title: Emergence and evolution of social self-management of Parkinson's disease: study protocol for a 3-year prospective cohort study.
abstract: BACKGROUND
  Parkinson's disease affects facial, vocal and trunk muscles. As symptoms progress, facial expression becomes masked, limiting the person's ability to communicate emotions and intentions to others. As people with the disease live and reside in their homes longer, the burden of caregiving is unmitigated by social and emotional rewards provided by an expressive individual. Little is known about how adults living with Parkinson's disease manage their social lives and how an inability to be emotionally expressive can affect social connections and health. Because social networks have been shown to be crucial to the overall well-being of people living with chronic diseases, research is needed on how expressive capacity affects life trajectories and health.
  
  
  METHODS
  The overall objective is to understand the emergence and evolution of the trajectories of the self-management of the social lives of people living with Parkinson's disease. The central hypothesis is that expressive capacity predicts systematic change in the pattern of social self-management and quality of life outcomes. The specific aims of this 3-year longitudinal study of 120 people with the disease and a maximum of 120 care partners are: 1) characterize social self-management trajectories over a 3-year period; 2) estimate the degree to which expressive nonverbal capacity predicts the trajectory; and 3) determine the moderating effect of gender on the association between expressive capacity and change in social self-management. Each participant will be assessed 14 times to detect rapid and non-linear changes in social participation and management of social activities; social network; and social comfort, general health and well-being.
  
  
  CONCLUSIONS
  This project will provide evidence to guide the development of interventions for supporting social integration of those living with Parkinson's disease, thus leading to improved overall health. It focuses on the novel construct of social self-management and known factors-expressive capacity and gender-that contribute to stigmatization. The repeated measures design detects triggers of rapid changes in social and health outcomes.
authors.affiliation: Department of Occupational Therapy, School of Arts & Sciences, Tufts University, Medford, MA, USA. Linda.tickle_degnen@tufts.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Tickle-Degnen
authors.forename: Marie
authors.initials: M
authors.lastname: Saint-Hilaire
authors.forename: Cathi A
authors.initials: CA
authors.lastname: Thomas
authors.forename: Barbara
authors.initials: B
authors.lastname: Habermann
authors.forename: Linda S Sprague
authors.initials: LS
authors.lastname: Martinez
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.forename: Farzad
authors.initials: F
authors.lastname: Noubary
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D011446:Prospective Studies; D012107:Research Design; D012648:Self Care; D012737:Sex Factors; D012959:Socioeconomic Factors