The Mediating Effect of Spiritual Well-Being and Quality of Life for Persons with Parkinson's Disease in Northern Taiwan.

BACKGROUND: Parkinson's disease (PD), a degenerative disease with irreversible motor dysfunction, impacts patients' quality of life (QoL). Spirituality can provide a sense of hope and meaning when individuals are faced with adverse life events, such as a diagnosis of PD. However, few studies have examined the relationship between spiritual well-being and QoL for persons with PD. OBJECTIVE: To explore the relationships between the disease characteristics, spirituality and QoL for persons with PD, and verify the mediating effects of spirituality on the relationship. METHODS: This cross-sectional study recruited patients with PD (n = 110) by convenience sampling from a neurological clinic in northern Taiwan. Variables were measured using the Spirituality Index of Well-Being Chinese version (SIWB-C) and the 39-item Parkinson's disease Quality of Life Questionnaire Chinese version (PDQ-39-C) self-report questionnaires. Descriptive analysis and linear hierarchical regression were conducted to examine the studied variables and explore the mediating effect of spiritual wellbeing. RESULTS: Those whose scores were significantly better in PDQ-39 were younger, employed, with shorter disease duration and less severe condition with better functioning on their early stages and lower LEDD; additionally, those who had better quality of life also experienced better spiritual wellbeing than the counterparts. The regression model demonstrated spiritual self-efficacy had mediating effects between disease characteristics and QoL, explaining 69.8%of the variance (adjusted R2 = 65.3%). CONCLUSION: The results can be the references for future strategies and interventions, focusing on increasing spiritual self-efficacy and reducing the impact of disease severity to improve QoL for persons with PD.

Poor functional recovery may indicate restenosis in patients after coronary angioplasty.

OBJECTIVE: To investigate whether poor response to exercise training can detect restenosis in asymptomatic patients after percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Case-control study. SETTING: A hospital-based outpatient cardiac rehabilitation program in Taiwan. PARTICIPANTS: Sixteen patients aged 49.7+/-7.8 years who had undergone PTCA and completed a 3-month exercise program. Patients were separated into a restenosis group (n=7; age, 46.4+/-9.8y) and a nonrestenosis group (n=9; age, 52.3+/-12.9y), according to their angiography follow-up results. The interval between PTCA and angiography ranged from 6 months to 2 years. INTERVENTION: Bicycle exercise workouts were conducted 3 times a week during rehabilitation, with exercise intensity adjusted to each patient's ventilatory threshold. MAIN OUTCOME MEASURES: A graded exercise test with gas analysis was conducted before training, at 6 weeks and at 3 months after training, to evaluate the sequential changes of cardiorespiratory function. RESULTS: After 3 months of training, the nonrestenosis group showed an increase of 30.4% in peak oxygen uptake (Vo(2)peak, P<.05), 13.7% in peak oxygen pulse (P<.05), 22.2% in peak rate-pressure product (P<.05), and 13.6% in peak work rate (P<.05). Most of the improvement occurred within the first 6 weeks of training. The restenosis group did not show significant increase in these variables. At the ventilatory threshold, the nonrestenosis group also displayed a significant increase of Vdot;o(2), oxygen pulse, and work rate. However, the restenosis group showed no improvement after training. CONCLUSION: Functional recovery appears to be a good indicator of restenosis for patients after PTCA. A poor response to exercise can be noted within 6 weeks of training in PTCA patients with restenosis.

Improvement of cardiorespiratory function after percutaneous transluminal coronary angioplasty or coronary artery bypass grafting.

OBJECTIVE: The objective of this study was to investigate the effect of a 3-mo training program for patients with either a percutaneous transluminal coronary angioplasty (PTCA) or a coronary artery bypass grafting (CABG). DESIGN: Forty-four patients participated in a 3-mo outpatient cardiac rehabilitation program. Graded exercise tests with gas analysis were conducted before and after training to evaluate the changes of cardiorespiratory function. RESULTS: In the pretraining examination, the PTCA group showed a higher peak oxygen uptake (VO2peak) and work rate than the CABG group. In the posttraining examination, the PTCA group increased 14.6% in VO2peak. Meanwhile, the CABG group increased 32.8% in VO2peak. At the ventilatory threshold, both groups also significantly increased in Vo2. CONCLUSIONS: A 3-mo cardiac rehabilitation program for patients with PTCA or CABG could favorably enhance their cardiorespiratory function. Although the pretraining VO2peak was lower for the patients with CABG, their training potential was greater, and hence they could achieve a similar level of aerobic capacity as the PTCA group.