Behavioral therapy to treat urinary symptoms in Parkinson's disease

行为疗法治疗帕金森病的泌尿系统症状

• 批准号: 8838206
• 负责人: Elizabeth Camille Vaughan
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838206
• 关键词: Adult; Adverse effects; Affect; Aging; Aging-Related Process; Anti-Cholinergics; Antiparkinson Agents; Autonomic Dysfunction; Behavior Control; Behavior Therapy; Behavioral; Biometry; Bladder; Caring; Clinical Trials Design; Cognitive; Cognitive aging; Data; Disease; Disease Management; Doctor of Philosophy; Elderly; Epidemiology; Evidence based treatment; Exercise; Expert Opinion; Faculty; Frequencies; Functional disorder; Funding; Gender; General Population; Geriatrics; Goals; Guidelines; Health Services; Individual; Intervention; Knowledge; Learning; Measures; Mentors; Modeling; Motor; Movement Disorders; Neuropsychology; Outpatients; Parkinson Disease; Participant; Patients; Pelvic Floor Muscle; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physical therapy exercises; Population; Prevalence; Psychology; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Reaction Time; Reading; Research; Research Methodology; Research Personnel; Serial Learning; Severities; Severity of illness; Staging; Stratification; Symptoms; Therapeutic; Training; United States; Urinary Incontinence; Urine; Veterans; Vulnerable Populations; abstracting; base; burden of illness; career; career development; clinical care; diaries; disability; follow-up; implicit memory; improved; longitudinal analysis; lower urinary tract symptoms; motor skill learning; non-motor symptom; primary outcome; skills; success; urinary

DESCRIPTION (provided by applicant) An estimated 40% of Parkinson's disease (PD) patients suffer from lower urinary tract symptoms (LUTS) including more than 25% who have urinary incontinence (UI). Current treatment guidelines, that recommend treatment with anticholinergic drugs, are based on expert opinion, because no randomized controlled trials of any therapy for LUTS (including UI) have been completed to date in adults with PD. Anticholinergic medications typically used to treat urinary symptoms can add to the anticholinergic burden of antiparkinsonian therapy, and thus to the cognitive and autonomic burdens of the illness. Meanwhile, behavioral interventions for UI - including pelvic floor muscle exercise (PFME) therapy - have proven efficacy in randomized controlled trials and are free of side effects. Exercise-based behavioral interventions for UI require individuals to learn motor skills (PFME) and implement an adaptive strategy. As a first step in improving evidence-based treatment guidelines, the candidate published an abstract of the only known study demonstrating the feasibility and potential therapeutic benefit of using exercise-based behavioral therapy to treat UI in adults with PD. Randomized controlled trials of behavioral therapy would provide a logical next step to optimize the care of veterans with PD and LUTS. The project goals for this proposal include: 1. Evaluate the efficacy of exercise-based behavioral therapy to treat LUTS among veterans with PD using a randomized controlled trial design. 2. Explore the mechanism utilized by PD participants to learn and implement the exercise-based behavioral strategy as a motor task of procedural learning using implicit memory. 3. Gain knowledge and expertise in aging processes that affect the ability to learn and remember both factual knowledge and procedural skills. 4. Gain understanding of autonomic dysfunction and technical skill in evaluating autonomic function. 5. Gain advanced biostatistical training in the analysis of longitudinal data. Mentoring: The mentoring team combines faculty with expertise in research methodology, the care of persons with PD, and management of voiding dysfunction. Mentors include: Theodore M. Johnson, II, MD, MPH (Primary, geriatrics), Kathryn L. Burgio, PhD (behavioral psychology), and Jorge L. Juncos, MD (movement disorders). Advisors: Gerald McGwin, PhD (biostatistics) and Felicia Goldstein, PhD (neuropsychology). Career and Research Plan: A randomized controlled trial is proposed to assess the efficacy of pelvic floor muscle exercise-based behavioral therapy to treat LUTS in adults with PD. After stratification by UI severity, PD severity, and gender, a group of 60 subjects (30 in each group) will be randomized to receive behavioral therapy or a behavioral control over 8 weeks. A 6-month follow-up is planned among participants who complete the behavioral therapy intervention. The primary outcome (frequency of UI) will be measured using a seven-day bladder diary. A motor task of procedural learning (Serial Reaction Time Task (SRTT)) will be administered at baseline to all participants. Exploratory analyses will assess performance on the SRTT as a predictor of success in implementing exercise-based behavioral therapy to reduce weekly UI frequency. Career development activities include advanced biostatistical coursework in epidemiologic modeling and longitudinal analyses. Advanced coursework and directed readings in cognitive aging are proposed. The candidate will increase her knowledge of autonomic dysfunction through directed readings, coursework, and practical training. The candidate expects the proposed career and research plan will prepare her to apply for Merit Review funding to establish independence as an investigator and provide needed evidence to support guidelines for the treatment of LUTS in veterans with PD.

