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Korb A, Tajbakhsh S, Comai GE. Functional specialisation and coordination of myonuclei. Biol Rev Camb Philos Soc 2024; 99:1164-1195. [PMID: 38477382 DOI: 10.1111/brv.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Myofibres serve as the functional unit for locomotion, with the sarcomere as fundamental subunit. Running the entire length of this structure are hundreds of myonuclei, located at the periphery of the myofibre, juxtaposed to the plasma membrane. Myonuclear specialisation and clustering at the centre and ends of the fibre are known to be essential for muscle contraction, yet the molecular basis of this regionalisation has remained unclear. While the 'myonuclear domain hypothesis' helped explain how myonuclei can independently govern large cytoplasmic territories, novel technologies have provided granularity on the diverse transcriptional programs running simultaneously within the syncytia and added a new perspective on how myonuclei communicate. Building upon this, we explore the critical cellular and molecular sources of transcriptional and functional heterogeneity within myofibres, discussing the impact of intrinsic and extrinsic factors on myonuclear programs. This knowledge provides new insights for understanding muscle development, repair, and disease, but also opens avenues for the development of novel and precise therapeutic approaches.
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Affiliation(s)
- Amaury Korb
- Institut Pasteur, Université Paris Cité, CNRS UMR 3738, Stem Cells & Development Unit, 25 rue du Dr. Roux, Institut Pasteur, Paris, F-75015, France
| | - Shahragim Tajbakhsh
- Institut Pasteur, Université Paris Cité, CNRS UMR 3738, Stem Cells & Development Unit, 25 rue du Dr. Roux, Institut Pasteur, Paris, F-75015, France
| | - Glenda E Comai
- Institut Pasteur, Université Paris Cité, CNRS UMR 3738, Stem Cells & Development Unit, 25 rue du Dr. Roux, Institut Pasteur, Paris, F-75015, France
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2
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Lajlar N, Vidmar G, Moharić M. Differences in respiratory function, depressive symptoms and quality of life between patients with hereditary motor and sensory neuropathy and myotonic dystrophy undergoing maintenance rehabilitation. Int J Rehabil Res 2024; 47:20-25. [PMID: 38096027 DOI: 10.1097/mrr.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Hereditary motor and sensory neuropathy (HMSN) and myotonic dystrophy (MD) are chronic neuromuscular diseases that cause progressive muscular impairment and impact patient's quality of life. Conflicting findings in existing literature underscore the need for focussed research on specific health aspects in these patients. The aim of the study was to explore the differences in respiratory function, depressive symptoms and quality of life between patients with HMSN and MD undergoing maintenance rehabilitation. Our prospective observational study included 62 HMSN patients (median age 53.5, range 19-79 years; 38 women) and 50 MD patients (median age 54.0, range 18-77 years; 34 women) undergoing maintenance rehabilitation. They performed respiratory function tests (vital capacity, forced vital capacity, forced expiratory volume and peak expiratory flow) and respiratory muscle strength tests (maximum inspiratory pressure, maximum expiratory pressure and sniff nasal inspiratory force). The Center for Epidemiological Studies-Depression Scale was used to evaluate depression, and their health-related quality of life was assessed using the Quality of Life in Genetic Neuromuscular Disease Questionnaire. Using logistic regression, we examined group-difference in presence of depressive symptoms while accounting for age, symptoms duration, and marital status. Multiple linear regression was used to assess the difference in quality-of-life scores, adjusting for age, gender, and symptoms' duration. The HMSN group achieved statistically significantly better results than the MD group on all respiratory measures (about 17% absolute difference in the respiratory function measures and 30% relative difference in the respiratory muscle strength measures on average). Both groups exhibited a high level of depression symptoms (HMSN 24%, MD 44%; estimated adjusted odds-ratio MD vs. HMSN 1.9, 95% CI 0.8-4.5, P = 0.127). We did not find a statistically significant difference between the groups regarding quality-of-life domains, though a trend towards better quality-of-life among the HMSN patients could be observed. The implication for future practice is that the MD patients would potentially benefit the most from targeted respiratory-rehabilitation interventions, and both groups could benefit from focussed mental-health interventions.
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Affiliation(s)
- Nika Lajlar
- Celje General Hospital, Celje
- Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Gaj Vidmar
- University Rehabilitation Institute
- Faculty of Medicine, University of Ljubljana, Ljubljana
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Metka Moharić
- University Rehabilitation Institute
- Faculty of Medicine, University of Ljubljana, Ljubljana
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3
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Cruz KLT, Santos ICS, de Jesus Alves de Baptista CR, Mattiello-Sverzut AC. Quality of life assessment instruments in children and adolescents with neuromuscular diseases: a systematic scoping review. Health Qual Life Outcomes 2024; 22:18. [PMID: 38360791 PMCID: PMC10870459 DOI: 10.1186/s12955-024-02232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE (1) To identify instruments used to assess quality of life (QoL) in children and adolescents with neuromuscular diseases; (2) To identify the psychometric properties contained in these instruments. METHODS This is a scoping review in which the electronic databases Embase, Scielo, Scopus, Pubmed and Lilacs were used as well as grey literature. The following terms were used in the search for articles published in the last 10 years: children, adolescents, neuromuscular disease, and quality of life. RESULTS In total, 15 articles were included and evaluated, indicating 7 instruments used to assess QoL (PedsQL™ Inventory 3.0 Neuromuscular Module, the PedsQL™ 4.0, the PedsQL DMD Module, the PedsQL ™ MFS, the SOLE, the KIDSCREEN and the LSI-A). The number of items ranged from 17 to 45. In addition, 6 instruments showed psychometric properties, but only 2 showed good and high quality, either in internal reliability or reproducibility. CONCLUSION Our results were able to map the main QoL assessment instruments of children and adolescents with neuromuscular disease and the most cited instrument was the PedsQL™ Inventory 3.0 Neuromuscular Module. Larger studies that assess psychometric properties and that are validated for most diseases are needed.
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Affiliation(s)
- Karoliny Lisandra Teixeira Cruz
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil
| | - Isadora Cristina Sousa Santos
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil
| | | | - Ana Claudia Mattiello-Sverzut
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil.
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Voet N, Pater R, Garmendia J, Sistiaga A, Labayru G, Gallais B, de Groot I, Muslemani S, Gagnon C, Graham C. Patient-Reported Outcome Measures in Neuromuscular Diseases: A Scoping Review. J Neuromuscul Dis 2024; 11:567-577. [PMID: 38517800 PMCID: PMC11091642 DOI: 10.3233/jnd-240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
Patient-reported outcome measures (PROMs) are valuable in comprehensively understanding patients' health experiences and informing healthcare decisions in research and clinical care without clinicians' input. Until now, no central resource containing information on all PROMS in neuromuscular diseases (NMD) is available, hindering the comparison and choice of PROMs used to monitor NMDs and appropriately reflect the patient's voice. This scoping review aimed to present a comprehensive assessment of the existing literature on using PROMs in children and adults with NMD. A scoping methodology was followed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines to assess the literature on PROMs in NMDs. Eligibility criteria encompassed articles describing psychometric development or evaluation of generic or disease-specific PROM-based instruments for adults and children with specific NMDs. The data charting process involved extracting measurement properties of included PROMs, comprising validity, reliability, responsiveness, and interpretability information. The review identified 190 PROMs evaluated across 247 studies in individuals with NMDs. The majority of PROMs were disease specific. The physical functioning domain was most assessed. Validity was the most frequently investigated measurement property, with a limited number of PROMs sufficiently evaluated for a range of psychometric characteristics. There is a strong need for further research on the responsiveness and interpretability of PROMs and the development of PROMs on social functioning in NMD.
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Affiliation(s)
- Nicoline Voet
- Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ronne Pater
- Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joana Garmendia
- Department of Clinical and Health Psychology and Research Methodology; Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
| | - Andone Sistiaga
- Department of Clinical and Health Psychology and Research Methodology; Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
| | - Garazi Labayru
- Department of Clinical and Health Psychology and Research Methodology; Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
| | - Benjamin Gallais
- ÉCOBES, research and transfer, Cégep de Jonquière, Jonquière, Canada
| | - Ingrid de Groot
- Patient association Spierziekten Nederland, Baarn, The Netherlands
| | - Samar Muslemani
- Medicine & Health Sciences Faculty, Université de Sherbrooke, Quebec, Canada; CR-CHUS and CIUSSS Saguenay–Lac-St-Jean research centres, Québec, Canada
| | - Cynthia Gagnon
- Medicine & Health Sciences Faculty, Université de Sherbrooke, Quebec, Canada; CR-CHUS and CIUSSS Saguenay–Lac-St-Jean research centres, Québec, Canada
| | - Christopher Graham
- Department of Psychological Sciences and Health, University of Strathclyde, Scotland
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Rodríguez MP, Cabello-Verrugio C. Soluble Factors Associated with Denervation-induced Skeletal Muscle Atrophy. Curr Protein Pept Sci 2024; 25:189-199. [PMID: 38018212 DOI: 10.2174/0113892037189827231018092036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 11/30/2023]
Abstract
Skeletal muscle tissue has the critical function of mechanical support protecting the body. In addition, its functions are strongly influenced by the balanced synthesis and degradation processes of structural and regulatory proteins. The inhibition of protein synthesis and/or the activation of catabolism generally determines a pathological state or condition called muscle atrophy, a reduction in muscle mass that results in partial or total loss of function. It has been established that many pathophysiological conditions can cause a decrease in muscle mass. Skeletal muscle innervation involves stable and functional neural interactions with muscles via neuromuscular junctions and is essential for maintaining normal muscle structure and function. Loss of motor innervation induces rapid skeletal muscle fiber degeneration with activation of atrophy-related signaling and subsequent disassembly of sarcomeres, altering normal muscle function. After denervation, an inflammation stage is characterized by the increased expression of pro-inflammatory cytokines that determine muscle atrophy. In this review, we highlighted the impact of some soluble factors on the development of muscle atrophy by denervation.
