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Background: Although several studies have reported positive effects of mind-body exercises on symptom management and health-related quality of life (HRQOL) of people living with Parkinson's disease (PD), it is not known whether these effects are attributable to a change in anxiety and depression.Purpose: To compare the effects of mindfulness yoga to conventional stretching exercises in a randomized controlled trial while examining potentially mediating effects of anxiety and depression.Methods: 138 adults with PD were randomized to eight weekly yoga (n = 71) or stretching (n = 67) sessions. Symptom experiences, anxiety and depression, and HRQOL outcomes were assessed at baseline, immediate post-intervention, and 3-month post-intervention.Results: Generalized estimating equation analyses revealed that, compared to stretching, yoga significantly improved patients' nonmotor (time-by-group interaction, T1:β = -1.99, p = .008; T2:β = -2.86, p < .001) and motor (time-by-group interaction, T1:β = -1.77, p = .03) symptom experiences. The mediation analysis found that the changes in anxiety and depression were the mediators in the associations between non-motor experience and HRQOL; while only the changes in depression were found to be the mediator in the relationship between motor experience and HRQOL.Conclusions: Yoga is superior to conventional stretching exercises in improving nonmotor and motor symptoms in daily living. Reduced anxiety and depression play a role in mediating the positive effects of the mindfulness yoga intervention. To optimize HRQOL, rehabilitation should reinforce psychological care in addition to pharmacological treatments and physical relief of PD symptoms. Future studies are needed to identify strategies for facilitating the implementation and sustainability of mind-body rehabilitation to enhance the quality of care for PD. [ABSTRACT FROM AUTHOR]

Background: Freezing of gait (FOG) is one of the most disabling gait disorders affecting 80% of patients with Parkinson's disease (PD). Clinical guidelines recommend a behavioral approach for gait rehabilitation, but there is a wide diversity of behavioral modalities. Objective: The objective of this network meta-analysis was to compare the effectiveness of different behavioral interventions for FOG management in PD patients. Methods: Six databases were searched for randomized controlled trials of behavioral interventions for FOG management among PD patients from 1990 to December 2021. Bayesian network meta-analysis was used to combine both direct and indirect trial evidence on treatment effectiveness, while the surface under the cumulative ranking (SUCRA) score was used to estimate the ranked probability of intervention effectiveness. Results: Forty-six studies were included in the qualitative synthesis. Among, 36 studies (1454 patients) of 72 interventions or control conditions (12 classes) were included in the network meta-analysis, with a mean intervention period of 10.3 weeks. After adjusting for the moderating effect of baseline FOG severity, obstacle training [SMD −2.1; 95% credible interval (Crl): −3.3, −0.86], gait training with treadmill (SMD −1.2; 95% Crl: −2.0, −0.34), action observation training (SMD −1.0; 95% Crl: −1.9, −0.14), conventional physiotherapy (SMD −0.70; 95% Crl: −1.3, −0.12) and general exercise (SMD −0.64; 95% Crl: −1.2, −0.11) demonstrated significant improvement on immediate FOG severity compared to usual care. The SUCRA rankings suggest that obstacle training, gait training on treadmill and general exercises are most likely to reduce FOG severity. Conclusion: Obstacle training, gait training on treadmill, general exercises, action observation training and conventional physiotherapy demonstrated immediate real-life benefits on FOG symptoms among patients with mild–moderate PD. With the promising findings, the sustained effects of high complexity motor training combined with attentional/cognitive strategy should be further explored. Future trials with rigorous research designs using both subjective and objective outcome measures, long-term follow-up and cost-effective analysis are warranted to establish effective behavioral strategies for FOG management. [ABSTRACT FROM AUTHOR]

In the section "Clinical implications and recommendations", second paragraph should read as As for community rehabilitation, general exercises demonstrated an evident medium effect size of 0.51 compared to usual care (beyond the 95% Crl). The sole practice of exercises without high complexity motor training or cognitive compensation strategy might be inadequate to ameliorate FOG in PD patients. [Extracted from the article]

Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. Cross-sectional study. Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS–Symptoms–Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts. [ABSTRACT FROM AUTHOR]