描述（由申请人提供） 估计有40％的帕金森氏病（PD）患者患有较低的尿路症状（LUTS），其中包括超过25％的尿失禁（UI）。当前建议用抗胆碱能药物治疗的治疗指南基于专家意见，因为在患有PD的成年人中，尚未完成对LUTS（包括UI）的任何疗法（包括UI）的随机对照试验。抗胆碱能药物通常用于治疗泌尿症状，可能会增加抗帕金森氏疗法的抗胆碱能力负担，从而增加疾病的认知和自主负担。同时，UI的行为干预措施（包括骨盆底肌肉运动（PFME）疗法）在随机对照试验中已证明了功效，并且没有副作用。基于运动的UI行为干预需要个人学习运动技能（PFME）并实施自适应策略。作为改善基于证据的治疗指南的第一步，该候选人发表了摘要的摘要，摘要表明，使用基于运动的行为疗法来治疗PD成人的UI具有可行性和潜在的治疗益处。行为疗法的随机对照试验将提供一个合乎逻辑的下一步，以优化具有PD和LUTS的退伍军人的护理。该提案的项目目标包括：1。使用随机对照试验设计，评估基于运动的行为疗法在PD中处理LUT的功效。 2。探索PD参与者使用的机制来学习和实施基于运动的行为策略，作为使用隐式记忆的程序学习的运动任务。 3.在衰老过程中获得知识和专业知识，这些过程影响了学习和记住事实知识和程序技能的能力。 4。了解评估自主功能的自主功能障碍和技术技能。 5。在纵向数据分析中获得高级生物统计训练。指导：指导团队将教职员工与研究方法的专业知识，PD人员的护理以及缺乏功能障碍的管理相结合。导师包括：西奥多·约翰逊（Theodore M.顾问：杰拉尔德·麦格温（Gerald McGwin）博士（生物统计学）和Felicia Goldstein，PhD（神经心理学）。职业和研究计划：提出了一项随机对照试验，以评估基于PD的成年人的LUTS治疗LUTS的骨盆肌肉锻炼的功效。通过UI严重程度，PD严重程度和性别分层后，将随机分配60名受试者（每组30名），以在8周内接受行为疗法或行为控制。计划在完成行为疗法干预的参与者中进行6个月的随访。主要结果（UI的频率）将使用7天的膀胱日记来测量。程序学习的运动任务（串行反应时间任务（SRTT））将在基准时给所有参与者。探索性分析将评估SRTT的绩效，以预测实施基于运动的行为疗法以降低每周UI频率的成功。职业发展活动包括流行病学建模和纵向分析的高级生物统计课程。提出了高级课程和认知衰老中的定向阅读。候选人将通过定向阅读，课程和实践培训来提高她对自主功能障碍的了解。候选人期望拟议的职业和研究计划将使她准备申请优异的审查资金，以建立独立作为研究者，并提供所需的证据，以支持与PD退伍军人在退伍军人中治疗LUTS的指南。