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Affiliation(s)
- Marianny Portal Rodríguez
- Laboratory of Muscle Pathology, Fragility, and Aging, Faculty of Life Sciences, Universidad Andres Bello, Santiago, 8370146, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile
| | - Claudio Cabello-Verrugio
- Laboratory of Muscle Pathology, Fragility, and Aging, Faculty of Life Sciences, Universidad Andres Bello, Santiago, 8370146, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile
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Edwards V, Vari C, Rose M, Graham CD, O'Connell N, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease: a nested qualitative study within the ACTMus randomized controlled trial. Front Psychol 2023; 14:1233526. [PMID: 38106380 PMCID: PMC10722278 DOI: 10.3389/fpsyg.2023.1233526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction In adults, muscle disease (MD) is typically a chronic long-term condition that can lead to a reduced quality of life (QoL). Previous research suggests that a psychological intervention, in particular Acceptance and Commitment Therapy (ACT), may help improve QoL for individuals living with chronic conditions such as MD. Methods This nested qualitative study was incorporated within a randomized controlled trial which evaluated a guided self-help ACT intervention for people living with MD to explore their experiences of the intervention. Semi-structured interviews (n = 20) were conducted with those who had received ACT. Data were analyzed via thematic analysis. Results There were four overarching themes. (1) Views on whether therapy sessions would help with a medical condition: participants' expectations regarding ACT varied. Some participants were skeptical about mindfulness. (2) I was able to look at things in a different way: participants described increased meaningful activity, greater awareness of thoughts and emotions and acceptance or adaptation to mobility problems. Some described improvement in the quality of relationships and a sense of feeling free. (3) Treating the body and the mind together: following the intervention participants noted that a holistic approach to healthcare is beneficial. (4) Intervention delivery: The remote delivery was generally seen as helpful for practical reasons and allowed participants to speak openly. Participants voiced a need for follow-up sessions. Discussion Overall, the intervention was experienced as acceptable. Suggested improvements included de-emphasizing the role of mindfulness and adding follow-up sessions.
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Affiliation(s)
- Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael Rose
- Department of Neurology, King's College Hospital, London, United Kingdom
| | - Christopher D. Graham
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Nicola O'Connell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Emma Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Wojtek Rakowicz
- Wessex Neurological Service, University Hospital Southampton, Southampton, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Inflammation Biology, Centre for Rheumatic Disease, Faculty of Life Sciences and Medicine, King's College London, Weston Education Centre, London, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Senn KC, Thiele S, Kummer K, Walter MC, Nagels KH. Patient-Reported Health-Related Quality of Life, Anxiety and Depression in Patients with Inclusion Body Myositis: A Register-Based Cross-Sectional Study in Germany. J Clin Med 2023; 12:5051. [PMID: 37568453 PMCID: PMC10420164 DOI: 10.3390/jcm12155051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Inclusion body myositis (IBM) is a rare neuromuscular disease and the most prevalent idiopathic inflammatory myopathy (IIM) in patients aged older than 50 years. A systematic review has shown that no clear-cut conclusions can be drawn about the health-related quality of life (HRQoL) and mental health in IBM. We aimed to assess the HRQoL and mental health, to explore associated disease-related and socioeconomic factors as well as the utilization of psychological support in German IBM patients. This cross-sectional study included 82 patients registered in the German IBM patient registry. Patients had completed a survey battery including the EQ-5D-5L, the Individualized Neuromuscular Quality of Life (INQoL) and the Hospital Anxiety and Depression Scale German version (HADS-D). The physical HRQoL dimension was suggested to be most relevant. Most impaired life domains of HRQoL were mobility, independence, and activities. We identified significant differences in the total INQoL score for the degree of disability and care level as well as in depression for the degree of disability (p < 0.05), respectively. Most patients indicated no symptoms of anxiety (64.6%) and depression (62.2%). A more need-oriented psychological support in German IBM patients, reporting doubtful or definite anxiety or depression, could be suggested.
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Affiliation(s)
- Katja C. Senn
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstrasse 25, 95445 Bayreuth, Germany;
| | - Simone Thiele
- Friedrich Baur Institute at the Department of Neurology, LMU University Hospital, LMU Munich, Ziemssenstrasse 1, 80336 Munich, Germany; (S.T.); (M.C.W.)
| | - Karsten Kummer
- Department of Neurology, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Maggie C. Walter
- Friedrich Baur Institute at the Department of Neurology, LMU University Hospital, LMU Munich, Ziemssenstrasse 1, 80336 Munich, Germany; (S.T.); (M.C.W.)
| | - Klaus H. Nagels
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstrasse 25, 95445 Bayreuth, Germany;
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Osa S, Enoki Y, Miyajima T, Akiyama M, Fujiwara Y, Taguchi K, Kim YG, Matsumoto K. SCIATIC DENERVATION-INDUCED SKELETAL MUSCLE ATROPHY IS ASSOCIATED WITH PERSISTENT INFLAMMATION AND INCREASED MORTALITY DURING SEPSIS. Shock 2023; 59:417-425. [PMID: 36427072 DOI: 10.1097/shk.0000000000002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Background: Patients with underlying skeletal muscle atrophy are likely to develop aggravated sepsis. However, no study has experimentally verified the association between the prognosis of sepsis and muscle atrophy, and the mechanism of aggravation of sepsis under muscle atrophy remains unclear. In this study, we investigated the effect of skeletal muscle atrophy induced by sciatic denervation (DN), an experimental muscle atrophy model, on sepsis prognosis. Methods: Skeletal muscle atrophy was induced by DN of the sciatic nerve in C57BL/6J male mice. Cecal ligation and puncture (CLP) was performed to induce sepsis. Results: The survival rates of the sham and DN groups 7 days after CLP were 63% and 35%, respectively, wherein an approximately 30% reduction was observed in the DN group ( P < 0.05, vs. sham-CLP). The DN group had a higher bacterial count in the blood 48 h after CLP ( P < 0.05, vs. sham-CLP). Notably, NOx (a metabolite of nitric oxide) concentrations in DN mice were higher than those in sham mice after CLP ( P < 0.05, vs. sham-CLP), whereas serum platelet levels were lower 48 h after CLP ( P < 0.05, vs. sham-CLP). In organ damage analysis, DN mice presented increased protein expression of the kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), a kidney injury marker, after CLP (NGAL 48 h after CLP, P < 0.05, vs. sham-CLP; KIM-1 24 h after CLP, P < 0.01, vs. sham-CLP). Furthermore, nitro tyrosine levels in the kidneys of DN mice were higher 48 h after CLP compared with those in sham-CLP mice, indicating the accumulation of nitrative stress ( P < 0.05, vs. sham-CLP). Serum cytokine levels were increased in both groups after CLP, but decreased in the sham group 48 h after CLP and remained consistently higher in the DN group (tumor necrosis factor [TNF]-α: P < 0.05, sham-CLP vs. DN-CLP; interleukin (IL)-1β: P < 0.01, sham-CLP vs. DN-CLP; IL-6: P < 0.05, DN vs. DN-CLP; IL-10: P < 0.05, sham-CLP vs. DN-CLP). Conclusions: We verified that skeletal muscle atrophy induced by DN is associated with poor prognosis after CLP-induced sepsis. Importantly, mice with skeletal muscle atrophy presented worsening sepsis prognosis at late onset, including prolonged infection, persistent inflammation, and kidney damage accumulation, resulting in delayed recovery.
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Affiliation(s)
- Sumika Osa
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Taichi Miyajima
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Masahiro Akiyama
- Research Center for Drug Discovery, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Yukio Fujiwara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Kumamoto Chuo-ku, Kumamoto, Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
| | - Yun-Gi Kim
- Research Center for Drug Discovery, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Shibakoen, Minato-ku, Tokyo, Japan
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Younger DS. On the path to evidence-based therapy in neuromuscular disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:315-358. [PMID: 37562877 DOI: 10.1016/b978-0-323-98818-6.00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Neuromuscular disorders encompass a diverse group of acquired and genetic diseases characterized by loss of motor functionality. Although cure is the goal, many therapeutic strategies have been envisioned and are being studied in randomized clinical trials and entered clinical practice. As in all scientific endeavors, the successful clinical translation depends on the quality and translatability of preclinical findings and on the predictive value and feasibility of the clinical models. This chapter focuses on five exemplary diseases: childhood spinal muscular atrophy (SMA), Charcot-Marie-Tooth (CMT) disorders, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), acquired autoimmune myasthenia gravis (MG), and Duchenne muscular dystrophy (DMD), to illustrate the progress made on the path to evidenced-based therapy.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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10
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Gould RL, Thompson BJ, Rawlinson C, Kumar P, White D, Serfaty MA, Graham CD, McCracken LM, Bursnall M, Bradburn M, Young T, Howard RJ, Al-Chalabi A, Goldstein LH, Lawrence V, Cooper C, Shaw PJ, McDermott CJ. A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND): study protocol. BMC Neurol 2022; 22:431. [PMID: 36380299 PMCID: PMC9664029 DOI: 10.1186/s12883-022-02950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Motor neuron disease (MND) is a rapidly progressive, fatal neurodegenerative disease that predominantly affects motor neurons from the motor cortex to the spinal cord and causes progressive wasting and weakening of bulbar, limb, abdominal and thoracic muscles. Prognosis is poor and median survival is 2-3 years following symptom onset. Psychological distress is relatively common in people living with MND. However, formal psychotherapy is not routinely part of standard care within MND Care Centres/clinics in the UK, and clear evidence-based guidance on improving the psychological health of people living with MND is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT) may be particularly suitable for people living with MND and may help improve their psychological health. AIMS To assess the clinical and cost-effectiveness of ACT modified for MND plus usual multidisciplinary care (UC) in comparison to UC alone for improving psychological health in people living with MND. METHODS The COMMEND trial is a multi-centre, assessor-blind, parallel, two-arm RCT with a 10-month internal pilot phase. 188 individuals aged ≥ 18 years with a diagnosis of definite, laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis, and additionally the progressive muscular atrophy and primary lateral sclerosis variants, will be recruited from approximately 14 UK-based MND Care Centres/clinics and via self-referral. Participants will be randomly allocated to receive up to eight 1:1 sessions of ACT plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and at 6- and 9-months post-randomisation. The primary outcome will be quality of life at six months. Secondary outcomes will include depression, anxiety, psychological flexibility, health-related quality of life, adverse events, ALS functioning, survival at nine months, satisfaction with therapy, resource use and quality-adjusted life years. Primary analyses will be by intention to treat and data will be analysed using multi-level modelling. DISCUSSION This trial will provide definitive evidence on the clinical and cost-effectiveness of ACT plus UC in comparison to UC alone for improving psychological health in people living with MND. TRIAL REGISTRATION ISRCTN Registry, ISRCTN12655391. Registered 17 July 2017, https://www.isrctn.com/ISRCTN12655391 . PROTOCOL VERSION 3.1 (10/06/2020).
