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CSP2023: 326 The relationship between physical and psychological symptoms in Parkinson's Disease: A systematic review and meta-regression analysis

Hodgson, Philip, Jordan, Alastair ORCID: https://orcid.org/0000-0002-7669-4753, Sinani, Charikleia ORCID: https://orcid.org/0000-0001-8942-8780 and Charura, Divine ORCID: https://orcid.org/0000-0002-3509-9392 (2024) CSP2023: 326 The relationship between physical and psychological symptoms in Parkinson's Disease: A systematic review and meta-regression analysis. Physiotherapy, 123. e52-e53.

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Purpose: It is widely recognized that individuals with Parkinson’s Disease (PD) can experience both physical and psychological symptoms such as tremor, muscle stiffness, anxiety, depression, and apathy. However, the relationship between physical and psychological symptoms is poorly understood and appears to be rarely acknowledged in current literature. Considering any potential relationship between physical and psychological symptoms should improve our understanding of the condition and may translate to improved symptom management and outcomes for patients. The primary aim of this review was to examine available literature reporting outcomes for both physical function and measures of anxiety and/or depression in individuals with PD, with the secondary aim of completing meta-regression analysis to quantify possible relationships, where appropriate.

Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Systematic searches of four databases (MEDLINE, CINAHL, AMED, and APA PsychInfo) were completed, identifying studies published before 22/10/2021 (PROSPERO CRD42021281392). Studies were screened against pre-defined inclusion and exclusion criteria, with included studies reporting objective findings from physical and psychological assessments commonly used in clinical and research settings. Abstract and full-text screening was completed in two stages by two reviewers independently. Quality and risk of bias was assessed using the EPHPP Quality Assessment Tool for Quantitative Studies. Disagreements were resolved through discussion and, if necessary, by a third reviewer. Quantitative baseline measures for the pre-defined physical and psychological outcome measures were extracted and meta regression analysis of the relationship between variables completed using R.

Results: Of 1,175 studies retrieved, 40 were selected for analysis with only one study assessing the relationship between physical and psychological outcomes within their cohort. 27 studies were also eligible for meta-regression analysis - a total sample of 1,211 participants. Meta-regression analysis of 5 combinations of paired physical and psychological outcomes showed a significant moderating effect of symptoms of depression (Beck Depression Index) on mobility (Timed-Up-and-Go Test) (Coefficient = 0.3675, 95% CI 0.0901 to 0.6450, P = 0.0123) and balance (Berg Balance Score) scores (Coefficient = -1.2518, 95% CI -1.7687 to -0.7349, P = 0.0002).

Conclusion(s): Although physical and psychological outcomes of interest were used in all included studies, only one examined their relationship. Our meta-regression analysis suggests that symptoms of depression may influence measures of mobility and balance. Specifically, as the severity of symptoms of depression increase, performance on measures of mobility and balance worsen.

Impact: Clinicians and researchers should be aware of both the physical and psychological symptoms of PD and consider the potential for these to be inter-related. Further work is required to formally assess the relationship between the physical and psychological symptoms of PD and monitor this over time.

Keywords: Parkinson's Disease, Mental Health, Symptom Interaction

Item Type: Article
Status: Published
DOI: https://doi.org/10.1016/j.physio.2024.04.064
School/Department: School of Science, Technology and Health
URI: https://ray.yorksj.ac.uk/id/eprint/10235

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