Recognition of the burden on the family is necessary for the continuity of care for the person with Parkinson's disease (PD), 1 especially during the Covid‐19 pandemic with lockdown restrictions. Overburdening family members can lead to symptoms of anxiety and depression and ultimately to an inability to maintain the informal role as a caregiver. This, in turn, can lead to premature formal home care and admission to a nursing home. The economic benefits of informal care are considerable, and therefore, it is important to increase the resilience of informal caregivers in an early phase and prevent overload at a later stage of the care process. Recently, we have adapted the existing online intervention “Partner in Balance” (PiB), developed for informal caregivers of people with mild dementia, 2 to PD: Parkinson Partner in Balance (PPiB). PiB concerns a self‐management training, aimed at maintaining a healthy balance in daily life (http://www.partnerinbalance.org/). It is given in a so‐called “blended” form, in which four of nine online modules, tailored to the needs of the caregiver, are combined with face‐to‐face and online conversations with a coach. Module themes are acceptance, balance in activities, communication, coping with stress, focusing on the positive, insecurities and rumination, self‐understanding, the changing family member, and social relations and support. PiB was experienced as feasible and appeared effective in terms of increased self‐efficacy, perceived control, and quality of life compared to usual care. 2 The modular design of PiB and the online environment provided an excellent infrastructure to further develop PiB into the version for caregivers of patients with PD (PPiB).
In line with the Medical Research Council (MRC) framework, a stepwise approach was adopted to explore the potential user needs for PPiB, followed by a pilot evaluation to test its feasibility and the measurement tools before the effect evaluation. Fifteen participants, all women, were divided over three trained coaches, and 11 participants (73%) completed the program within 8 weeks. Reasons for dropout were overburdening at the start (n = 2) and insufficient motivation (n = 2). Data were collected at baseline and after 8 weeks, including self‐report of self‐efficacy, perceived control, and mood. Structured interviews with both the coaches and the (11) participants showed that PPiB met the need for support, offered sufficient information and tools, and was not experienced as burdensome. The support of a coach was experienced as positive and stimulating by all participants. Exploratory data analysis in 11 participants showed significant improvement for self‐efficacy (P = 0.049) and perceived control (P = 0.035) but no significant change in mood (see Table 1).
TABLE 1.
Outcome (measurement tools) after Parkinson partner in balance
| Outcome | Pre‐intervention mean (SD) n = −11 | Post‐intervention mean (SD) n = 9 | P‐value* |
| Self‐efficacy | 54.5 (12.6) | 64.3 (11.3) | 0.049 |
| Perceived control | 22.9 (5.7) | 23.9 (5.9) | 0.035 |
| Anxiety | 7.3 (4.8) | 5.6 (3.5) | 0.79 |
| Depression | 6.2 (3.8) | 4.6 (3.0) | 0.53 |
Wilcoxon test; self‐efficacy is based on the Caregiver Self‐Efficacy Scale 4 (higher scores indicate higher levels), perceived control is based on the Pearlin Mastery Scale 5 (higher scores indicate higher levels), and anxiety and depression are both based on the Hospital Anxiety and Depression Scale 6 (higher scores indicate higher levels with those >8 meaning clinically significant anxiety and depression).
In conclusion, PPiB is feasible and promising for caregivers of patients with PD and contributes to the development of self‐management programs from a biopsychosocial perspective, which is still in its infancy in PD. 3 The next step will be to determine its effectiveness. Parallel to this, the program has been implemented as an online intervention in healthcare, and its introduction has been very much appreciated during the Covid‐19 pandemic in which e‐health is the answer to continue healthcare and support.
Author Roles
(1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique.
A.A.D.: 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B
L.M.M.B.: 1A, 1B, 1C, 3B
A.E.P.M.: 1B, 1C, 3B
A.J.H.M.: 1B, 1C, 3B
M.E.V.: 1A, 1B, 2C, 3B
Financial Disclosures
Funding for this work was received from CZ Group, Health Services, and The Netherlands (201700294). This work was considered as non‐WMO applicable according to the METC MUMC/Maastricht University 2018–0637. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
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