Programme(s) to which this project applies:
|☑ MPhil/PhD||☒ MRes[Med]||☒ URIS|
Between 40–50% of patients with Parkinson’s disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery.
There is evolving evidence to suggest that the use of individual mindfulness techniques has very desirable therapeutic effects on stress and symptom management in PD. Two such techniques are meditation and yoga. ‘Mindfulness in stillness’ and ‘mindfulness in motion’, respectively, meditation focuses on maintaining mental awareness in the present moment, and yoga relies on maintaining mental awareness through physical exertion. Investigating the individual use of these mindfulness techniques compared to usual care can provide a wider repertoire of evidence-based interventions to support the psychological health of PD patients.
This multi-center, three-arm randomized controlled trial will adopt sequential explanatory mixed-method design to investigate the effects on anxiety and depression and acceptability among PD patients of meditation alone and yoga alone compared to usual care control over a 6-month study period. 168 PD patients will be randomly allocated to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses are measured as mediating variables. All outcome evaluations will be assessed at baseline, 1-week, and 4-month post-intervention. The qualitative part will invite 30 participants from each intervention group to participate in individual interviews to explore their experiences and acceptance of the mindfulness technique as a lifestyle intervention for psychological distress management. Generalised Estimating Equation models with intention-to-treat analysis will be used to compare the changes in all outcomes over time within and between different arms (i.e. time effect, group effect, group*time effect). Inductive thematic analysis will be used for the qualitative data.
This study will generate high scientific evidence to inform the application of mindfulness as a public health practice preventing progression of psychological distress in PD patients to a clinically severe level. The self-help nature of such practice also implies its high relevance in enriching primary care for this clinical cohort.
Dr YY Kwok, School of Nursing
Dr. Jojo Kwok is an Assistant Professor at the School of Nursing, The University of Hong Kong, as well as a registered nurse and certified yoga instructor in Hong Kong. Her research focuses on chronic illness care, gerontology, mental health and behavioral medicine, with a special emphasis on Parkinson’s disease. Her ongoing research projects include the effects and mechanisms of individual mindfulness techniques in people with Parkinson’s disease. Her research findings have been published in leading international journals such as JAMA Neurology, Journal of the American Medical Directors Association and Journal of Neurology, and featured as impactful news in both local and international mass media, including Reuters Health and Radio Television Hong Kong. She has also been invited to present in international conferences such as the International Conference on Frontiers in Yoga Research and its Applications (INCOFYRA) and Symposium on Yoga Research. She has received an Outstanding New Researcher Award, an Early Career Award and a Meritorious Scientific Abstract Award offered by the International Society of Behavioral Medicine (ISBM) in 2021 and 2018, respectively.
In addition to her research achievement, Dr. Kwok has received a Pi Iota Chapter Scholarship Award (Nurse Leader) in 2020 from The Sigma Theta Tau International Honor Society of Nursing in recognition of her significant contribution and leadership in community services. She has been appointed as an external reviewer for national competitive research grants such as the Dutch Research Council (NOW) Talent Programme and the Austrian Science Fund. She is dedicated to her profession. She has been appointed as a council member of the Hong Kong Parkinson's Disease Foundation (HKPDF) in 2022, and a committee member of the HKPDF Education and Training Committee since 2016 to contribute to quarterly education materials regarding evidence-based nursing practice for Parkinson’s disease.
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