title: Patients' expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach.
abstract: OBJECTIVE
  To study patients' expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD).
  
  
  METHODS
  PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests.
  
  
  RESULTS
  Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified.
  
  
  CONCLUSIONS
  The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).
authors.affiliation: Department of Neurology, University of Cologne, , Cologne, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Maier
authors.forename: Catharine J
authors.initials: CJ
authors.lastname: Lewis
authors.forename: Nina
authors.initials: N
authors.lastname: Horstkoetter
authors.forename: Carsten
authors.initials: C
authors.lastname: Eggers
authors.forename: Elke
authors.initials: E
authors.lastname: Kalbe
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.forename: Mateusz
authors.initials: M
authors.lastname: Zurowski
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: Christiane
authors.initials: C
authors.lastname: Woopen
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D057565:Apathy; D003469:Culture; D046690:Deep Brain Stimulation / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D055809:Illness Behavior; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D017060:Patient Satisfaction; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D020531:Subthalamic Nucleus / Q000503:physiopathology; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: NEUROPSYCHIATRY; NEUROPSYCHOLOGY; PARKINSON'S DISEASE; QUALITY OF LIFE; STEREOTAXIC SURGERY