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK.
| | - Benjamin J Thompson
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlotte Rawlinson
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
| | - Pavithra Kumar
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David White
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marc A Serfaty
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
- Priory Hospital North London, London, UK
| | | | | | - Matt Bursnall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert J Howard
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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Lin H, Ma X, Sun Y, Peng H, Wang Y, Thomas SS, Hu Z. Decoding the transcriptome of denervated muscle at single-nucleus resolution. J Cachexia Sarcopenia Muscle 2022; 13:2102-2117. [PMID: 35726356 PMCID: PMC9398230 DOI: 10.1002/jcsm.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 02/18/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Skeletal muscle exhibits remarkable plasticity under both physiological and pathological conditions. One major manifestation of this plasticity is muscle atrophy that is an adaptive response to catabolic stimuli. Because the heterogeneous transcriptome responses to catabolism in different types of muscle cells are not fully characterized, we applied single-nucleus RNA sequencing (snRNA-seq) to unveil muscle atrophy related transcriptional changes at single nucleus resolution. METHODS Using a sciatic denervation mouse model of muscle atrophy, snRNA-seq was performed to generate single-nucleus transcriptional profiles of the gastrocnemius muscle from normal and denervated mice. Various bioinformatics analyses, including unsupervised clustering, functional enrichment analysis, trajectory analysis, regulon inference, metabolic signature characterization and cell-cell communication prediction, were applied to illustrate the transcriptome changes of the individual cell types. RESULTS A total of 29 539 muscle nuclei (normal vs. denervation: 15 739 vs. 13 800) were classified into 13 nuclear types according to the known cell markers. Among these, the type IIb myonuclei were further divided into two subgroups, which we designated as type IIb1 and type IIb2 myonuclei. In response to denervation, the proportion of type IIb2 myonuclei increased sharply (78.12% vs. 38.45%, P < 0.05). Concomitantly, trajectory analysis revealed that denervated type IIb2 myonuclei clearly deviated away from the normal type IIb2 myonuclei, indicating that this subgroup underwent robust transcriptional reprogramming upon denervation. Signature genes in denervated type IIb2 myonuclei included Runx1, Gadd45a, Igfn1, Robo2, Dlg2, and Sh3d19 (P < 0.001). The gene regulatory network analysis captured a group of atrophy-related regulons (Foxo3, Runx1, Elk4, and Bhlhe40) whose activities were enhanced (P < 0.01), especially in the type IIb2 myonuclei. The metabolic landscape in the myonuclei showed that most of the metabolic pathways were down-regulated by denervation (P < 0.001), while some of the metabolic signalling, such as glutathione metabolism, was specifically activated in the denervated type IIb2 myonulei. We also investigated the transcriptomic alterations in the type I myofibres, muscle stem cells, fibro-adipogenic progenitors, macrophages, endothelial cells and pericytes and characterized their signature responses to denervation. By predicting the cell-cell interactions, we observed that the communications between myofibres and muscle resident cells were diminished by denervation. CONCLUSIONS Our results define the myonuclear transition, metabolic remodelling, and gene regulation networks reprogramming associated with denervation-induced muscle atrophy and illustrate the molecular basis of the heterogeneity and plasticity of muscle cells in response to catabolism. These results provide a useful resource for exploring the molecular mechanism of muscle atrophy.
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Affiliation(s)
- Hongchun Lin
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Nephrology Division, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinxin Ma
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Yuxiang Sun
- Nephrology Division, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Peng
- Nephrology Division, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanlin Wang
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sandhya Sara Thomas
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zhaoyong Hu
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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12
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Senn KC, Gumbert L, Thiele S, Krause S, Walter MC, Nagels KH. The health-related quality of life, mental health and mental illnesses of patients with inclusion body myositis (IBM): results of a mixed methods systematic review. Orphanet J Rare Dis 2022; 17:227. [PMID: 35710430 PMCID: PMC9204871 DOI: 10.1186/s13023-022-02382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Inclusion body myositis (IBM) is a rare neuromuscular disease (NMD) and effective therapies are not available. Thus, it is relevant to determine the health-related quality of life (HRQoL) in IBM patients including aspects of mental health and illnesses. Objectives To identify and summarize the assessment of HRQoL, mental health and illnesses in IBM, the major factors that determine and influence them as well as the respective influence of IBM in general and compared to other NMD as a systematic review. Methods We performed a mixed methods systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted within the databases PubMed, PsycINFO, LIVIVO and the Cochrane Database. Data were narratively summarized and categorized in the physical, psychological and social HRQoL dimensions. Results The systematic screening totalled 896 articles. Six studies were finally identified, comprising of 586 IBM patients. The applied patient reported outcome measures (PROMs) varied. Quantitatively, the main physical impairments (e.g. weakness, functioning, role perception) were assessed using the general population or other NMD as comparators. Results on social and psychological HRQoL were frequently inconsistent. Qualitatively, psychological and social limitations accompanied IBM related physical deteriorations. Conclusions A research gap exists regarding rigour determinants of HRQoL and mental illness in IBM. In-depth qualitative studies could help to prepare the ground for the assessment of long-term HRQoL data combined with appropriately focussed psychological PROMs advancing the understanding of the HRQoL in IBM throughout the course of the disease from a patient perspective. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02382-x.
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Affiliation(s)
- Katja C Senn
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstrasse 25, 95445, Bayreuth, Germany.
| | - Laura Gumbert
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstrasse 25, 95445, Bayreuth, Germany.,SMA Europe, Im Moos 4, 79112, Freiburg, Germany
| | - Simone Thiele
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Sabine Krause
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Maggie C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Klaus H Nagels
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstrasse 25, 95445, Bayreuth, Germany
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13
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Maier M, Stoltenburg C, Sarpong-Bengelsdorf A, Lebek S. Validity and Reliability of the German Version of the CP QOL-Child and CP QOL-Teen Questionnaire. Neuropediatrics 2022; 53:102-108. [PMID: 34879423 DOI: 10.1055/s-0041-1740377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the study was to determine the psychometric properties of the German version of the Cerebral Palsy Quality of Life Questionnaire for Children and Adolescents (CP QOL-Child and -Teen). It is a condition-specific questionnaire with a self-report version, measuring well-being rather than ill-being, which differs from existing measurement methods. Fourteen children (9-12 years) and 64 caregivers (4-12 years) answered the child questionnaire. Twenty-one adolescents and 26 caregivers (all adolescents 13-18 years) replied to the teen version. Functioning was categorized by the Gross Motor Function Classification System. For CP QOL-child internal consistency (Cronbach's α) ranged from 0.58 to 0.88 and for CP QOL-Teen from 0.68 to 0.95. Test-retest reliability after 2 to 4 weeks ranged between 0.75 and 0.94 in children's version and 0.89 and 0.96 in teen's version. Correlation with well-established generic KIDSCREEN-10 questionnaire was moderate to strong. The German versions of CP QOL-Child and -Teen are appropriate tools for assessing the quality of life of children and adolescents with cerebral palsy in the German-speaking population.
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Affiliation(s)
- Manuel Maier
- Department of Neuropediatrics, SPZ for Chronically Sick Children, Charité - Berlin University of Medicine, Berlin, Germany
| | - Corinna Stoltenburg
- Department of Neuropediatrics, SPZ for Chronically Sick Children, Charité - Berlin University of Medicine, Berlin, Germany
| | | | - Susanne Lebek
- Department of Neuropediatrics, SPZ for Chronically Sick Children, Charité - Berlin University of Medicine, Berlin, Germany.,Department of Pediatric Orthopedic Surgery and Neuro-Orthopedics, Center for Musculoskeletal Surgery, Charité - Berlin University of Medicine, Berlin, Germany
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14
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Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis. Eur J Phys Rehabil Med 2022; 58:271-279. [PMID: 34786907 PMCID: PMC9980500 DOI: 10.23736/s1973-9087.21.07120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.
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Affiliation(s)
- Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
- Institute for Rehabilitation, Belgrade, Serbia -
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - François C Boyer
- Department of Physical and Rehabilitation Medicine, Reims Champagne Ardenne University, Sebastopol Hospital, Reims, France
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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15
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Fujino H, Saito T, Takahashi MP, Takada H, Nakayama T, Imura O, Matsumura T. Quality of life and subjective symptom impact in Japanese patients with myotonic dystrophy type 1. BMC Neurol 2022; 22:55. [PMID: 35164706 PMCID: PMC8842550 DOI: 10.1186/s12883-022-02581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although functional impairment in patients with myotonic dystrophy is an important determinant of the quality of life (QoL), patients' subjective evaluation of their symptoms may also affect their QoL. The aim of this study was to investigate the association between subjective symptom impact and the QoL of patients with myotonic dystrophy, after controlling for functional impairment. METHODS Eligible patients with myotonic dystrophy type 1 (DM1) were recruited from four hospitals in Japan. The subjective symptom impact of four symptoms (muscle weakness, fatigue, pain, and myotonia) and overall QoL were evaluated using the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. Functional impairment was assessed using the modified Rankin Scale. RESULTS Seventy-seven patients with DM1 were included in this study. Overall QoL was significantly associated with subjective symptom impact of muscular weakness, fatigue, pain, myotonia, swallowing difficulty, and droopy eyelids. In the regression models, disease duration (beta = 0.11) and moderate to severe functional impairment (beta = 0.33) explained a significant part of the overall QoL. Furthermore, muscular weakness, fatigue, and myotonia significantly explained additional variance of the overall QoL (beta = 0.17-0.43). CONCLUSIONS Subjective symptom impact and functional impairment are independent features influencing the QoL of Japanese patients with DM1.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, 5650871, Japan. .,Department of Special Needs Education, Oita University, 700 Dannoharu, Oita, Japan. .,Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan.,Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
| | - Masanori P Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan
| | - Hiroto Takada
- Department of Neurology, National Hospital Organization Aomori National Hospital, 155-1 Megasawa-Hirano, Aomori, Japan
| | - Takahiro Nakayama
- Department of Neurology, Yokohama Rosai Hospital, 3211 Kozukue, Yokohama, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.,Faculty of Social Sciences, Nara University, 1500 Misasagi, Nara, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
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16
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Tolchin DW. Rehabilitation in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Shi Y, Dan Z, Tao Z, Miao Q, Chang T, Zhang X, Jiang X, Li X. The translation and validation of the Organ Transplant Symptom and Well-Being Instrument in China. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000718. [PMID: 36962583 PMCID: PMC10021454 DOI: 10.1371/journal.pgph.0000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
To translate the Organ Transplant Symptom and Well-Being instrument (OTSWI) into Chinese and test the reliability and validity of the Chinese version. A total of 259 patients with organ transplants were recruited from The First Affiliated Hospital of China Medical University in Shenyang, from November 2020 to January 2021. Construct validity was evaluated using exploratory factor analysis (EFA) and reliability were assessed using test-retest reliability and internal consistency. The Cronbach's α of the Chinese version of the Organ Transplant Symptom and Well-being instrument was 0.93. EFA demonstrated that 80.785% of the total variance was explained by a seven-factor solution. The criterion validity of the SF-36 was -0.460 (p < .01), while the test-retest reliability was 0.710. The Chinese version of the OTSWI questionnaire is a valid and reliable instrument for assessing the quality of life of organ transplant patients for symptoms and well-being in China.