Purpose: Health-related quality of life (HRQOL) is an increasingly critical outcome of chronic illness care. However, its disease-independent attributes, particularly its spiritual resilient indicators, for people with Parkinson's disease (PD) have not been explicitly examined. This study aimed to (i) assess the associations between psychological distress, spiritual resilience and HRQOL, and (ii) examine the mediating effects of spiritual resilience on psychological distress and HRQOL amongst individuals with PD. Methods: This is a secondary data analysis of the baseline data of a clinical trial that involved 138 individuals with PD. The subjects completed a structured questionnaire assessing psychological distress in terms of anxiety and depression, spiritual resilience in terms of perceived affliction and perceived equanimity, severity of motor symptoms and disease-specific HRQOL. Results: Analysis by independent t test suggested that distressed individuals with PD demonstrated less spiritual resilience and presented poorer HRQOL than non-distressed individuals with PD. Multiple linear regression models revealed that high emotional distress was associated with low spiritual resilience and poor HRQOL. The mediation analysis found that after simultaneously controlling for the degree of perceived affliction and perceived equanimity, a significant reduction was observed in the direct effect between psychological distress and HRQOL. This result indicated the partially mediating roles of perceived affliction and equanimity in the pathways between psychological distress and HRQOL. Conclusion: In order to enhance HRQOL, PD interventions should address the spiritual resilience of patients in addition to providing psychological care and physical relief of symptoms. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a chronic condition that results in not only physical deterioration but also a spectrum of psychosocial outcomes that demand continuous adjustment and coping. Previous qualitative research into the illness experiences has been conducted mainly in Western populations, yet little is known about Chinese PD patients' adjustment. The aims of this qualitative description study were to (a) understand the illness and adjustment experiences, (b) explore the reasons for psychological distress and (c) discern the adjustment strategies adopted along the course of illness, from the perspective of Hong Kong Chinese PD patients. Individual semi‐structured interviews were conducted with 14 patients from January to June, 2016. Data were analysed using thematic analysis. Two themes emerged from the interviews: confronting the changes caused by Parkinson's disease and adjusting to living with Parkinson's disease. Participants reported experiencing turmoil due to progressive loss of functions and abilities, changes in role and identity and unattended emotional needs in the course of their illness. Considering the chronic and fluctuating nature of PD, rehabilitation programs should be applied to address not only the physical symptoms but also the psychological needs of PD patients. Behavioral strategies facilitating active health behaviours and accommodative psychological adjustment are salient to facilitate the holistic well‐being of PD patients. [ABSTRACT FROM AUTHOR]

Neurodegenerative diseases (NDDs) are characterized by neuronal damage and progressive loss of neuron function. Microbiome-based interventions, such as dietary interventions, biotics, and fecal microbiome transplant, have been proposed as a novel approach to managing symptoms and modulating disease progression. Emerging clinical trials have investigated the efficacy of interventions modulating the GM in alleviating or reversing disease progression, yet no comprehensive synthesis have been done. A systematic review of the literature was therefore conducted to investigate the efficacy of microbiome-modulating methods. The search yielded 4051 articles, with 15 clinical trials included. The overall risk of bias was moderate in most studies. Most microbiome-modulating interventions changed the GM composition. Despite inconsistent changes in GM composition, the meta-analysis showed that microbiome-modulating interventions improved disease burden (SMD, − 0.57; 95% CI − 0.93 to − 0.21; I2 = 42%; P = 0.002) with a qualitative trend of improvement in constipation. However, current studies have high methodological heterogeneity and small sample sizes, requiring more well-designed and controlled studies to elucidate the complex linkage between microbiome, microbiome-modulating interventions, and NDDs. [ABSTRACT FROM AUTHOR]

Background: Psychological distress is prevalent among people with Parkinson's disease (PD) and aggravates their motor symptoms, thereby leading to increased disability, high healthcare costs, and poor health-related quality of life (HRQoL). The under-recognition and adverse effects of the pharmacological management of anxiety and depression among the PD population are considerable. Thus, adopting a Complementary and Alternative Management (CAM) approach to address this problem is important. Yoga, one of the most common "mind-body" CAM therapies, can improve the psychological wellbeing of people with chronic illnesses. However, limited research on the effects of yoga in people with PD has been conducted. This study will determine the effects of yoga on the psychological wellbeing of people with mild-to-moderate PD and will compare these effects with those of stretching and resistance training exercises.Methods: A community-based, single-blind, randomized trial will be conducted. A total of 126 subjects will be recruited and randomly divided into yoga (n = 63) or stretching and resistance exercise (n = 63) groups. For 8 weeks, the yoga group will receive a weekly 90-min session of yoga, and the control group will receive a weekly 60-min session of stretching and resistance exercises. The primary outcome will be the level of psychological distress measured using the Hospital Anxiety and Depression Scale. The secondary outcomes will include the severity of motor symptoms measured by the Movement Disorders Society - Unified Parkinson's Disease Scale - Part III Motor Examination; mobility, balance, and fall risk measured by the Timed Up and Go test; spiritual wellbeing measured by the Holistic Wellbeing Scale; and HRQoL measured by the Parkinson's Disease Questionnaire-8. Assessment will be conducted at baseline, 8th, and 20th weeks of follow-ups.Discussion: This study will be the first randomized trial to compare the effect of yoga versus stretching and resistance training exercises in a PD population. Results will contribute to the value of yoga as a therapeutic option for managing psychological distress in PD patients. Multiple outcomes including psychological, physiological, and spiritual and HRQoL will also be measured to elucidate the potential mechanisms of yoga. The effect of yoga on people with chronic illnesses will further be elucidated. This information should contribute to future research, practice, and policy related to PD management.Trial Registration: WHO Primary Registry - Chinese Clinical Trials Registry (ChiCTR): CUHK_CCRB00522 Registered on 8 October 2016; date of approval 19 August 2016. [ABSTRACT FROM AUTHOR]