Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.
Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
J Psychosom Res. 2017 Dec;103:1-8. doi: 10.1016/j.jpsychores.2017.09.008. Epub 2017 Sep 21.
In Parkinson's disease (PD) patients, fluctuations in symptoms commonly occur after many years of dopamine replacement therapy. The so-called wearing-off phenomenon exists of both motor and non-motor symptoms, such as rigidity and anxiety. Current treatment options are limited and an integrated approach is needed to address the complex interactions between motor and non-motor symptoms. Since wearing-off is eventually inevitable, treatment needs to focus on coping, acceptance and self-efficacy. We developed the body awareness training, named BEWARE, combining physical therapy with acceptance and commitment therapy to help PD patients deal better with wearing-off related anxiety (WRA).
This was an investigator-blinded randomized controlled trial. Forty PD patients with WRA were randomly assigned to the BEWARE or to the treatment as usual (TAU) condition. Assessments were performed prior to and immediately after the treatment period, and at 3-months follow up. The primary outcome was self-efficacy, secondary outcomes focused on mobility, daily functioning, anxiety, depression and quality of life.
There was no significant improvement in self-efficacy in the BEWARE treatment condition when compared to TAU. However, standing balance and emotional wellbeing showed a significant improvement, and feelings of stigmatization showed a trend-significant decrease in the BEWARE condition.
We consider the BEWARE training to be a promising therapeutic approach to address WRA. Improvement points from the participants included 1) less frequent but longer therapy sessions; 2) active involvement of caregivers; and 3) the development of a supportive workbook. The optimized treatment protocol needs further evaluation in a phase III RCT.
ClinicalTrials.gov identifier: NCT02054845.
在帕金森病（PD）患者中，经过多年的多巴胺替代疗法后，症状通常会出现波动。所谓的“开-关”现象存在运动和非运动症状，如僵硬和焦虑。目前的治疗选择有限，需要采用综合方法来解决运动和非运动症状之间的复杂相互作用。由于“开-关”现象最终不可避免，因此治疗需要侧重于应对、接受和自我效能。我们开发了一种名为 BEWARE 的身体意识训练，将物理治疗与接受和承诺疗法相结合，帮助 PD 患者更好地应对与“开-关”现象相关的焦虑（WRA）。
这是一项研究者设盲的随机对照试验。40 名有 WRA 的 PD 患者被随机分配到 BEWARE 或常规治疗（TAU）条件。在治疗前、治疗后立即和 3 个月随访时进行评估。主要结果是自我效能，次要结果集中在移动性、日常功能、焦虑、抑郁和生活质量。
与 TAU 相比，BEWARE 治疗条件下的自我效能没有显著改善。然而，站立平衡和情绪健康有显著改善，而污名化的感觉则呈下降趋势。
我们认为 BEWARE 训练是一种有前途的治疗方法，可用于解决 WRA。参与者提出的改进点包括 1）较少但较长的治疗时间；2）照顾者的积极参与；3）支持性工作手册的开发。需要进一步在 III 期 RCT 中评估优化后的治疗方案。
ClinicalTrials.gov 标识符：NCT02054845。