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Affiliation(s)
- Ying Shi
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
| | - Zhang Dan
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Zijun Tao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Qi Miao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Tiantian Chang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xu Zhang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaoyu Jiang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaofei Li
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
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18
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Theadom A, Rodrigues M, Ranta A, Poke G, Love D, Jones K, Ao BT, Hammond-Tooke G, Parmar P, O'Grady G, Roxburgh R. Impact and predictors of quality of life in adults diagnosed with a genetic muscle disorder: a nationwide population-based study. Qual Life Res 2021; 31:1657-1666. [PMID: 34837601 DOI: 10.1007/s11136-021-03046-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the impact of genetic muscle disorders and identify the sociodemographic, illness, and symptom factors influencing quality of life. METHODS Adults (aged 16-90 years) with a confirmed clinical or molecular diagnosis of a genetic muscle disorder identified as part of a nationwide prevalence study were invited to complete an assessment of the impact of their condition. Quality of life was measured using the World Health Organization Quality of Life questionnaire. Impact was measured via the prevalence of symptoms and comparisons of quality of life against New Zealand norms. Multivariate regression models were used to identify the most significant predictors of quality of life domains. RESULTS 490/596 participants completed the assessment (82.2% consent rate). Quality of life was lower than the general population on physical (t = 9.37 p < 0.0001, d = 0.54) social (t = 2.27 p = 0.02, d = 0.13) and environmental domains (t = 2.28 p = 0.02, d = 0.13), although effect sizes were small. No difference was found on the psychological domain (t = - 1.17 p = 0.24, d = 0.07). Multivariate regression models (predicting 42%-64% of the variance) revealed personal factors (younger age, being in employment and in a relationship), symptoms (lower pain, fatigue, and sleep difficulties), physical health (no need for ventilation support, fewer activity limitations and no comorbidities), and psychosocial factors (lower depression, anxiety, behavioural dyscontrol and higher self-efficacy, satisfaction with health care and social support) contributed to improved quality of life. CONCLUSIONS A range of factors influence the quality of life in adults diagnosed with a genetic muscle disorder and some may serve as targets for multi-faceted intervention.
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Affiliation(s)
- Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, 90 Akoranga Dr, Northcote, 0627, New Zealand.
| | - Miriam Rodrigues
- Neurology Department, Auckland City Hospital, Auckland, New Zealand
| | - Annemarei Ranta
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gemma Poke
- Genetic Health Service NZ, Capital and Coast District Health Board, Wellington, New Zealand
| | - Donald Love
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Kelly Jones
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, 90 Akoranga Dr, Northcote, 0627, New Zealand
| | - Braden Te Ao
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, 90 Akoranga Dr, Northcote, 0627, New Zealand
- Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, 90 Akoranga Dr, Northcote, 0627, New Zealand
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Gina O'Grady
- Paediatric Neuroservices, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Richard Roxburgh
- Neurology Department, Auckland City Hospital, Auckland, New Zealand
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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19
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Åkerblom Y, Zetterberg L, Larsson BJ, Nyholm D, Nygren I, Åsenlöf P. Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases. BMC Palliat Care 2021; 20:154. [PMID: 34641829 PMCID: PMC8507097 DOI: 10.1186/s12904-021-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Up to 85% of people with motor neuron disease (MND) report pain, but whether pain has negative impact on quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQOL) in patients with MND. METHODS In this cross sectional study, 61 patients were recruited from four multidisciplinary teams in Sweden, whereof 55 responded to the pain measure (The Brief Pain Inventory - Short form) and were included in the main analyses. Disease severity was measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version, and individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting. RESULTS Forty-one (74%) of the participants who answered BPI-SF (n = 55) reported pain. Thirty-nine (71%) of those reported pain during the past 24 h. The severity of pain was on average moderate, with eight participants (14%) reporting severe pain (PSI ≥ 7). Satisfaction with IQOL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQOL between those reporting pain/not reporting pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U = 249, p = 0.452). There was neither any correlation between pain severity and satisfaction with IQOL, nor between disease severity and satisfaction with IQOL. CONCLUSIONS The results add to the hypothesis that associations between non-motor symptoms such as pain prevalence and pain severity and IQOL in MND are weak. Pain prevalence was high and the results pointed to that some participants experienced high pain severity, which indicate that pain assessments and pain treatments tailored to the specific needs of the MND population should be developed and scientifically evaluated.
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Affiliation(s)
- Ylva Åkerblom
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24 Uppsala, Sweden
| | - Lena Zetterberg
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24 Uppsala, Sweden
| | | | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, 75185 Uppsala, Sweden
| | - Ingela Nygren
- Department of Neuroscience, Neurology, Uppsala University, 75185 Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24 Uppsala, Sweden
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20
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Gagliardi D, Costamagna G, Abati E, Mauri E, Brusa R, Scudeller L, Andreoli L, Citterio G, Piccin E, Magri F, Meneri M, Velardo D, Sciacco M, Bresolin N, Corti S, Comi GP. Impact of COVID-19 on the quality of life of patients with neuromuscular disorders in the Lombardy area, Italy. Muscle Nerve 2021; 64:474-482. [PMID: 34296433 PMCID: PMC8441795 DOI: 10.1002/mus.27378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022]
Abstract
Introduction:/Aims Patients with neuromuscular disorders (NMDs), including many elderly, immunosuppressed, and disabled individuals, may have been particularly affected during the coronavirus disease 2019 (COVID‐19) pandemic in Lombardy, a COVID‐19 high‐incidence area between February and May 2020. We aimed to evaluate the effects of the COVID‐19 pandemic on the quality of life (QoL) and perceived disease burden of this group of patients. Methods We conducted a cross‐sectional phone‐based survey study between June 1 and June 14, 2020, on a sample of 240 NMD patients followed at our clinic in Milan, Italy. We asked about perceived NMD burden and QoL before and during the COVID‐19 pandemic. We collected responses on access to outpatient care and ancillary services. We investigated the presence of symptoms suggestive of COVID‐19 infection and confirmed cases. Results We collected 205 responses: 53 patients (25.9%) reported a subjective worsening of the underlying NMD. QoL measures showed a significant worsening between pre and pandemic time frames (odds ratio, 2.14 95%; confidence interval, 1.82–2.51). Outpatient visits were postponed in more than half of cases (57.1%), with 104 patients (50.7%) experiencing a cancellation of scheduled diagnostic tests. 79 patients (38.5%) reported at least one symptom attributable to COVID‐19 infection. Among the 10 patients tested with nasopharyngeal swabs, 6 tested positive and 3 died from respiratory failure, including 2 patients on corticosteroid/ immunosuppressive therapy. Discussion The COVID‐19 pandemic affected QoL and limited access to outpatient care and ancillary services of NMD patients in Lombardy between February and May 2020.
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Affiliation(s)
- Delia Gagliardi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Costamagna
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Abati
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Mauri
- Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Brusa
- Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigia Scudeller
- Scientific Direction, Clinical Trial Center, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy
| | - Luca Andreoli
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy
| | - Gaia Citterio
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy
| | - Eleonora Piccin
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy
| | - Francesca Magri
- Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Megi Meneri
- Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Velardo
- Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Sciacco
- Neuromuscular and Rare Diseases Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nereo Bresolin
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Pietro Comi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuromuscular and Rare Diseases Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Wei QQ, Hou Y, Chen Y, Ou R, Cao B, Zhang L, Yang T, Shang H. Health-related quality of life in amyotrophic lateral sclerosis using EQ-5D-5L. Health Qual Life Outcomes 2021; 19:181. [PMID: 34284776 PMCID: PMC8290546 DOI: 10.1186/s12955-021-01822-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The study aimed to appraise the health-related quality of life (HRQoL) measured by the five-level EuroQol-5 dimensions (EQ-5D-5L) in amyotrophic lateral sclerosis (ALS), and to explore the associations between non-motor symptoms (mood changes, cognitive disturbances and sleep disturbances). METHODS EQ-5D-5L descriptive scores were converted into a single aggregated "health utility" score. A calibrated visual analog scale (EQ-VAS) was used for self-rating of current health status. Multiple logistic regression analysis was used to explore the factors associated with HRQoL. RESULTS Among the 547 enrolled ALS patients who were assessed using EQ-5D-5L, the highest frequency of reported problems was with usual activities (76.7%), followed by self-care (68.8%) and anxiety/depression (62.0%). The median health utility score was 0.78 and the median EQ-VAS score was 70. Clinical factors corresponding to differences in the EQ-5D-5L health utility score included age of onset, onset region, the ALS Functional Rating Scale-Revised (ALSFRS-R) score, and King's College stages. Patients with depression, anxiety, and poor sleep had lower health utility scores. Patients with excessive daytime sleepiness and rapid eye movement sleep behavior disorder had lower EQ-VAS scores. Multivariate logistic analysis indicated that ALSFRS-R scores, depression, and anxiety were associated with health utility scores. After adjusting other parameters, ALSFRS-R score, stages, and depression were significantly associated with EQ-VAS scores (P < 0.05). CONCLUSION This study examined HRQoL in ALS patients using the Chinese version of the EQ-5D-5L scale across different stages of the disease. We found that HRQoL is related to disease severity and to mood disturbances. Management of non-motor symptoms may help improve HRQoL in ALS patients.
