The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study

Abstract

BackgroundParkinson’s disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.MethodsAn exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012–2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18–75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.ResultsGroup 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = −0.59) and at 6-month post intervention (t-score = −1.42) as reported by the PDQ-39 SI. However this finding was not significant (p = 0.56 and 0.16 respectively). A small yet significant effect size (β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score −1.8, p = 0.04). Four secondary measures are reported.ConclusionsOur findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson’s disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820, 17th April 2012.

Remote delivery of psychological interventions for Parkinson's disease

“…Preliminary face-to-face mindfulness interventions in PD have demonstrated shortterm improvements in motor symptoms (Pickut et al, 2015;Dissanayaka et al, 2016a) and non-motor symptoms, including depression (Cash et al, 2016;Dissanayaka et al, 2016a), anxiety (Dissanayaka et al, 2016a), cognition (Cash et al, 2016;Dissanayaka et al, 2016a), distress (Dissanayaka et al, 2016a), and coping skills (Fitzpatrick et al, 2010). A recent six-week group mindfulness intervention involving lifestyle management strategies for PD patients showed a significant reduction in depression and stress, and improvements in mindfulness and ADL at sixmonth follow-up (Advocat et al, 2016). In-person ACT-based interventions for wearing-off related anxiety (Dissanayaka et al, 2016b) associated with prolonged dopamine-replacement therapy in PD are currently underway (Ghielen et al, 2015).…”

Nonpharmacologic Interventions for the Self-Management of Anxiety in Parkinson’s Disease: A Comprehensive Review

“…In the second nonsignificant experimental trial, effects of a six-week mindfulness-based intervention using a dyad of patients and caregivers was compared to a waitlist control group ( N = 57) [38]. The Depression Anxiety Stress Scale-21 (DASS-21) [39] was used to measure anxiety as a secondary outcome.…”

Evaluation of a psychoeducational intervention compared with education in people with Parkinson's disease and their informal caregivers: a quasi‐experimental study

“…The sample size was calculated using the statistical program STATA 12.1 to detect a medium‐large difference in the primary outcome (quality of life), based on data from previous studies which used the same quality of life scales. The size effect (clinically relevant difference) was set at 10 in patients and 15 in caregivers and the mean and standard deviation on which the sample size was based was 29.03 (15.44) in patients (PDQ‐39 scale) and 104.70 (25.04) in caregivers (SQLC scale; Advocat et al, 2016; Martínez‐Martín et al, 2005; Navarta‐Sánchez et al, 2016). The statistical significance was set at p < 0.05.…”

“…The interventions already tested (A'Campo et al, 2010; Advocat et al, 2016; Hempel et al, 2008; Lindskov et al, 2007; Tan et al, 2014) were also analysed to design both interventions. Finally, we conducted earlier research to identify specific needs of patients with PD and their informal caregivers in our context (Navarta‐Sánchez et al, 2017) and addressed them in the interventions.…”