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis. Qual Life Res 22, 1543–1553 (2013). https://doi.org/10.1007/s11136-012-0289-1

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