Analysis of the application value of the Roy Adaptation Model in Parkinson's disease nursing care: A non-blinded, single-center observational study

Xu, Yong-Li; Hu, Yunxin; Luo, Na; Sun, Lu; Xiao, Xiaomei; Tang, Liu; Li, Yan

doi:10.1016/j.clinsp.2025.100820

person Yong-Li Xu

read · approved the manuscript for publication · project administrators · contributed to the supervision · resources · methodology · validation · and literature review of the study · drafting · editing · and critical review of content of the manuscript for intellectual content · agree to be accountable for all aspects of this study · ensuring its integrity · accuracy

schoolDepartment of Neurology VI, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0004-4771-557X

person Yunxin Hu

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schoolDepartment of Neurology VI, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0004-7949-8506

person Na Luo

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schoolDepartment of Neurology VI, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0002-8004-2501

person Lu Sun

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schoolDepartment of Nursing Administration, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0005-8351-5521

person Xiaomei Xiao

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schoolDepartment of Neurology VI, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0008-7816-8440

person Liu Tang

read · approved the manuscript for publication · methodology · formal analysis · data curation · validation · supervision · and literature review of the study · drafting · editing · and critical review of content of the manuscript for intellectual content · agree to be accountable for all aspects of this study · ensuring its integrity · accuracy

schoolDepartment of Neurology VI, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0002-5997-5876

person Yan Li *

read · approved the manuscript for publication · resources · methodology · formal analysis · software · visualization · and literature review of the study · drafting · editing · and critical review of content of the manuscript for intellectual content · agree to be accountable for all aspects of this study · ensuring its integrity · accuracy

schoolDepartment of Nursing Administration, Guangdong 999 Brain Hospital, Guangzhou, Guangdong Province, China, 510650

0009-0008-9848-8345

person* Corresponding author.
E-mail address:liyan1311@crmedical.hk (Y. Li)

Edited by

José Maria Soares Junior

Declaration of competing interest

The authors declare that they have no conflicts of interest or any competing interests regarding the results and/or discussions reported in this research.

Study	Published year	Patients’ ethnicity	Sample size (N; eyes)	Age	Main disease(s)	Main conclusions
Case report, Du et al.⁵	2024	Chinese	1	78 years	Dyskinesia hyperpyrexia syndrome	Reducing dopaminergic medications with standard medical care is effective in dyskinesia hyperpyrexia syndrome.
Randomized control study, Zhang et al.⁷	2021	Chinese	120	65 to 85 years (average 74.22±7.97 years)	Hypertension	Nursing intervention based on Roy’s adaptation model enhances self-efficacy, self-management, behaviors, and quality of life, adherence, and compliance of elderly hypertensive patients.
Cross-sectional study, Huang et al.⁸	2024	Chinese	203	≥18-year	Parkinson’s disease	Seasonal variation in temperature may affect motor symptoms in patients with Parkinson’s disease.
Prospective study, Zeng et al.⁹	2022	Chinese	80	Average: 64.21±8.74 years	Parkinson’s disease	Triangle’s tiered and graded management care is effective in Parkinson’s disease patients.
Cross-sectional study, Deal et al.¹⁰	2019	United States of America	29	Mean: 60.8	Parkinson’s disease	Daily activities instruments evaluate everyday life activities of Parkinson’s disease patients.

Parameters		Cohorts		Comparisons between groups
Parameters		Control group	Observation group
Non-treatment interventions		Routine nursing care	The Roy Adaptation Model
Numbers of patients		136	136	p-value	Degree of freedom	Test value	95 %CI
Sex	Male	70(51)	72(53)	0.903 (χ²-test)	1	0.0147	0.7655 to 1.232
Sex	Female	66(49)	64(47)	0.903 (χ²-test)	1	0.0147	0.7655 to 1.232
Age (years)		65.39±4.37	66.02±4.48	0.242 (Unpaired t-test)	270	1.174	−0.4266 to 1.687
Disease duration (years)		5.92±2.78	6.01±2.86	0.793 (Unpaired t-test)	270	0.2632	−0.5833 to 0.7633
Ethnicity	Han Chinese	129(94)	124(91)	0.342 (Fisher-Freeman-Halton test)	N/A	1.384	0.7587 to 2.525
	Mongolian	5(4)	9(7)
	Tibetan	1(1)	2(1)
	Uyghur Muslim	1(1)	1(1)
Education	Primitive	33(24)	32(24)	0.943 (χ²-test for Independence)	2	0.1167	N/A
	Below graduate	83(61)	82(61)
	Graduate or above	20(15)	22(15)
Hoehn-Yahr Stage	I	69(51)	59(43)	0.257 (χ²-test for Independence)	2	2.715	N/A
	II	42(31)	55(40)
	III	25(18)	22(17)
Medication regimens	Dopamine agonist	38(28)	35(26)	0.931 (χ²-test for Independence)	4	0.8538	N/A
	Dopamine agonist + Sleep problem treatments	55(40)	51(38)
	Dopamine agonist + gabapentin (Neurontin)	25(18)	30(22)
	Dopamine agonist + Sleep problem treatments + gabapentin (Neurontin)	15(11)	17(11)
	Others (not specified by physician)	3(3)	3(3)