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Affiliation(s)
- Qian-Qian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Yongping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Bei Cao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Tianmi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, China.
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22
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Schorling E, Senn KC, Thiele S, Gumbert L, Krause S, Schreiber-Katz O, Walter MC, Reilich P, Nagels KH. Health-related Quality of Life and Satisfaction with German Health Care Services in Patients with Charcot-Marie-Tooth Neuropathy. J Neuromuscul Dis 2021; 9:211-220. [PMID: 34057093 DOI: 10.3233/jnd-210667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BackgroundCharcot-Marie-Tooth (CMT) neuropathies entail a large group of diseases with different gene mutation patterns, which produce heterogeneous phenotypes. Although health-related quality of life (HRQOL) is significantly impaired, a comprehensive assessment of HRQOL in CMT patients in Germany considering phenotypical heterogeneity represented a research gap.ObjectiveThe aim was to assess HRQOL and the satisfaction with health care in CMT patients in Germany.MethodsCMT patients > 15 years with a genetically confirmed CMT subtype were recruited through a national CMT patient registry. HRQOL was assessed using the EQ-5D-5L questionnaire. Furthermore, subjective impairments in daily or work activities and satisfaction with health care were assessed using 4-point scales.ResultsHRQOL in CMT patients (n = 385) was impaired compared to the German population. Most patients reported problems in the dimension mobility (89.6%), pain/discomfort (89.4%) and usual activities (81.0%). Except for patients with hereditary neuropathy with liability to pressure palsy (HNPP), we found no differences in HRQOL between the CMT subtypes. 72.0%of CMT patients were satisfied with available health care services. However, patients reported to expect more CMT-specific knowledge and support as well as easier prescription and cost coverage procedures from health professionals and insurances.ConclusionsThe patient-reported outcomes in the assessed CMT cohort elucidate the need for more specific health care services that also address the heterogeneous phenotypes. Although the assessment has been limited to the German health services setting, insights may be applicable to CMT-specific care in other national settings.
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Affiliation(s)
- Elisabeth Schorling
- University of Bayreuth, Institute for Healthcare Management and Health Sciences, Bayreuth, Germany.,Max Rubner-Institute, Kulmbach, Germany
| | - Katja C Senn
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Bayreuth, Germany
| | - Simone Thiele
- Ludwig-Maximilians-University of Munich, Friedrich-Baur-Institute, Department of Neurology, Munich, Germany
| | - Laura Gumbert
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Bayreuth, Germany
| | - Sabine Krause
- Ludwig-Maximilians-University of Munich, Friedrich-Baur-Institute, Department of Neurology, Munich, Germany
| | | | - Maggie C Walter
- Ludwig-Maximilians-University of Munich, Friedrich-Baur-Institute, Department of Neurology, Munich, Germany
| | - Peter Reilich
- Ludwig-Maximilians-University of Munich, Friedrich-Baur-Institute, Department of Neurology, Munich, Germany
| | - Klaus H Nagels
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Bayreuth, Germany
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23
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Al-Ahmer I, Elshony H. Determinants of quality of life changes with plasmapheresis in patients with myasthenia gravis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Immunomodulation, including IVIG and plasma exchange, is useful for a crisis or severe exacerbation. Plasma exchange may be slightly faster and more effective in a myasthenic crisis than IVIG. The aim of the current study was to determine the changes in the quality of life (QOL) after plasmapheresis and factors influencing these changes.
Results
This study was conducted on 98 MG patients diagnosed as moderate to severe myasthenia gravis (according to Myasthenia Gravis Foundation of America classification), 81 patients received alternate day 5 sessions plasmapheresis (TPE group) and 17 patients were on medical treatment only (control group). All patients were subjected to full history, through clinical neurological evaluation and scored with quantitative myasthenia gravis (QMG) score for MG severity at start and after 1 m. Both groups completed the QOL questionnaire at baseline and after 1 month. The MG-QOL-15 scores were computed and we analyzed the change in the QOL scores from baseline to after plasmapheresis groups and compared it with the results for the control group. The scores in QOL scales had significantly decreased after plasmapheresis, and the improvement in QOL scores had a good correlation with the decrease in QMGS. The improvement in QOL and QMG was significantly correlated with younger age, female gender, shorter duration of the illness, presence of AchR antibodies, antibody titer, and thymus hyperplasia.
Conclusion
Plasmapheresis is effective in improving quality of life in myasthenia gravis patients and this improvement influenced by age, gender, duration of illness, presence of AchR antibodies and their titer, and the thymus pathology.
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24
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Cevik AB, Olgun N. The Predictors of Painful Diabetic Neuropathy and Its Effect on Quality of Life. Pain Manag Nurs 2021; 23:345-352. [PMID: 34030993 DOI: 10.1016/j.pmn.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/22/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowing the prevalence and predictors of neuropathic pain and its impacts on the quality of life (QoL) using measurement tools is important for good diabetes management. In Turkish society, neuropathic pain, its predictors and its impact on the quality of life of diabetics are not considered enough. OBJECTIVES This study examined the prevalence and predictors of neuropathic pain and its impacts on the quality of life in diabetics in Rize Province, Turkey. DESIGN This study was designed as a cross-sectional, correlational study. SETTING Data collected through face-to-face interviews. The sample size was determined using the formula [n= N t2pq / d2 (N-1) + t2pq]. PARTICIPANT The sample of the study consisted of 122 people with diabetes who visited the diabetes outpatient clinic of the hospital. METHODS A Personal Information Form, Douleur Neuropathique en 4 questions (DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to collect data. Pain intensity was measured using Visual Analogue Scale (VAS) RESULTS: The prevalence of the diagnosed painful diabetic polyneuropathy (PDPN) was found to be 22.9%. On the other hand, the prevalence of the undiagnosed PDPN was found to be 44.3% according to DN4 and 27.9% according to LANSS. The VAS pain score was determined as 1.99±1.20 (range: 1-5). In the people with PDPN, nephropathy was seen 4.514 times more frequently according to DN4 and 7.217 times more frequently according to LANSS. Painful diabetic peripheral neuropathy had negative effects on all dimensions of QoL except for social function and mental health (p <0.05). CONCLUSIONS It is important for nurses to determine the prevalence and predictive factors of PDPN in their region and to evaluate the effect of pain on the quality of life of diabetics. Nurses should attempt to increase the quality of life of people with diabetes by reducing the predictors affecting pain.
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Affiliation(s)
- Ayfer Bayindir Cevik
- Bartın University, Faculty of Health Sciences, Ağdacı Mahallesi, Ağdacı Köyü Yolu, Bartın, Turkey.
| | - Nermin Olgun
- Hasan Kalyoncu University, Yeşilkent, Gaziantep, Turkey
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Peseschkian T, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Büchner B, Weiland U, Schönfelder E, Heinrich F, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. A Nation-Wide, Multi-Center Study on the Quality of Life of ALS Patients in Germany. Brain Sci 2021; 11:372. [PMID: 33799476 PMCID: PMC7998410 DOI: 10.3390/brainsci11030372] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Improving quality of life (QoL) is central to amyotrophic lateral sclerosis (ALS) treatment. This Germany-wide, multicenter cross-sectional study analyses the impact of different symptom-specific treatments and ALS variants on QoL. Health-related QoL (HRQoL) in 325 ALS patients was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) and EuroQol Five Dimension Five Level Scale (EQ-5D-5L), together with disease severity (captured by the revised ALS Functional Rating Scale (ALSFRS-R)) and the current care and therapies used by our cohort. At inclusion, the mean ALSAQ-5 total score was 56.93 (max. 100, best = 0) with a better QoL associated with a less severe disease status (β = -1.96 per increase of one point in the ALSFRS-R score, p < 0.001). "Limb-onset" ALS (lALS) was associated with a better QoL than "bulbar-onset" ALS (bALS) (mean ALSAQ-5 total score 55.46 versus 60.99, p = 0.040). Moreover, with the ALSFRS-R as a covariate, using a mobility aid (β = -7.60, p = 0.001), being tracheostomized (β = -14.80, p = 0.004) and using non-invasive ventilation (β = -5.71, p = 0.030) were associated with an improved QoL, compared to those at the same disease stage who did not use these aids. In contrast, antidepressant intake (β = 5.95, p = 0.007), and increasing age (β = 0.18, p = 0.023) were predictors of worse QoL. Our results showed that the ALSAQ-5 was better-suited for ALS patients than the EQ-5D-5L. Further, the early and symptom-specific clinical management and supply of assistive devices can significantly improve the individual HRQoL of ALS patients. Appropriate QoL questionnaires are needed to monitor the impact of treatment to provide the best possible and individualized care.
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Affiliation(s)
- Tara Peseschkian
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany;
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany;
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany;
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany;
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany;
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Boriana Büchner
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
| | - Ulrike Weiland
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Felix Heinrich
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Thomas Klopstock
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
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de Almeida FEO, do Carmo Santana AK, de Carvalho FO. Multidisciplinary care in Amyotrophic Lateral Sclerosis: a systematic review and meta-analysis. Neurol Sci 2021; 42:911-923. [PMID: 33443670 DOI: 10.1007/s10072-020-05011-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) has been the most recommended approach for symptom management in amyotrophic lateral sclerosis (ALS) but there is conflicting evidence about its effectiveness on survival and quality of life (QoL) of ALS patients. We conducted a systematic review to determine the effects of multidisciplinary care compared to general neurological care in survival and quality of life of ALS patients. A comprehensive literature search using Scopus, MEDLINE-PubMed, Cochrane, Web of Science, PEDro, and Science Direct was undertaken. Studies related to multidisciplinary care or general neurological care in ALS patients that assessed survival and quality of life and were published in the period up to and including January 2020 were included. A total of 1192 studies were initially identified, but only 6 were included. All studies that investigated survival showed and advantage of MDC over NC, and this benefit was even greater for bulbar onset patients. A meta-analysis was performed and showed a mean difference of 141.67 (CI 95%, 61.48 to 221.86), indicating that patients who received MDC had longer survival than those who underwent NC (p = 0.0005). Concerning QoL, only one study found better mental health scores related to QoL for patients under MDC. Multidisciplinary care is more effective than general neurology care at improving survival of patients with ALS, but only improves mental health outcomes related to quality of life of these patients.
