An Explanatory Study of the Lower Urinary Tract Symptom Experience and Quality of Life in Men with Parkinson's Disease
Joanne P. Robinson, PhD, APRN, BC, College of Nursing, Rutgers, The State University of New Jersey, Associate Professor, Newark, NJ 07102, Lisette K. Bunting-Perry, MScN, RN, CCRC, Veterans Affairs Medical Center/University of Pennsylvania School of Nursing, Associate Clinical Director, Parkinson's Disease Research, Education, & Clinical Center/Doctoral Candidate, Philadelphia, PA 19104, Helene Moriarty, PhD, RN, CS, Veterans Affairs Medical Center/University of Pennsylvania School of Nursing, Nurse Researcher/Adjunct Professor, Philadelphia, PA 19104, and Tamara Avi-Itzhak, DSc, York College, City University of New York, Associate Professor, Jamaica, NY.
Parkinson's disease (PD), the second most common neurological disorder in the US, contributes to considerable disability and diminished quality of life. Lower urinary tract symptoms (LUTS) are common in PD patients, but are seldom addressed clinically and have not been well studied. Theoretical understanding of the LUTS experience in PD patients is fundamental to designing interventions for LUTS in this population. The purpose of this study was to test propositions of the Theory of Unpleasant Symptoms concerning LUTS intensity, LUTS distress, and health related quality of life (HRQL) in men with PD. Methods: Participants in this cross-sectional study were men recruited from the movement disorder clinic of a Veterans Affairs Medical Center. Eligibility criteria included: self-reported LUTS, idiopathic PD diagnosis, Mini Mental Status Exam score ≥ 24, and English language competence. The sample (N=88) was primarily Caucasian (96%) with mild bilateral disease (68%) and a mean age of 72 years (sd=8). Measures of study variables were the Unified Parkinson's Disease Rating Scale (neurological symptoms and functional status); Male Urogenital Distress Inventory (LUTS intensity and LUTS distress); and Male Urinary Symptom Impact Questionnaire (HRQL). Correlations among variables were examined. Multiple regression was used to identify configurations of predictors of LUTS intensity, LUTS distress, and HRQL. Results: Cognitive/affective function (p<.001) and age (p<.01) explained 16.4% of the variance in LUTS intensity. Cognitive/affective function (p<.001) also explained 14.1% of the variance in LUTS distress. LUTS intensity and LUTS distress were highly correlated (r=.90, p<.001). The best predictive model of HRQL included LUTS distress (p<.001) and activity of daily living function (p<.01), which explained 64.5% of the variance. Conclusion: Findings support propositions of the Theory of Unpleasant Symptoms and the need to design and test interventions with a psychoeducational component to mitigate LUTS distress and improve HRQL in men with PD.