Items	Time point	Control group, n = 136	Observation group, n = 136	t-value	p-value
Self-care	Before	2.55 ± 0.87	2.56 ± 0.69	0.074	0.941
Self-care	After	1.66 ± 0.48	1.43 ± 0.44a	2.913	0.004
Speech	Before	2.88 ± 0.82	2.79 ± 0.78	0.656	0.513
Speech	After	1.95 ± 0.55	1.73 ± 0.59a	2.249	0.026
Reduced bimanual activity	Before	2.67 ± 0.84	2.62 ± 0.77	0.362	0.718
Reduced bimanual activity	After	1.95 ± 0.55	1.48 ± 0.43a	5.551	<0.001
Rigidity	Before	2.74 ± 0.67	2.68 ± 0.71	0.507	0.613
Rigidity	After	1.93 ± 0.56	1.64 ± 0.45a	3.329	0.001
Posture	Before	2.71 ± 0.54	2.79 ± 0.46	0.950	0.354
Posture	After	1.85 ± 0.53	1.59 ± 0.52a	2.858	0.005
Upper limb Swing	Before	2.77 ± 0.73	2.79 ± 0.69	0.164	0.870
Upper limb Swing	After	2.48 ± 0.63	1.43 ± 0.42a	5.574	<0.001
Gait	Before	2.81 ± 0.69	2.82 ± 0.72	0.683	0.934
Gait	After	2.31 ± 0.55	1.52 ± 0.52a	5.468	0.001
Tremor	Before	2.48 ± 0.61	2.52 ± 0.58	0.392	0.969
Tremor	After	1.93 ± 0.46	1.76 ± 0.45a	2.176	0.031
Facial expression	Before	2.85 ± 0.74	2.79 ± 0.68	0.492	0.623
Facial expression	After	2.29 ± 0.46	1.71 ± 1.56a	2.941	0.004
Rising from the chair	Before	2.87 ± 0.63	2.89 ± 0.67	0.351	0.741
Rising from the chair	After	2.55 ± 0.46	1.53 ± 0.48a	12.862	<0.001

Items	Groups	Before Treatment	After Treatment
Parkinsonian symptoms	Control group, n = 136	48.95 ± 7.45	37.02 ± 3.55
	Observation group, n = 136	49.53 ± 7.19	32.24 ± 0.3a
	t-value	0.482	15.647
	p-value	0.075	<0.001
Systemic symptoms	Control group, n = 136	22.94 ± 4.88	14.12 ± 2.28
	Observation group, n = 136	24.24 ± 3.26	13.26 ± 0.69a
	t-value	1.837	4.21
	p-value	0.070	<0.001
Emotional functioning	Control group, n = 136	32.39 ± 5.22	26.23 ± 6.55
	Observation group, n = 136	32.63 ± 6.18	24.22 ± 1.23a
	t-value	0.245	3.517
	p-value	0.807	0.001
Social functioning	Control group, n = 136	23.42 ± 6.53	17.63 ± 3.95
	Observation group, n = 136	23.85 ± 6.82	15.22 ± 1.43a
	t-value	0.376	6.69
	p-value	0.708	<0.001

Items	Groups	Before Treatment	After Treatment	Cronbach’s α
Daily living activities	Control group, n = 136	75.62 ± 6.94	81.35 ± 7.80	0.86
	Observation group, n = 136	75.33 ± 6.89	92.45 ± 8.62a
	t-value	0.202	7.846
	p-value	0.840	<0.001
Health behavior	Control group, n = 136	78.49 ± 6.95	84.52 ± 7.58	0.85
	Observation group, n = 136	78.62 ± 7.05	93.15 ± 8.95a
	t-value	0.108	6.068
	p-value	0.914	<0.001
Compliance behavior	Control group, n = 136	70.23 ± 6.79	89.46 ± 7.45	0.83
	Observation group, n = 136	69.78 ± 6.75	94.53 ± 7.55a
	t-value	0.388	3.803
	p-value	0.699	<0.001
Emotional management	Control group, n = 136	73.16 ± 7.44	82.31 ± 7.68	0.81
	Observation group, n = 136	72.35 ± 7.45	90.82 ± 7.82a
	t-value	0.634	6.403
	p-value	0.527	<0.001

Group	n	Very satisfied	Generally satisfied	Dissatisfied	Total satisfaction rate
Control group	136	60 (44.12)	56 (41.18)	20 (14.71)	116 (85.29)
Observation group	136	80 (58.82)	50 (36.76)	6 (4.41)	130 (95.59)
χ²-value	‒	1.957	0.538	7.037	7.037
p-value	‒	0.190	0.864	0.014	0.014

Parameters	Test
Categorial variables
2 × 2 Tables	Fisher's exact test or Chi-Square test (if individual sample > 5 and sample size > 40). Chi-Square test with Yates’ corrections if individual sample < 10).
Larger than 2 × 2 cells Tables	Fisher-Freeman-Halton test if fewer than 6 elements in the contingency table per group otherwise Chi-Square of independence.
Continuous variables
Age (years)	p > 0.05 for both columns in the Kolmogorov and Smirnov method and the p = 0.387 for Bartlett's test. Therefore, two-tailed unpaired t-test was used.
Disease duration (years)	p > 0.05 for both columns in the Kolmogorov and Smirnov method and the p = 0.371 for Bartlett's test. Therefore, two-tailed unpaired t-test was used.
All parameters of Webster scores	p > 0.05 for both columns in the Kolmogorov and Smirnov method and the Bartlett's test. Therefore, two-tailed unpaired t-test was used.
All parameters of Parkinson's Disease Quality of Life Questionnaire score	p > 0.05 for both columns in the Kolmogorov and Smirnov method and the Bartlett's test. Therefore, two-tailed unpaired t-test was used.
All parameters of self-efficacy scores score	p > 0.05 for both columns in the Kolmogorov and Smirnov method and the Bartlett's test. Therefore, two-tailed unpaired t-test was used.

[1] The table maintains the original format and statistical presentation, with scores shown as mean ± standard deviation. An unpaired t-test was used for statistical analyses.

[2] p-values <0.05 indicate statistical significance.

[3] Higher scores indicate more severe symptoms.

[4] The degree of freedom was 270 for all comparisons.

[TFN1] ^a
Significantly lower scores compared that of the control group.