帕金森病的正念疗法:法国全国调查和使用 MBSR 计划(M-Park)的试点干预可行性试验。

IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Revue neurologique Pub Date : 2024-10-01 DOI:10.1016/j.neurol.2024.03.013
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引用次数: 0

摘要

背景:在帕金森病(PD)的治疗过程中,非药物辅助干预措施,尤其是身心疗法的重要性与日俱增。其中,正念冥想似乎特别有效,尤其是对焦虑和抑郁症状。然而,目前有关帕金森病正念冥想标准化项目的知识仍然有限,尤其是在法国。为了增进这方面的知识,我们分两个阶段设计了 M-PARK 研究。第一阶段包括一项法国全国性调查,目的是了解帕金森病患者对正念冥想的期望、需求和举措。第二阶段为临床试验,目的是评估向帕金森病患者推荐的正念冥想(MBSR)计划的可行性、可接受性和效果:在第一阶段,向法国帕金森病患者协会(France Parkinson)成员和法国 MBSR 合格指导员发放了在线调查问卷。在第二阶段,30 名帕金森病患者参与了一项临床试验,其中包括一项标准的 MBSR 课程,以及课程前后一个月的两次额外评估访问。数据收集包括全面临床评估、抑郁和焦虑症状评估、睡眠评估、疼痛评估和生活质量评估,以及面对面访谈,以对项目的可接受性和生活体验进行定性评估。我们向三组共 10 名患者推荐了三个 MBSR 项目:其中两个项目因大流行而在线进行,一个项目推荐给无波动或轻微波动的患者(第 1 组),一个项目推荐给轻微至中度波动的患者(第 2 组),最后一个项目推荐给无波动或轻微波动的患者(第 3 组):法国调查:向法国帕金森协会会员发出的调查问卷共收到 209 份答复;向讲师发出的调查问卷共收到 68 份答复。三分之二的受访患者听说过正念冥想(66%),但并不知道这种方法的真正含义以及如何真正帮助他们。很少有指导者(29%)在其目前的实践中与帕金森病患者打过交道。然而,90% 的受访患者表示,他们赞成在护理中引入这种方法:临床试验:结果表明,无论是在线还是面对面,该计划对帕金森病患者来说都是可行和可接受的。在注册的 30 名患者中,有 25 人完成了该项目。没有观察到与正念冥想练习相关的不良反应。结果显示,焦虑症状、抑郁症状和生活质量的改善在统计学上有显著降低。此外,疼痛或睡眠质量方面的变化在统计学上并不明显。患者组之间的结果没有明显差异。在定性分析中,强调的主要主题与以下方面有关(i) 计划期间的生活体验;(ii) 日常生活的变化;(iii) 与疾病相关的变化。绝大多数完成计划的患者(24/25)认为他们的参与是积极或非常积极的。他们表示,在实施新的行为策略方面,尤其是在自我护理、接受和消除对疾病的认同方面,他们更好地管理了压力和情绪,也有了更大的自主权:结论:尽管人们对正念疗法抱有很高的期望,但帕金森氏症患者对现有的正念疗法项目知之甚少。然而,这项研究表明,无论是在线还是面对面提供的这些项目都特别有益,尤其是对焦虑和抑郁症状,至少在疾病的轻中度阶段是如此。
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Mindfulness in Parkinson's disease: A French national survey and a pilot intervention feasibility trial using the MBSR program (M-Park)

Background

Non-pharmacological complementary interventions, particularly mind-body practices, are of growing importance in the management of Parkinson's disease (PD). Among these, mindfulness meditation seems particularly effective, especially on anxiety and depression symptoms. However, current knowledge on mindfulness standardized programs in PD is still limited, particularly in France. Aiming at improving this knowledge we designed the M-PARK study in two phases. Phase 1 consisted in a French national survey to explore expectations, needs and initiatives for mindfulness meditation for PD patients. Phase 2 was a clinical trial with objectives to assess feasibility, acceptability and effects of a mindfulness (MBSR) program proposed to PD patients.

Methods

In phase 1, online questionnaires were addressed to members of a French PD patient's association (France Parkinson) and French MBSR qualified instructors. In Phase 2, a clinical trial involving 30 PD patients consisted of a standard MBSR program with two additional evaluation visits one month before and after the program. Data collection included a global clinical evaluation, assessment of depression and anxiety symptoms, sleep, pain and quality of life and a face-to-face interview for qualitative assessment of the acceptability and lived experience during the program. Three MBSR programs were proposed to three groups of ten patients: two were online due to the pandemic situation, one proposed to patients with no or minor fluctuations (group 1) and one for patients with slight to moderate fluctuations (group 2), and the last one face-to-face for patients with no or minor fluctuations (group 3).

Results

French survey: 209 responses were collected for the questionnaire sent to the members of the association France Parkinson; and 68 for the questionnaire sent to the instructors. Two-thirds of patients surveyed had heard of mindfulness meditation (66%), but were unaware of what this approach really consisted and how it could really help them. Few instructors (29%) had had to deal with patients with PD in their current practice. Yet 90% of patients surveyed indicated they were in favor of introducing this type of approach into their care.

Clinical trial

The results indicated that the program is feasible and acceptable both online and face-to-face for patients with PD. Among the 30 patients enrolled, 25 completed the program. No unwanted effects related to mindfulness meditation practice were observed. The results showed a statistically significant reduction in anxiety symptoms, depressive symptoms, and improvement in quality of life. Furthermore, no statistically significant change was measured for pain or sleep quality. There was no striking difference in results observed between the patient groups. For the qualitative analysis, major themes highlighted were in relation with: (i) the lived experience during program; (ii) changes in the daily life; and (iii) disease-related changes. A large majority of patients who completed the program (24/25) described their participation as positive or very positive. They reported better management of stress and emotions, as well as greater autonomy in implementing new behavioral strategies, particularly in terms of self-care, acceptance, and de-identification from the disease.

Conclusion

Despite high expectations, PD patients are poorly informed about available mindfulness programs. This study however shows that these programs, whether offered online or face-to-face, are particularly beneficial, especially for anxiety and depressive symptoms, at least in mild-to-moderate stages of the disease.
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来源期刊
Revue neurologique
Revue neurologique 医学-临床神经学
CiteScore
4.80
自引率
0.00%
发文量
598
审稿时长
55 days
期刊介绍: The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
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