In individuals diagnosed with Parkinson’s disease (P), does the implementation of complementary supportive therapies in conjunction with standard practice (I) improve quality of life

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Article Title, Date, and Author

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Author(s) and year

Research

Question/Purpose

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Study

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dependent

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Evidence Strength & Quality Rating

(JHNEBP), include

limitations/strengths

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Student Initials

Roseanne D. Dobkin, Sarah L. Mann, Michael A. Gara, Alejandro Interian, Kailyn M. Rodriguez, Matthew Menza (2020).

It was to see if patients with depression and Parkinson's disease (PD) can effectively alleviate their depressive symptoms significantly more than treatment as usual (TAU) alone with telephone-based cognitive-behavioral treatment (T-CBT) and TAU together (Dobkin et al., 2020).

It aims to use T-CBT as a way to get through access obstacles to multidisciplinary, evidence-based care and reduce depression in patients with PD, which is considered a need that is not often taken care of. It also aims to take advantage of telemedicine to extend the reach of evidence-based, PD-based depression treatment, and its great benefits for PD self-management. With T-CBT, patients with PD can benefit from their own home, and they do not have to live near any mental health services (Dobkin et al., 2020).

A randomized controlled trial

There were 72 people with PD and depression whose ages ranged from 59-75 years old. There were 35 males and 37 females. They were randomized into 37 people doing T-CBT and TAU together, which is the intervention, with 35 people doing only TAU, the control group. The setting was the Departments of Neurology and Psychiatry at Rutgers–Robert Wood Johnson Medical School. Between August 2015 and September 2017 from the Departments of Neurology and Psychiatry at Rutgers–Robert Wood Johnson Medical School, local PD support groups, and Fox Trial Finder (a clinical trial match tool), participants were found and recruited. When the last evaluation finished in June 2018, follow-up finished for patients as well (Dobkin et al., 2020).

The independent variables are T-CBT plus TAU and TAU alone. The primary dependent variable is the Hamilton Depression (HAM-D) Rating Score, which measures depressive symptoms. The secondary outcomes are anxiety and quality of life scores.

T-CBT and TAU together greatly improved mood (HAM-D) compared to TAU over the course of the trial ( F4,249 = 14.89, p < 0.0001) ( tables 2 and 3 and figure 2). Treatment effects ( p < 0.0001) were maintained at 6-month follow-up ( p < 0.0001). Self-reported depressive symptoms (BDI) (F4,244 = 5.07, p < 0.001), anxiety (HAM-A) (F4,249 = 8.63, p < 0.0001), and quality of life (SF-36 MCS) (F4,241 = 3.62, p = 0.007) had significant improvements (Dobkin et al., 2020). Depression and anxiety decreased while quality of life increased. Effects were consistent through 6-month follow-up (tables 2 and 3) (Dobkin et al., 2020).

This is Level 1, quality A research. A randomized controlled trial is one of the most top levels of research to find the relationship between the intervention and focused outcomes. This article provides consistent results with a sufficient sample size, adequate control, and definitive conclusions. Results are valid and reliable even after a 6 month follow-up.Strengths and limitations are clearly stated in the article. Here are the article’s limitations. One of them is that results may not apply well to people with advanced PD. The second one is that an existing practice control was used to compare the T-CBT results to the current care standard, and TAU may boost effect sizes relative to other kinds of comparison conditions. The third one is that it’s not doable to fully separate the effects of T-CBT from broad factors, such as therapeutic relationship, time, and attention, that can very well impact all psychotherapy outcomes (Dobkin et al., 2020). This would lower the chances of T-CBT being the major factor, but based on the study results, the T-CBT intervention seemed to have more of an impact that would lower the chances of the broad factors being more of a contribution. Fourth, this study had an a priori test of T-CBT's effectiveness at lowering negative thoughts, a key treatment target, but it was not made to assess the relative contributions of specific components of the intervention (e.g., cognitive, behavioral, and caregiver engagement strategies) or other clinical factors (e.g., antidepressant medication status) to the end treatment effect, which will be the focus of future dismantling studies (Dobkin et al., 2020). Fifth, even though 41% of T-CBT participants got to or went over the study criteria of depression “much improved” (CGI-I ≤ 2), and mean HAM-D scores lowered more than 1.5 standard deviations (SDs) in the T-CBT group, there were still reports of post-residual symptoms. This applies to the other tools and results. Finally, while remote delivery of interdisciplinary PD services is expanding and being seen as critical for advancing care, limitations stay on insurance coverage for telemental health services like T-CBT (Dobkin et al., 2020). Reimbursement may also be hard to achieve based on patients’ eligibilities of telehealth. In addition to the quality rating strengths, here are other strengths of the article. It helps the promise of telemedicine to extend the reach of evidence-based, PD depression treatment, and its grand benefits for PD self-management, into usual neurologic care. It addresses some gene

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