Use of Figurative Language by People With Parkinson Disease to Describe “Off” Periods

Abstract

BackgroundOFF periods are characterized by the reemergence of motor and non-motor symptoms in individuals with PD and often negatively impact daily functioning. Individuals’ experiences are diverse and may be difficult to articulate; figurative language is often used by patients to describe such experiences. Our objective was to understand how individuals with Parkinson’s Disease (PD) use figurative language to explain OFF periods and how experts interpret such expressions.MethodsIndividuals with self-reported PD participating in the online Fox Insight (FI) study were invited to participate in a survey about OFF periods. Those endorsing OFF periods were asked to describe their experiences with open-ended free text responses. Instances where any type of figurative language was used were identified and classified into themes. Three movement disorder neurologists reviewed each phrase and specified what symptoms they felt were likely represented.Results109 instances of figurative language phrases were identified across descriptions from 86 patients. Allusions to viscous materials (e.g. mud, cement) and effects of chemicals (e.g. drunkenness) were common (18.35% and 17.43% of phrases, respectively). Most phrases were interpreted by the neurologists as representing motor symptoms, but neurologists agreed on what specific symptom was being referred to for only 42 (38.5%) phrases.ConclusionTo describe OFF periods, individuals with PD use various forms of figurative language, but this language is not uniformly interpreted and understood by specialists. Given the subjective interpretation of figurative language, exploring what patients are trying to convey when they employ such language is important and could improve patient-physician communication.

Narrative medicine pinpoints loss of autonomy and stigma in Parkinson’s disease

“…(p. 98). This could impact factors such as physician-patient interaction, as was demonstrated by a study into the metaphors used by 86 individuals with Parkinson’s disease for whom their figurative language was not uniformly interpreted and understood by neurologists 27 .…”

“…The use of metaphors was reviewed and a list of themes common to at least two of the metaphors was generated. This method was previously used in a study among individuals with Parkinson’s disease imagining their “off” periods 27 . Classifications were reviewed by authors B.W.F., R.K., A.A.K., and B.R.B., and final classifications were chosen after discussion.…”