Wearing-off detection in clinical practice: The wearing off real practice key (WORK-PD) study in Parkinson's disease

Altavista, Maria Concetta; Cassetta, Emanuele; Brusa, Livia; Viselli, F.; Denaro, A.; Ventriglia, Mariacarla; Pasqualetti, Patrizio; Peppe, Antonella

doi:10.1016/j.parkreldis.2014.11.002

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…Initially, the 32‐item Wearing‐OFF Questionnaire (WOQ‐32) demonstrated its efficacy in the screening of wearing‐OFF . Shorter, more easily applicable versions of this tool, such as the WOQ‐19/Quick, WOQ‐9, and Q10, were subsequently developed without loss of sensitivity. However, these questionnaires cannot be specifically used for nonmotor wearing‐OFF given that they encompass both motor and nonmotor symptoms.…”

Section: Management Of Nmfmentioning

confidence: 99%

The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations

et al. 2016

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Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the “levodopa miracle.” It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l‐dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow‐up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society

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Section: Management Of Nmfmentioning

confidence: 99%

The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations

et al. 2016

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“…One article was not used because it lacked any type of language validation [ 37 ], and two articles presented post hoc analyses of the same populations outlined in other articles that we include [ 38 , 39 ]. Nine articles did not present clinimetric properties [ 40 – 48 ], and among them, two provided data using which we could calculate only PPV [ 41 , 43 ]. One was a review [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

Clinimetrics of the 9- and 19-Item Wearing-Off Questionnaire: A Systematic Review

Mantese

Schumacher-Schuh

Rieder

2018

Parkinson's Disease

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The treatment of Parkinson's disease (PD) with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops, which necessitates complex posology adjustment or adjuvant therapy. This phenomenon may not be well recognized, especially if it is mild or involves nonmotor symptoms. Questionnaires were developed to improve the recognition of the wearing-off phenomenon. The questionnaires consist of a list of symptoms that patients must check if they have and if the symptoms improve with medication. A recent review by the Movement Disorder Society suggested the 19-item (WOQ-19) and 9-item (WOQ-9) questionnaires as screening tools for the wearing-off phenomenon. However, there has not been a systematic review to assess the questionnaires' clinimetric properties, such as sensitivity, specificity, test-retest reliability, and responsiveness. We conducted an extensive search for studies using these two tools. We identified 3 studies using WOQ-19 and 5 studies using WOQ-9. Both questionnaires seem to have good sensitivity (0.81–1). WOQ-19 has variable specificity (0.39–0.8), depending on the number of positive items, while WOQ-9 lacks specificity (0.1–0.69). Only one study using WOQ-19 reported test-retest, and only two studies reported responsiveness. Thus, this report describes the first independent systematic review to exam quantitatively the clinimetric properties of these two questionnaires.

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“…In this study, WO was defined as a generally predictable reemergence of motor and non-motor symptoms that usually occurred before the next scheduled doses of antiparkinsonian medications and relieved after the doses, which occurs at least once a day (5,6).…”

Section: The Definition Of Womentioning

confidence: 99%

“…Some other factors might influence the identification of WO, such as insufficient time and patients' misunderstanding (4). Some scales were developed to help clinicians to identify WO (5,6). Among them, the 9-item wearing-off questionnaire (WOQ-9), a patient self-assessment scale, has been recommended by MDS as a WO diagnostic screening tool for its high sensitivity (7,8).…”

Section: Introductionmentioning

confidence: 99%

Wearing-off Identification in Parkinson's Disease: The shapd-woq Study

Wan¹,

Yuan²,

Hou³

et al. 2020

Front. Neurol.

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Objectives: To clarify the frequency of wearing-off phenomenon (WO) and the validity of the Chinese version of the 9-item wearing-off questionnaire (CWOQ-9) in WO identification in this large population.Methods: Parkinson's patients treated with antiparkinsonian medications were consecutively recruited into this observational, cross-sectional investigation. Patients completed the CWOQ-9 prior to the independent clinician assessment.Results: A total of 1,385 patients were included in the analysis. The mean age was 69.7 ± 9.5 years and the mean disease duration was 5.8 ± 4.7 years. Clinicians identified WO in 763 patients, with an overall prevalence of 55.1%. In patients within 1 year of disease duration, clinicians diagnosed WO in eight patients, with a percentage of 12.9%. With the disease progression, the WO frequency gradually increased to 76.2% in patients with 10-15 years of disease duration. Then, it slowly decreased at a longer disease duration. The occurrence of WO was closely associated with the disease duration, H&Y staging, and levodopa daily dose. CWOQ-9 identified 1,071 patients (1071/1398, 77.33%) that had WO-related symptoms. The mean CWOQ-9 score was 3.4 ± 1.6. CWOQ-9 corresponded with clinician assessments of WO in 734 of 763 cases; clinicians disagreed with the CWOQ-9 considering the presence of WO in 337 of 1,071 cases. The sensitivity and specificity of CWOQ-9 were 96.2 and 45.8%, respectively.Conclusions: WO occurred frequently at the early and middle stage of PD. CWOQ-9 was qualified as a pre-visiting screening tool for clinicians to better identify WO.

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Wearing-off detection in clinical practice: The wearing off real practice key (WORK-PD) study in Parkinson's disease

Cited by 13 publications

References 23 publications

The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations

The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations

Clinimetrics of the 9- and 19-Item Wearing-Off Questionnaire: A Systematic Review

Wearing-off Identification in Parkinson's Disease: The shapd-woq Study

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