Trajectories and Predictors of Activity Participation Among People with Parkinson Disease: A 3-Year Longitudinal Study.

OBJECTIVE

To investigate how participation changes over time among individuals with Parkinsondisease (PD) and identify factors influencing these changes, focusing on impairment level and social factors.

DESIGN

Secondary analysis of a 3-year prospective cohort study of social self-management of PD. Data were collected during 4 in-person assessments conducted at baseline and then annually thereafter. Multilevel modeling was used to analyze data from the 4 time points.

SETTING

Department of Occupational Therapy Research Laboratory and Department of Neurology Movement Disorder Clinic.

PARTICIPANTS

A total of 86 individuals (N = 86) with idiopathic PD (Hoehn & Yahr stages I-IV; mean age ± SD, 65.0 ± 9.6y).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Participation was measured by the Activity Card Sort. Potential predictors contributing to changes in participation included motor impairment (Movement Disorder Society-Unified Parkinson Disease Rating Scale-III), depressive symptoms (Geriatric Depression Scale), cognitive function (Montreal Cognitive Assessment), social isolation (Nottingham Health Profile), and social support (Health Management Resources Survey).

RESULTS

There were no significant changes in overall activity participation over the 3-year period among the participants with PD. More severe depressive symptoms were associated with reduced participation in instrumental (β = -0.42, P < .01), high-demand leisure (β = -0.22, P = .04), and social activities (β = -0.41, P < .01). Greater social support from family and friends (β = 0.77, P = .03) and organizations (β = 1.07, P < .01) was associated with greater participation in social activities.

CONCLUSIONS

Depressive symptoms were a significant within-person driver of restricted participation in instrumental, high-demand leisure, and social activities, as well as in the global domain, whereas higher social support from organizations, family, and friends predicted greater participation, particularly in social and global activity participation. Early detection of depressive symptoms and strategies to enhance social support resources may help promote sustained activity participation in this population.