Triple perspective: assessing deep brain stimulation outcomes in Parkinson's disease

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for advanced Parkinson’s disease (PD), often leading to positive motor and non-motor outcomes. While objective motor improvements after DBS are well documented, less is known about how patients and all those involved in their care perceive these benefits on a subjective level. Objectives: The primary aim of the study was to investigate the perception gap between patients, caregivers, and treating neurologists regarding DBS physical and psychological benefits in PD and their correlates. Methods: 25 PD patients (age 58.9 ± 8.0 years; 9 women) who underwent bilateral STN-DBS, along with their caregivers and neurologists, rated perceived psychological and physical improvements 6 months after surgery using a two-item Visual Analogue Scales (VAS, 0–10). Intraclass correlation coefficients (ICC [95% confidence interval]) were calculated to assess reliability between raters. Results: Patients, caregivers, and neurologists reported an average improvement of about 60% in the psychological domain and over 75% in the physical domain (p < 0.001). No significant differences emerged between groups in two domains (p > 0.05). Inter-rater agreement was moderate-to-good for psychological improvement (0.74 [0.41–0.90], p < 0.001), moderate for physical improvement (0.69 [0.27–0.88], p = 0.003), and good overall (0.79 [0.50–0.92], p < 0.001). Conclusions: PD patients, caregivers, and neurologists largely agree on the benefits of DBS six months post-surgery, reinforcing the reliability of patient self-report in outcome assessment. Integrating patient self-reports with proxy assessments enhances the evaluation of DBS outcomes, supporting a more comprehensive and patient-centered approach to both treatment assessment and post-surgical care.