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Affiliation(s)
| | | | - Fernanda Oliveira de Carvalho
- Sergipe University Hospital of Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil. .,Health Sciences Graduate Center of Universidade Federal de Sergipe-UFS, São Cristóvão, SE, 49100-000, Brazil.
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27
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Dai J, Xiang Y, Fu D, Xu L, Jiang J, Xu J. Ficus carica L. Attenuates Denervated Skeletal Muscle Atrophy via PPARα/NF-κB Pathway. Front Physiol 2020; 11:580223. [PMID: 33343385 PMCID: PMC7744683 DOI: 10.3389/fphys.2020.580223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022] Open
Abstract
Treatment options for denervated skeletal muscle atrophy are limited, in part because the underlying molecular mechanisms are not well understood. Unlike previous transcriptomics studies conducted in rodent models of peripheral nerve injury, in the present study, we performed high-throughput sequencing with denervated atrophic biceps muscle and normal (non-denervated) sternocleidomastoid muscle samples obtained from four brachial plexus injury (BPI) patients. We also investigated whether Ficus carica L. (FCL.) extract can suppress denervated muscle atrophy in a mouse model, along with the mechanism of action. We identified 1471 genes that were differentially expressed between clinical specimens of atrophic and normal muscle, including 771 that were downregulated and 700 that were upregulated. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed that the differentially expressed genes were mainly enriched in the GO terms “structural constituent of muscle,” “Z disc,” “M band,” and “striated muscle contraction,” as well as “Cell adhesion molecules,” “Glycolysis/Gluconeogenesis,” “Peroxisome proliferator-activated receptor alpha (PPARα) signaling pathway,” and “P53 signaling pathway.” In experiments using mice, the reduction in wet weight and myofiber diameter in denervated muscle was improved by FCL. extract compared to saline administration, which was accompanied by downregulation of the proinflammatory cytokines interleukin (IL)-1β and IL-6. Moreover, although both denervated groups showed increased nuclear factor (NF)-κB activation and PPARα expression, the degree of NF-κB activation was lower while PPARα and inhibitor of NF-κB IκBα expression was higher in FCL. extract-treated mice. Thus, FCL. extract suppresses denervation-induced inflammation and attenuates muscle atrophy by enhancing PPARα expression and inhibiting NF-κB activation. These findings suggest that FCL. extract has therapeutic potential for preventing denervation-induced muscle atrophy caused by peripheral nerve injury or disease.
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Affiliation(s)
- Junxi Dai
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yaoxian Xiang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Da Fu
- Central Laboratory, Shanghai Tenth People's Hospital, Shanghai, China
| | - Lei Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Junjian Jiang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jianguang Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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28
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Quality of Life Structural Equation Model for Patients With Amyotrophic Lateral Sclerosis. Rehabil Nurs 2020; 46:253-261. [PMID: 32991398 DOI: 10.1097/rnj.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to propose and test a quality of life model among Korean patients with amyotrophic lateral sclerosis (ALS) using structural equation modeling. DESIGN A cross-sectional study was performed. METHODS Data from 184 patients with ALS were collected from two university hospitals in Seoul and Busan, South Korea, between June and December 2018. FINDINGS The modified model indices indicated adequate data fit. Quality of life predictors were social support, physical functional status, depression, and general health perception. CONCLUSION This study improved the understanding of quality of life for Korean patients with ALS, including complex direct and indirect relationships among quality of life factors. CLINICAL RELEVANCE Depression was identified as the most influential factor in this population; hence, early assessment and timely intervention for depression are essential for better quality of life in patients with ALS.
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Unmet supportive care needs mediate the relationship between functional status and quality of life in patients with amyotrophic lateral sclerosis. Palliat Support Care 2020; 17:650-654. [PMID: 31104645 DOI: 10.1017/s1478951519000221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aims of this study were to identify the unmet care needs and to examine the mediating effect of unmet supportive care needs in the relationship between functional status and quality of life (QOL) in Korean patients with amyotrophic lateral sclerosis (ALS). METHOD This was a cross-sectional study conducted among 186 patients with ALS recruited from a tertiary hospital in Seoul, South Korea. ALS patients' functional status, unmet supportive care needs, and QOL were assessed by Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, the Amyotrophic Lateral Sclerosis Supportive Care Needs Instrument, and the Amyotrophic Lateral Sclerosis Specific Quality of Life - Revised Instrument, respectively. Mediation analysis was tested using Baron and Kenny's regression analysis and a Sobel test. RESULT The mean score for functional status was 33.35 ± 8.89; for unmet supportive care needs it was 2.40 ± 0.66; and for QOL it was 4.95 ± 1.29. Functional status was significantly correlated with unmet care needs and QOL. Unmet care needs satisfaction demonstrated a complete mediating effect on the relationship between functional status and QOL of the patients with ALS (β = -0.53, p < 0.001) and the effect was significant (Sobel test; Z = 5.48, p < 0.001). SIGNIFICANCE OF RESULTS Although QOL was negatively affected by the functional status in our sample, the relationship was fully mediated via unmet supportive care needs. Because there is no cure for ALS, and the condition is rapidly progressive with a lethal outcome, providing care by meeting patients' needs is a critical aspect of caring for these patients. Early assessment of supportive care needs, providing services, and referring ALS patients to appropriate resources could enhance their QOL.
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30
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Ehmsen JT, Höke A. Cellular and molecular features of neurogenic skeletal muscle atrophy. Exp Neurol 2020; 331:113379. [PMID: 32533969 DOI: 10.1016/j.expneurol.2020.113379] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/28/2022]
Abstract
Neurogenic atrophy refers to the loss of muscle mass and function that results directly from injury or disease of the peripheral nervous system. Individuals with neurogenic atrophy may experience reduced functional status and quality of life and, in some circumstances, reduced survival. Distinct pathological findings on muscle histology can aid in diagnosis of a neurogenic cause for muscle dysfunction, and provide indicators for the chronicity of denervation. Denervation induces pleiotypic responses in skeletal muscle, and the molecular mechanisms underlying neurogenic muscle atrophy appear to share common features with other causes of muscle atrophy, including activation of FOXO transcription factors and corresponding induction of ubiquitin-proteasomal and lysosomal degradation. In this review, we provide an overview of histologic features of neurogenic atrophy and a summary of current understanding of underlying mechanisms.
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Affiliation(s)
- Jeffrey T Ehmsen
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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Mutation spectrum and health status in skeletal muscle channelopathies in Japan. Neuromuscul Disord 2020; 30:546-553. [PMID: 32660787 DOI: 10.1016/j.nmd.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
Skeletal muscle channelopathies, including non-dystrophic myotonia and periodic paralysis, are rare hereditary disorders caused by mutations of various ion channel genes. To define the frequency of associated mutations of skeletal muscle channelopathies in Japan, clinical and genetic data of two academic institutions, which provides genetic analysis service, were reviewed. Of 105 unrelated pedigrees genetically confirmed, 66 pedigrees were non-dystrophic myotonias [CLCN1 (n = 30) and SCN4A (n = 36)], 11 were hyperkalemic periodic paralysis (SCN4A), and 28 were hypokalemic periodic paralysis [CACNA1S (n = 16) and SCN4A (n = 12)]. Of the 30 families with myotonia congenita, dominant form (Thomsen type) consisted 67%, and unique mutations, A298T, P480T, T539A, and M560T, not found in Western countries, were commonly identified in CLCN1. Hypokalemic periodic paralysis caused by SCN4A mutations consisted 43% in Japan, which was much higher than previous reports. Furthermore, the quality of life of the patients was assessed using the patient-reported outcome measures, SF-36 and INQoL, for 41 patients. This study indicated that the etiology of skeletal muscle channelopathies in Japan was not identical to previous reports from Western countries, and provided crucial information for genetics as well as future therapeutic interventions.
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Ehmsen JT, Kawaguchi R, Mi R, Coppola G, Höke A. Longitudinal RNA-Seq analysis of acute and chronic neurogenic skeletal muscle atrophy. Sci Data 2019; 6:179. [PMID: 31551418 PMCID: PMC6760191 DOI: 10.1038/s41597-019-0185-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022] Open
Abstract
Skeletal muscle is a highly adaptable tissue capable of changes in size, contractility, and metabolism according to functional demands. Atrophy is a decline in mass and strength caused by pathologic loss of myofibrillar proteins, and can result from disuse, aging, or denervation caused by injury or peripheral nerve disorders. We provide a high-quality longitudinal RNA-Seq dataset of skeletal muscle from a cohort of adult C57BL/6J male mice subjected to tibial nerve denervation for 0 (baseline), 1, 3, 7, 14, 30, or 90 days. Using an unbiased genomics approach to identify gene expression changes across the entire longitudinal course of muscle atrophy affords the opportunity to (1) establish acute responses to denervation, (2) detect pathways that mediate rapid loss of muscle mass within the first week after denervation, and (3) capture the molecular phenotype of chronically atrophied muscle at a stage when it is largely resistant to recovery.
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Affiliation(s)
- Jeffrey T Ehmsen
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Riki Kawaguchi
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Ruifa Mi
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Giovanni Coppola
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
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Jacques MF, Stockley RC, Onambele-Pearson GL, Reeves ND, Stebbings GK, Dawson EA, Groves L, Morse CI. Quality of life in adults with muscular dystrophy. Health Qual Life Outcomes 2019; 17:121. [PMID: 31307472 PMCID: PMC6632211 DOI: 10.1186/s12955-019-1177-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Muscle weakness is a defining characteristic of Muscular Dystrophy (MD); however, yet while speculated, objective measures of muscle weakness has not been reported in relation to quality of life in adults with MD. OBJECTIVES 1) compare the self-reported QoL of adults with Duchenne MD (DMD), Beckers MD (BMD), Limb-Girdle MD (LGMD) and Fascioscapulohumeral MD (FSHD, and a non-MD (CTRL) group; 2) present and compare between groups measures of Impairment (Muscle Strength and Activities of Daily Living) and Perception (Fatigue, Pain and Self-Efficacy); and 3) identify associations between QoL domains and measures of Impairment and Perception (See above). METHODS Seventy-Five males, including MD classifications DMD, BMD, LGMD, FSHD and CTRL, completed measures for QoL, Knee-Extension Maximal Voluntary Contraction (KEMVC), Fatigue, Pain, Self-Efficacy and Activities of Daily Living (ADL). RESULTS QoL was lower across many domains in MD than CTRL. FSHD scored lower than DMD for mental wellbeing domains. KEMVC associated with Physical-Function domain for BMD. Pain, Self-Efficacy and ADLs associated with QoL domains, with Fatigue the most consistently associated. CONCLUSION The present study identified differences between MD classifications within self-perceptions of mental-health. Muscle weakness is a defining feature of MD; however, it doesn't define QoL in adults with MD. A greater understanding of mental wellbeing, independence, and management of fatigue and pain, are required to improve QoL for adults with MD.
