Protocol: The effect of pharmacological or non-pharmacological interventions for Parkinson’s Disease on Quality of Life: An Umbrella Systematic Review
Creators: name: Butler, Ailsa
name: Zhao, Dylan
name: Packer, Thomas
name: Truell, Robert
name: Draper, Thomas
name: Livingstone-Banks, Jonathan
name: Hatfield, Thomas
Publisher: name: OSF Registries
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: PD
subject: Parkinson's
subject: Parkinson's Disease
subject: Protocol
subject: QOL
subject: Quality of Life
subject: Umbrella review
subject: Umbrella systematic review

description: Parkinson’s Disease (PD) is a debilitating neurodegenerative condition which results in both motor symptoms such as tremor, bradykinesia, and rigidity; and non-motor symptoms like fatigue, cognitive impairment, and urinary incontinence[1,2]. Globally, the prevalence of PD is estimated to be over 8.5 million, highest in those over 65[3]. The pathological loss of dopaminergic neurons in the substantia nigra; and later, more widespread degeneration, underlies the development of Parkinsonian motor symptoms[1,2] such as ‘gait impairments’[4] and non-motor symptoms including depression and cognitive impairment. Ultimately, these symptoms adversely affect Quality of Life (QOL) in PD patients[5]. QOL refers to an “...individual’s overall well-being and satisfaction” [6]. Of particular interest to us is Health-related QOL (HR-QOL): “...a component of QOL and is a patient-reported outcome, with physical, mental and social domains that can be measured at single points and over time periods”[6]. The guidance for the management of PD as defined by the National Institute for Health and Care Excellence (NICE) has accumulated evidence outlining that PD adversely affects QOL, and that QOL should in turn be targeted by treatment[7]. However, how, and which, of the myriad of treatment options presented affect QOL is not always clear (one exception is where it is stated that palliative care aims to benefit QOL)[8]. An effect on ‘activities of daily living,’ as well as particular symptoms and their side effects, is available in documentation for professionals and patients alike[8], yet an emphasis on QOL is lacking. Particularly considering that there are currently no curative or disease-modifying treatments for PD[2,8], it is crucial that treatment centres around how an individual can improve their QOL whilst living with this disease[7]. We aim to re-emphasise the importance of QOL as a crucial patient-centred outcome when selecting interventions to manage the treatment of an individual with PD[6,9] and intend to present policymakers and healthcare professionals with a document that links the effect of an intervention for PD on QOL. We hope that this will make it clearer to see which interventions may be beneficial for an individual to improve their QOL specifically. The development of an Umbrella Systematic Review (USR) which summates and critiques the quality of the evidence presented in systematic reviews (SRs) which explore the effect of a particular intervention on QOL, would be well placed to meet this aim[10]. Indeed, a scoping search has revealed the presence of suitable SRs (e.g. physical exercise and QOL, by Ernst et al. (2023)[11]; or ‘self-management interventions’ and QOL, by Pigott et al. (2022)[12]), making an USR feasible. Furthermore, while an important USR does already exist that describes the impact of particular psychological interventions for non-motor symptoms in PD on (amongst other outcomes) QOL (see[13])- to our knowledge, there are no USRs that incorporate SRs on all intervention types targeting any potential symptom of PD. This protocol details the methodology to conduct a uniquely wide-scoping USR to meet these aims- re-emphasising the importance of QOL in PD, and demonstrating which interventions may be beneficial for an individual to improve their QOL specifically. --- 1. Poewe, W. et al. Parkinson disease. Nat Rev Dis Primers 3, 1–21 (2017). 2. Poewe, W., Seppi, K., Marini, K. &amp; Mahlknecht, P. New hopes for disease modification in Parkinson’s Disease. Neuropharmacology vol. 171 Preprint at https://doi.org/10.1016/j.neuropharm.2020.108085 (2020). 3. Ou, Z. et al. Global Trends in the Incidence, Prevalence, and Years Lived With Disability of Parkinson’s Disease in 204 Countries/Territories From 1990 to 2019. Front Public Health 9, (2021). 4. Soh, S. E., Morris, M. E. &amp; McGinley, J. L. Determinants of health-related quality of life in Parkinson’s disease: A systematic review. Parkinsonism and Related Disorders vol. 17 1–9 Preprint at https://doi.org/10.1016/j.parkreldis.2010.08.012 (2011). 5. Schrag, A., Jahanshahi, M. &amp; Quinn, N. How does Parkinson’s disease affect quality of life? A comparison with quality of life in the general population. Movement Disorders 15, 1112–1118 (2000). 6. Stocchi, F., Martínez-Martin, P. &amp; Reichmann, H. Quality of life in Parkinson’s disease - patient, clinical and research perspectives. Eur Neurol Rev 9, 12–18 (2014). 7. Rahman, S., Griffin, H. J., Quinn, N. P. &amp; Jahanshahi, M. Quality of life in Parkinson’s disease: The relative importance of the symptoms. Movement Disorders 23, 1428–1434 (2008). 8. NICE. Parkinson’s disease in adults_ Information for the public. https://www.nice.org.uk/guidance/ng71/ifp/chapter/Parkinsons-disease-the-care-you-should-expect (2017). 9. Soh, S. E., McGinley, J. &amp; Morris, M. E. Measuring quality of life in Parkinson’s disease: Selection of-an-appropriate health-related quality of life instrument. Physiotherapy vol. 97 83–89 Preprint at https://doi.org/10.1016/j.physio.2010.05.006 (2011). 10. Belbasis, L., Bellou, V. &amp; Ioannidis, J. P. A. Conducting umbrella reviews. BMJ Medicine 1, e000071 (2022). 11. Ernst, M. et al. Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis. Cochrane Database of Systematic Reviews vol. 2023 Preprint at https://doi.org/10.1002/14651858.CD013856.pub2 (2023). 12. Pigott, J. S., Kane, E. J., Ambler, G., Walters, K. &amp; Schrag, A. Systematic review and meta-analysis of clinical effectiveness of self-management interventions in Parkinson’s disease. BMC Geriatr 22, (2022). 13. Kampling, H., Brendel, L. K. &amp; Mittag, O. (Neuro)Psychological Interventions for Non-Motor Symptoms in the Treatment of Patients with Parkinson’s Disease: a Systematic Umbrella Review. Neuropsychology Review Preprint at https://doi.org/10.1007/s11065-019-09409-4 (2019).