帕金森病患者及其照护者的随机对照表达性写作试验。
Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers.
机构信息
Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA.
Department of Psychology, Virginia Commonwealth University, Richmond, USA.
出版信息
BMC Psychol. 2015 Nov 30;3:44. doi: 10.1186/s40359-015-0101-4.
BACKGROUND
Individuals with Parkinson's disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers.
METHODS
Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention.
RESULTS
Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions.
CONCLUSIONS
Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02217735 , Study Start Date: August 30, 2011.
背景
帕金森病（PD）患者及其照顾者面临情绪困扰和皮质醇过度分泌的风险。表达性写作是一种有效的补充干预措施，可以改善慢性疾病的心理和生理影响。本研究旨在评估针对 PD 患者及其照顾者的表达性写作干预的可行性和初步效果。
方法
将 27 名 PD 患者（N=27）及其 14 名照顾者（N=14）随机分为表达性（N=15 名患者，8 名照顾者）或中性（N=12 名患者，6 名照顾者）写作组。在基线、即刻后、4 个月和 10 个月时评估皮质醇觉醒反应（CAR）、非运动功能、生活质量和认知功能测试表现。
结果
失访是一个挑战，有 8 名患者（29.62%）和 4 名照顾者（28.57%）在开始干预前选择退出或在完成干预或第一次随访前失访。焦虑显著减轻，抑郁和照顾者负担略有改善，学习和记忆测试表现显著改善，但这些变化与写作条件无关。患者和照顾者以及写作条件之间的 CAR 随时间显著不同。
结论
在 PD 患者的小样本中，表达性写作在缓解皮质醇过度分泌方面表现出了一定的可行性和有效性；然而，较高的失访率以及表达性和中性写作条件在情绪和神经认知结果上没有差异表明，为了使该人群获得最佳效果，可能需要对表达性写作程序进行修改。
试验注册
ClinicalTrials.gov，NCT02217735，研究开始日期：2011 年 8 月 30 日。
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