Physical wellness, social functioning worse in patients with possible tardive dyskinesia

Key takeaways:

• Patient-rated severity and impact of possible TD were significantly associated with health and social functioning assessments.
• Those aware of visible abnormal involuntary movements had worse scores.

Physical wellness and social functioning were adversely affected in adults who were aware of abnormal involuntary movements indicative of tardive dyskinesia, according to research in the Journal of Patient-Reported Outcomes.

“Clinician-rated severity of tardive dyskinesia may not always correlate with patient perceptions of the significance of their TD,” Eiry W. Roberts, MD, chief medical officer at Neurocrine Biosciences, told Healio in an email. “Although many health care providers, patients and caregivers are aware of the impact of TD, quantitative assessments of health-related, quality-of-life impact of TD are limited.”

Investigators from Neurocrine and other research and academic institutions analyzed data from the RE-KINECT study — a real-world, observational study conducted at 37 outpatient psychiatry clinics in the United States from April 2017 to January 2018 — to determine the effects of potential tardive dyskinesia (TD) on patient health and social functioning.

Researchers divided participants into two cohorts: Cohort 1 consisted of patients with no visible abnormal involuntary movements or movements inconsistent with TD (n = 535) and cohort 2 included individuals with possible TD per clinician judgment (n = 204). Cohort 1 was further divided into a modified group of 450 individuals with no abnormal involuntary movements, while cohort 2 was divided into those aware of movements in the past 4 weeks (cohort 2A, n = 110) and those unaware of movements during that time (cohort 2NA, n = 94).

Participants were asked to complete EuroQoL’s EQ-5D-5L, which measures health in five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and the Sheehan Disability Scale (SDS) before clinical assessment and cohort assignment. The study also included evaluations of patient- and clinician-rated severity and patient-rated impact of possible TD (none, some, a lot).

Researchers used regression models to analyze associations between higher severity/impact scores and lower EQ-5D-5L utility, as well as associations between higher (worse) severity/impact scores and higher (worse) SDS total score.

According to results, a higher percentage of those in cohorts 2 and 2A reported moderate, severe or extreme problems across all EQ-5D-SL dimensions compared with those in modified cohort 1. And among cohort 2A individuals, patient-rated TD impact was highly and significantly associated with EQ-5D-5L utility (regression coefficient: 0.023) and SDS total score (1.027).

“Patient-reported outcomes regarding health and physical wellness (EQ-5D-5L) and social functioning (SDS) were generally worse in patients with clinician-confirmed possible TD (cohort 2) than in those with no abnormal involuntary movements (modified cohort 1),” researchers wrote.

Additionally, patient-rated severity was significantly associated with EQ-5D-5L utility (0.028), while clinician-rated severity was moderately associated with both EQ-5D-5L and SDS, although not statistically significant.

“The findings from this study demonstrated physical wellness and social functioning were diminished, particularly among patients with possible TD who were aware of their involuntary movements and rated those movements as having ‘a lot’ of impact on daily activities,” Roberts told Healio. “It is important for clinicians to not only assess possible presence and severity of TD, but also patient awareness of their own abnormal movements and the impact of these symptoms on the patients’ overall wellness.”