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Affiliation(s)
- Matthew F. Jacques
- Musculoskeletal Science & Sports Medicine Research Centre, School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | | | - Gladys L. Onambele-Pearson
- Musculoskeletal Science & Sports Medicine Research Centre, School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Neil D. Reeves
- Musculoskeletal Science & Sports Medicine Research Centre, School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Georgina K. Stebbings
- Musculoskeletal Science & Sports Medicine Research Centre, School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Ellen A. Dawson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | | | - Christopher I. Morse
- Musculoskeletal Science & Sports Medicine Research Centre, School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Neumann S, Quinting J, Rosenkranz A, de Beer C, Jonas K, Stenneken P. Quality of life in adults with neurogenic speech-language-communication difficulties: A systematic review of existing measures. JOURNAL OF COMMUNICATION DISORDERS 2019; 79:24-45. [PMID: 30851625 DOI: 10.1016/j.jcomdis.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Sandra Neumann
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Jana Quinting
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Anna Rosenkranz
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Carola de Beer
- SFB 1287 - Project B01, University of Potsdam, Campus Golm, Haus 14, 2.04, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany.
| | - Kristina Jonas
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
| | - Prisca Stenneken
- Pedagogics and Therapy in Speech-Language Disorders, Faculty of Human Sciences, University of Cologne, Klosterstr. 79b, 50931 Cologne, Germany.
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Siciliano M, Trojano L, Trojsi F, Monsurrò MR, Tedeschi G, Santangelo G. Assessing anxiety and its correlates in amyotrophic lateral sclerosis: The state-trait anxiety inventory. Muscle Nerve 2019; 60:47-55. [PMID: 30897219 DOI: 10.1002/mus.26475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We evaluated: (1) psychometric properties of State-Trait Anxiety Inventory Form Y (STAI Form Y); (2) clinical correlates of state and trait anxiety; (3) associations of anxiety with quality of life (QoL) dimensions. METHODS We assessed 159 patients with amyotrophic lateral sclerosis (ALS) on STAI Form Y and on tests and questionnaires for depression, apathy, QoL, and cognitive abilities. RESULTS Clinically diagnosed anxiety (by Mini International Neuropsychiatric Inventory) occurred in 30 (19%) patients. STAI Form Y fitted a 2-factor structure and showed good psychometric properties. State and trait anxiety were weakly associated with female sex, bulbar functional decay, and cognitive decline in language and memory; trait anxiety was associated with lower educational attainment and poorer scores on visuospatial tasks. State and trait anxiety were associated with poorer physical and psychosocial QoL dimensions. CONCLUSIONS Anxiety is tightly associated with QoL in ALS, and can be reliably assessed by STAI Form Y. Muscle Nerve, 2019.
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Affiliation(s)
- Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Rosaria Monsurrò
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
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Abu HO, Ulbricht C, Ding E, Allison JJ, Salmoirago-Blotcher E, Goldberg RJ, Kiefe CI. Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review. Qual Life Res 2018; 27:2777-2797. [PMID: 29948601 PMCID: PMC6196107 DOI: 10.1007/s11136-018-1906-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE This review systematically identified and critically appraised the available literature that has examined the association between religiosity and/or spirituality (R/S) and quality of life (QOL) in patients with cardiovascular disease (CVD). METHODS We searched several electronic online databases (PubMed, SCOPUS, PsycINFO, and CINAHL) from database inception until October 2017. Included articles were peer-reviewed, published in English, and quantitatively examined the association between R/S and QOL. We assessed the methodological quality of each included study. RESULTS The 15 articles included were published between 2002 and 2017. Most studies were conducted in the US and enrolled patients with heart failure. Sixteen dimensions of R/S were assessed with a variety of instruments. QOL domains examined were global, health-related, and disease-specific QOL. Ten studies reported a significant positive association between R/S and QOL, with higher spiritual well-being, intrinsic religiousness, and frequency of church attendance positively related with mental and emotional well-being. Approximately half of the included studies reported negative or null associations. CONCLUSIONS Our findings suggest that higher levels of R/S may be related to better QOL among patients with CVD, with varying associations depending on the R/S dimension and QOL domain assessed. Future longitudinal studies in large patient samples with different CVDs and designs are needed to better understand how R/S may influence QOL. More uniformity in assessing R/S would enhance the comparability of results across studies. Understanding the influence of R/S on QOL would promote a holistic approach in managing patients with CVD.
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Affiliation(s)
- Hawa O Abu
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Christine Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Eric Ding
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, 02903, USA
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02903, USA
- Warren Alpert School of Medicine & School of Public Health, Brown University, Providence, RI, 02903, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Felgoise SH, Feinberg R, Stephens HE, Barkhaus P, Boylan K, Caress J, Clawson LL, Elman L, Goutman SA, Mccluskey L, Russell J, Tiryaki E, Weiss M, Simmons Z. Amyotrophic lateral sclerosis-specific quality of life-short form (ALSSQOL-SF): A brief, reliable, and valid version of the ALSSQOL-R. Muscle Nerve 2018; 58:646-654. [PMID: 30028537 DOI: 10.1002/mus.26203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The Amyotrophic Lateral Sclerosis (ALS)-Specific Quality of Life instrument and its revised version (ALSSQOL and ALSSQOL-R) have strong psychometric properties, and have demonstrated research and clinical utility. In this study we aimed to develop a short form (ALSSQOL-SF) suitable for limited clinic time and patient stamina. METHODS The ALSSQOL-SF was created using Item Response Theory and confirmatory factor analysis on 389 patients. A cross-validation sample of 162 patients assessed convergent, divergent, and construct validity of the ALSSQOL-SF compared with psychosocial and physical functioning measures. RESULTS The ALSSQOL-SF consisted of 20 items. Compared with the ALSSQOL-R, optimal precision was retained, and completion time was reduced from 15-25 minutes to 2-4 minutes. Psychometric properties for the ALSSQOL-SF and its subscales were strong. DISCUSSION The ALSSQOL-SF is a disease-specific global QOL instrument that has a short administration time suitable for clinical use, and can provide clinically useful, valid information about persons with ALS. Muscle Nerve 58: 646-654, 2018.
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Affiliation(s)
- Stephanie H Felgoise
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Richard Feinberg
- National Board of Medical Examiners, Philadelphia, Pennsylvania, USA
| | - Helen E Stephens
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin Boylan
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - James Caress
- Department of Neurology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Lora L Clawson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Elman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Russell
- Department of Neurology, Lahey Clinic, Burlington, Massachusetts, USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
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Rose MR, Norton S, Vari C, Edwards V, McCracken L, Graham CD, Radunovic A, Chalder T. Acceptance and Commitment Therapy for Muscle Disease (ACTMus): protocol for a two-arm randomised controlled trial of a brief guided self-help ACT programme for improving quality of life in people with muscle diseases. BMJ Open 2018; 8:e022083. [PMID: 30287669 PMCID: PMC6194473 DOI: 10.1136/bmjopen-2018-022083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/04/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In adults, muscle disease (MD) is often a chronic long-term condition with no definitive cure. It causes wasting and weakness of the muscles resulting in a progressive decline in mobility, alongside other symptoms, and is typically associated with reduced quality of life (QoL). Previous research suggests that a psychological intervention, and in particular Acceptance and Commitment Therapy (ACT), may help improve QoL in MD. ACT is a newer type of cognitive behavioural treatment that aims to improve QoL by virtue of improvement in a process called psychological flexibility. The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of a guided self-help ACT programme for improving QoL in people with MD. Main secondary outcomes are mood, symptom impact, work and social adjustment and function at 9-week follow-up. METHODS AND ANALYSIS Acceptance and Commitment Therapy for Muscle Disease is an assessor-blind, multicentre, two-armed, parallel-group RCT to assess the efficacy of ACT plus standard medical care (SMC) compared with SMC alone. Individuals with a diagnosis of one of four specific MDs, with a duration of at least 6 months and with mild to moderate anxiety or depression (Hospital Anxiety and Depression Scale score ≥8) will be recruited from UK-based MD clinics and MD patient support organisations. Participants will be randomised to either ACT plus SMC or SMC alone by an independent randomisation service. Participants will be followed up at 3, 6 and 9 weeks. Analysis will be intention to treat, conducted by the trial statistician who will be blinded to treatment allocation. ETHICS AND DISSEMINATION The study has received full ethical approval. Study results will be disseminated via peer-reviewed publications, conference presentations and journal articles. Data obtained from the trial will enable clinicians and health service providers to make informed decisions regarding the efficacy of ACT for improving QoL for patients with MD. TRIAL REGISTRATION NUMBER NCT02810028. PROTOCOL VERSION V.11 (4 April 2017).
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Affiliation(s)
- Michael R Rose
- Department of Neurology, King's College Hospital, London, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lance McCracken
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Iversen K, Drivdal LM, Billaud Feragen KJ, Geirdal AØ. Quality of life in adults with lymphedema cholestasis syndrome 1. Health Qual Life Outcomes 2018; 16:146. [PMID: 30045736 PMCID: PMC6060525 DOI: 10.1186/s12955-018-0972-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/09/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND LCS1 (Lymphedema Cholestasis Syndrome 1/Aagenaes syndrome) is a rare, hereditary disorder, where the highest known prevalence is in Norway. The disorder is characterized by lymphedema and periodic cholestasis from birth or the neonatal period. This study aimed to examine internal reliability of the SF-36, in addition to the group's overall- and health related quality of life (OQoL and HRQoL) and psychosocial well-being. METHODS Twenty adults (aged 18-65) in Norway have been diagnosed with LSC1. Eighteen of these patients were included in the study and completed four questionnaires on overall and health related quality of life and psychosocial well-being: Cantril's Ladder (CL), The Kaasa Test, the SF-36, and a lymphedema anamnesis questionnaire. Demographic data were registered, and 15 of the patients underwent a physical examination of the lymphedema. SF-36 scores were compared with those of 360 age and gender matched controls drawn from an earlier survey of the Norwegian general population. The Mann-Whitney U test and Chi-square (χ2) test were used to test internal differences in the patient group. RESULTS Health-related quality of life (HRQOL) was significantly reduced in patients with LSC1 compared to controls, in three out of eight areas, role physical, general health and mental health. Females scored significantly better than males in the patient group in two areas of SF-36, in CL, and in one of three scales of The Kaasa Test. Severe lymphedema was found to be significantly correlated to bodily pain and reduced mental health. The level of education was positively correlated to mental health. CONCLUSION Overall quality of life (OQoL), health related quality of life (HRQoL) and psycho-social well-being were good in the patient group, but some dimensions of HRQoL were reduced. More severe extent of lymphedema was associated with poorer HRQoL.
