Ogura Hiromu, Nakagawa Ryoko, Ishido Miwako, Yoshinaga Yoko, Watanabe Jun, Kurihara Kanako, Hayashi Yuka, Nagaki Koichi, Mishima Takayasu, Fujioka Shinsuke, Tsuboi Yoshio
Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan.
Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan.
Parkinsons Dis. 2021 Dec 22;2021:1599477. doi: 10.1155/2021/1599477. eCollection 2021.
Patients with Parkinson's disease (PD) receiving levodopa treatment often report motor complications including wearing-off (WO), dyskinesia, and morning akinesia. As motor complications are associated with a decrease in patients' quality of life (QoL), it is important to identify their occurrence and commence immediate management. This study investigated whether differences in the perception of motor complications exist between patients and their physicians in routine clinical practice.
After an Internet-based screening survey, questionnaires were distributed to physicians and their patients in Japan. The 9-item Wearing-Off Questionnaire (WOQ-9) was used to objectively assess the presence of WO; patients with WOQ-9 scores ≥2 were considered to have WO. McNemar's test was used to compare physician assessment versus WOQ-9 scores, patient self-awareness versus physician assessment, and patient self-awareness versus WOQ-9, separately. Morning akinesia and dyskinesia were assessed by both physician assessment and patient self-awareness with McNemar's test. QoL was assessed using the 8-item Parkinson's Disease Questionnaire (PDQ-8) with the Wilcoxon rank-sum test.
A total of 235 patients with PD and their 92 physicians participated in this survey. A significant discordance was observed between the WOQ-9 and physician assessment of WO (67.2% vs 46.0%; < 0.0001). Furthermore, patient self-awareness of WO was 35.3% ( = 0.0004, vs physician). Morning akinesia (patient, 58.7%; physician, 48.9%; = 0.0032), dyskinesia (patient, 34.0%; physician, 23.4%; = 0.0006), and bodily discomfort (patient, 25.0; physician, 0.0; = 0.0102) of QoL were underrecognized by physicians.
This study investigated differences in the perception of WO between patients with PD and their physicians in routine clinical practice and highlighted that patients have a low awareness of the symptoms of WO compared with physician assessments and WOQ-9. Conversely, morning akinesia, dyskinesia, and bodily discomfort were underrecognized by physicians.
接受左旋多巴治疗的帕金森病（PD）患者常报告运动并发症，包括剂末现象（WO）、异动症和晨僵。由于运动并发症与患者生活质量（QoL）下降相关，识别其发生并立即开始管理很重要。本研究调查了在常规临床实践中患者与其医生对运动并发症的认知是否存在差异。
在基于互联网的筛查调查后，向日本的医生及其患者发放问卷。使用9项剂末现象问卷（WOQ - 9）客观评估剂末现象的存在；WOQ - 9得分≥2的患者被认为存在剂末现象。分别使用McNemar检验比较医生评估与WOQ - 9得分、患者自我认知与医生评估以及患者自我认知与WOQ - 9。通过医生评估和患者自我认知并使用McNemar检验评估晨僵和异动症。使用8项帕金森病问卷（PDQ - 8）并通过Wilcoxon秩和检验评估生活质量。
共有235例PD患者及其92名医生参与了本调查。观察到WOQ - 9与医生对剂末现象的评估之间存在显著不一致（67.2%对46.0%；<0.0001）。此外，患者对剂末现象的自我认知为35.3%（=0.0004，与医生相比）。医生对晨僵（患者为58.7%；医生为48.9%；=0.0032）、异动症（患者为34.0%；医生为23.4%；=0.0006）和生活质量中的身体不适（患者为25.0；医生为0.0；=0.0102）认识不足。
本研究调查了常规临床实践中PD患者与其医生对剂末现象认知的差异，并强调与医生评估和WOQ - 9相比，患者对剂末现象症状的认知较低。相反，医生对晨僵、异动症和身体不适认识不足。
