| ObjectivesThis study aims to improve a home rehabilitation exercise program suitable for elderly patients with Parkinson’s disease(PD)and implement its application to explore the intervention effect of home rehabilitation exercise on motor symptoms,anxiety and depression,sleep and quality of life in elderly patients with PD,in order to provide a scientific basis for the implementation of home exercise in elderly patients with PD.MethodsFrom December 2020 to December 2021,31 elderly patients with Parkinson’s disease who attended the department of neurology in a tertiary hospital in Jiangsu Province were selected by convenient sampling method,and the general demographic data,motor function,anxiety and depression,sleep and quality of life of the patients were evaluated at the baseline,and they were randomly divided into 15 intervention groups and 16 control groups.The intervention group underwent home rehabilitation exercises for 3 months,and the intervention was carried out with a rehabilitation exercise program,training 3-5 times a week.The home rehabilitation exercise program is divided into 11 sections,each movement is in 2-4 groups,each group is repeated 4-8 times,and each set takes about 40-60 minutes to complete.The control group was given health education and exercise guidance.Outpatient follow-up was conducted in the first and sixth months after enrollment to assess motor function,anxiety and depression,sleep,quality of life,and adverse events in both groups.The paired sample t-test,rank and order test,and Mann-Whitney U test were used to compare differences in motor symptoms,anxiety and depression,sleep,and quality of life in the two groups before and after the intervention.Results1 Baseline characteristics and influencing factors in elderly patients with PDThe average age of the participants included in this study was 72.9±1.08 years,the overall simple mental status examination(MMSE)was 27.61 ± 1.98 points,67.7%of patients lived only with their spouses,64.5%of patients had a stage Ⅱ disease severity,Parkinson’s disease course was 5.3(5.9)years,motor function score(UPDRS)was 56.55±16.85 points,38.7%of patients had anxiety tendencies,58.1%had mild anxiety,and 61.3%had a disease history of 61.3%.Patients had a tendency to depression,22.6%of the patients were mildly depressed,the sleep quality score was 117.52±20.12 points,and the quality of life score was 33.68±14.19;the turning time of elderly patients with PD took longer than that of healthy elderly people,and the difference was statistically significant(P<0.05).Patients were divided into UPDRS<56.55 and UPDRS≥56.55 based on the mean UPDRS score of 56.55,with significant differences in age(74 years vs 67.5 years,p<0.05 years)and daily levodopa equivalent dose(500mg vs 416mg,p<0.05).Patients were divided into<450 mg/day and ≥450 mg/day according to the median daily levodopa equivalent dose 450 mg/day,and the binary logisitic regression model showed that in the group with UPDRS≥56.55,the daily levodopa equivalent dose was its significant influencing factor,suggesting that the risk of dyskinesia exacerbation in the levodopa equivalent dose≥450 mg/day was 3.945 times that of the levodopa equivalent dose<450 mg/d.2 Evaluation of the efficacy of home rehabilitation exercise interventions2.1 Effect on the score of motor symptoms in elderly patients with PDCompared to baseline,the Intervention Group’s 1-month Follow-up Unified Parkinson’s Disease Rating Scale(UPDRS)scores(48.86± 14.68 vs 58.47± 13.55)and 6-month follow-up scores(48.21±12.50 vs 58.47± There was a significant decrease(P<0.05)in the subdimensional UPDRS-Ⅲ.score compared with the baseline(P>0.05),and no significant change was found in the control group in the total UPDRS score and the subdimensional UPDRS-Ⅲ score in 1 month and 6 months compared with the baseline(P>0.05).There were no significant differences between the two groups at 1 month and 6 months after the intervention in the UPDRS overall score and the sub-dimension UPDRS-Ⅲ score(P>0.05).2.2 Effect on anxiety and depression scores in elderly patients with PDCompared with the baseline,the Intervention Group alone had a significant decrease in the 1-month Follow-up Hamilton Anxiety Scale(HAMA)score(11.64±3.96 vs 14.73±5.26,P<0.05),and the Intervention Group saw no significant change in the 6-month follow-up(P>0.05),and in the Hamilton Depression Scale(HAMD)score,the intervention group followed up at 1 month(9.07±3.49 vs 12.07±4.22)and the 6-month follow-up(9.20±2.81 vs 12.07±4.22)there was a significant decrease(P<0.05),and no significant changes were found in the control group at 1 month follow-up and 6 months follow-up(P>0.05).2.3 Effect on sleep quality in elderly patients with PDIn the secondary outcome Parkinson’s disease sleep scale(PDSS)score,compared with baseline,no significant changes were found in the two groups of scores at 1 month and 6 months(P>0.05).There was also no statistical difference between the two groups(P>0.05).2.4 Effects on quality of life of elderly patients with PDThe overall 1-month follow-up of the Parkinson’s disease quality of life questionnaire(PDQ39)decreased significantly in both groups(the intervention group 28±9.57 vs 33.87± 11.89,the control group 24.65± 10.44 vs 33.5± 16.45,P<0.05),and there was no difference from baseline in the 6-month follow-up group(P>0.05),and in the kinematic subdivision,the intervention group alone had an improvement from the baseline at 1 month of follow-up(8.79±4.23 vs 10.33±5.64,P<0.05);in the ability to perform at a time of day-of-living subdimensionals,only the intervention group had improvement over baseline at 6 months of follow-up(4.21 ±2.70 vs 5.53±3.04,P<0.05),and in the emotional health subdimension,the scores of the two groups decreased significantly at 1 month of follow-up(the intervention group 3.64±2.52 vs 4.93±2.92,the control group 3.93±2.27 vs 5.19±2.56,P<0.05);in the cognitive subdimension,only the intervention group improved from baseline at 6 months of follow-up(4.14±1.73 vs 5.40±1.81,P<0.05);in the social subdimension,only the control group had a difference from baseline at 1 month of follow-up(1.36± 1.24 vs 2.25±2.11,P<0.05);in the stigma,social support,physical discomfort subdivision,the two groups were followed up for 1 month,There was no difference from baseline at 6 months of follow-up(P>0.05),and no significant difference between the total scores of the two groups and the scoring groups of each dimension(P>0.05).3 Relationship between improved motor function and quality of life in elderly patients with PDSpearman-related analysis showed that the UPDRS score was negatively correlated with sleep score(P<0.01)and positively correlated with quality of life(P<0.05)after the intervention,and the subdimensional UPDRS-Ⅲ score and anxiety score were also positively correlated with quality of life score(P<0.01);and sleep score was inversely correlated with quality of life score(P<0.05).Conclusion1.The overall motor function score of elderly patients with Parkinson’s disease is poor,accompanied by mild anxiety and depression,and the dose of levodopa equivalent is an independent risk factor affecting the motor function of patients with PD.2.The implementation of the home rehabilitation exercise program developed in this study can effectively improve motor function,anxiety and depression and improve the quality of life of elderly patients with PD.3.The quality of life of elderly patients with PD is related to the patient’s motor function,mood,sleep,etc.while paying attention to the patient’s motor function,it is also necessary to consider the negative impact of emotions and sleep,and conduct a comprehensive comprehensive assessment and follow-up management of the elderly PD patients. |
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