Open Access Study protocol

Emergence and evolution of social self-management of Parkinson’s disease: study protocol for a 3-year prospective cohort study

Linda Tickle-Degnen1*, Marie Saint-Hilaire2, Cathi A Thomas2, Barbara Habermann3, Linda S Sprague Martinez4, Norma Terrin5, Farzad Noubary5 and Elena N Naumova6

Author Affiliations

1 Department of Occupational Therapy, School of Arts & Sciences, Tufts University, Medford, MA, USA

2 Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University Medical School, Boston Medical Center, Boston, MA, USA

3 School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, USA

4 Department of Public Health & Community Medicine, School of Medicine, Tufts University, Boston, MA, USA

5 Department of Medicine, School of Medicine, Tufts University, Boston, MA, USA

6 Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA

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BMC Neurology 2014, 14:95  doi:10.1186/1471-2377-14-95

Published: 2 May 2014



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.


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.


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.

Parkinson’s disease; Social participation; Daily life activities; Care giving; Facial expressiveness; Gender