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Affiliation(s)
- Kristin Iversen
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Lill Monica Drivdal
- Department of Clinical Service, Oslo University Hospital, Ullevål, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Kristin J Billaud Feragen
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Amy Østertun Geirdal
- Faculty of Social Sciences, Oslo and Akershus University College of applied Sciences, Postboks 4 St. Olavs plass, 0130, Oslo, Norway
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Gwathmey KG, Sadjadi R, Horton WB, Conaway MR, Barnett-Tapia C, Bril V, Russell JW, Shaibani A, Mauermann ML, Hehir MK, Kolb N, Guptill J, Hobson-Webb L, Gable K, Raja S, Silvestri N, Wolfe GI, Smith AG, Malik R, Traub R, Joshi A, Elliott MP, Jones S, Burns TM. Validation of a simple disease-specific, quality-of-life measure for diabetic polyneuropathy: CAPPRI. Neurology 2018; 90:e2034-e2041. [PMID: 29728528 DOI: 10.1212/wnl.0000000000005643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/20/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We studied the performance of a 15-item, health-related quality-of-life polyneuropathy scale in the clinic setting in patients with diabetic distal sensorimotor polyneuropathy (DSPN). METHODS Patients with DSPN from 11 academic sites completed a total of 231 Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) scales during their clinic visits. Conventional and modern psychometric analyses were performed on the completed forms. RESULTS Conventional and modern analyses generally indicated excellent psychometric properties of the CAPPRI in patients with DSPN. For example, the CAPPRI demonstrated unidimensionality and performed like an interval-level scale. CONCLUSION Attributes of the CAPPRI for DSPN include ease of use and interpretation; unidimensionality, allowing scores to be summed; adequate coverage of disease severity; and the scale's ability to address relevant life domains. Furthermore, the CAPPRI is free and in the public domain. The CAPPRI may assist the clinician and patient with DSPN in estimating disease-specific quality of life, especially in terms of pain, sleep, psychological well-being, and everyday function. The CAPPRI may be most useful in the everyday clinical setting but merits further study in this setting, as well as the clinical trial setting.
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Affiliation(s)
- Kelly G Gwathmey
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Reza Sadjadi
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - William B Horton
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Mark R Conaway
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Carolina Barnett-Tapia
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Vera Bril
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - James W Russell
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Aziz Shaibani
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Michelle L Mauermann
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Michael K Hehir
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Noah Kolb
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Jeffrey Guptill
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Lisa Hobson-Webb
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Karissa Gable
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Shruti Raja
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Nicholas Silvestri
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Gil I Wolfe
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - A Gordon Smith
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Rabia Malik
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Rebecca Traub
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Amruta Joshi
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Matthew P Elliott
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Sarah Jones
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill
| | - Ted M Burns
- From the Departments of Neurology (K.G.G., A.J., M.P.E., S.J., T.M.B.), Internal Medicine (W.B.H.), and Public Health Sciences (M.R.C.), University of Virginia, Charlottesville; Massachusetts General Hospital/Harvard Medical School (R.S.), Boston, MA; Division of Neurology (C.B.-T., V.B.), Department of Medicine, The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University of Toronto and University Health Network, Toronto, Canada; Department of Neurology (J.W.R.), University of Maryland, Baltimore; Department of Neurology (A.S.), Baylor St. Luke's Medical Center, Houston, TX; Department of Neurology (M.L.M.), Mayo Clinic, Rochester, MN; Department of Neurology (M.K.H., N.K.), University of Vermont, Burlington; Department of Neurology (J.G., L.H.-W., K.G., S.R.), Duke University Medical Center, Durham, NC; Department of Neurology (N.S., G.I.W.), University at Buffalo, SUNY, Buffalo, NY; Department of Neurology (A.G.S.), Virginia Commonwealth University, Richmond; Department of Neurology (R.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (R.T.), University of North Carolina, Chapel Hill.
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Hunter M, Heatwole C, Luebbe E, Johnson NE. What Matters Most: A Perspective From Adult Spinal Muscular Atrophy Patients. J Neuromuscul Dis 2018; 3:425-429. [PMID: 27854231 DOI: 10.3233/jnd-160168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are multiple symptoms that affect adults with spinal muscular atrophy (SMA). The extent of these symptoms and their impact on individuals' lives is not fully known. We interviewed 15 adults with genetically confirmed SMA. Participants were asked to identify issues that have significant impact on their lives. Interviews were recorded, transcribed, coded, and analyzed. Participants provided 1045 direct quotes. 177 potential symptoms of importance were identified. Symptoms were grouped by like topics into fourteen symptomatic themes. The symptoms and issues identified by SMA patients alter their physical, mental, and social health and may be amendable to therapeutic intervention.
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Affiliation(s)
- Michael Hunter
- Department of Neurology, University of Utah School of Medicine, North Medical Drive East, Salt Lake City, UT, USA
| | - Chad Heatwole
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Elmwood Ave, Rochester, NY, USA
| | - Elizabeth Luebbe
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Elmwood Ave, Rochester, NY, USA
| | - Nicholas E Johnson
- Department of Neurology, University of Utah School of Medicine, North Medical Drive East, Salt Lake City, UT, USA
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Walklet E, Muse K, Meyrick J, Moss T. Do Psychosocial Interventions Improve Quality of Life and Wellbeing in Adults with Neuromuscular Disorders? A Systematic Review and Narrative Synthesis. J Neuromuscul Dis 2018; 3:347-362. [PMID: 27854227 PMCID: PMC5123628 DOI: 10.3233/jnd-160155] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Quality of life and well-being are frequently restricted in adults with neuromuscular disorders. As such, identification of appropriate interventions is imperative. The objective of this paper was to systematically review and critically appraise quantitative studies (RCTs, controlled trials and cohort studies) of psychosocial interventions designed to improve quality of life and well-being in adults with neuromuscular disorders. A systematic review of the published and unpublished literature was conducted. Studies meeting inclusion criteria were appraised using a validated quality assessment tool and results presented in a narrative synthesis. Out of 3,136 studies identified, ten studies met criteria for inclusion within the review. Included studies comprised a range of interventions including: cognitive behavioural therapy, dignity therapy, hypnosis, expressive disclosure, gratitude lists, group psychoeducation and psychologically informed rehabilitation. Five of the interventions were for patients with Amyotrophic Lateral Sclerosis (ALS). The remainder were for patients with post-polio syndrome, muscular dystrophies and mixed disorders, such as Charcot-Marie-Tooth disease, myasthenia gravis and myotonic dystrophy. Across varied interventions and neuromuscular disorders, seven studies reported a short-term beneficial effect of intervention on quality of life and well-being. Whilst such findings are encouraging, widespread issues with the methodological quality of these studies significantly compromised the results. There is no strong evidence that psychosocial interventions improve quality of life and well-being in adults with neuromuscular disorders, due to a paucity of high quality research in this field. Multi-site, randomised controlled trials with active controls, standardised outcome measurement and longer term follow-ups are urgently required.
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Affiliation(s)
- Elaine Walklet
- Health and Social Sciences Department, University of the West of England, Bristol, UK.,Psychology Department, University of Worcester, Worcester, UK
| | - Kate Muse
- Psychology Department, University of Worcester, Worcester, UK
| | - Jane Meyrick
- Health and Social Sciences Department, University of the West of England, Bristol, UK
| | - Tim Moss
- Health and Social Sciences Department, University of the West of England, Bristol, UK
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Böling S, Varho T, Haataja L. Longitudinal study showed that the quality of life of Finnish adolescents with cerebral palsy continued to be relatively good. Acta Paediatr 2018; 107:469-476. [PMID: 29055066 DOI: 10.1111/apa.14123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/11/2017] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Abstract
AIM This longitudinal study examined what perceptions paediatric patients with cerebral palsy (CP) and their caregivers had of the patient's quality of life (QoL). It examined changing trends as children with CP became adolescents and examined the feasibility of the Finnish version of the CP QOL-Teen questionnaire. METHODS Carried out in autumn 2015, this study formed part of the multi-centre Finnish national CP project and aimed to validate the CP QOL-Teen questionnaire, which was posted to 54 adolescents and their caregivers. They included 24 who had responded to CP QOL-Child questionnaire in 2013. RESULTS The questionnaires were returned by 27 pairs of adolescents and caregivers and one extra caregiver also responded. Of these, 24 pairs had taken part in the 2013 survey. The internal consistencies of the sum variables were found to be acceptable in all cases. Overall QoL showed an average score of 81.8 on a scale from 0 to 100. Adolescents reported significantly higher QoL than their caregivers. There were no significant differences between the responses of the children and adolescents. CONCLUSION We showed that QoL was relatively good in childhood and adolescence. The Finnish version of the CP QOL-Teen questionnaire was an appropriate clinical tool for assessing QoL.
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Affiliation(s)
- Sanna Böling
- Pediatric Neurology; University of Turku and Turku University Hospital of Turku; Turku Finland
| | - Tarja Varho
- Neuropaediatric Unit of Turku City Welfare Division; Turku Finland
| | - Leena Haataja
- Pediatric Neurology; Children's Hospital, University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Tascilar NF, Saracli O, Kurcer MA, Ankarali H, Emre U. Is there any relationship between quality of life and polysomnographically detected sleep parameters/disorders in stable myasthenia gravis? Acta Neurol Belg 2018; 118:29-37. [PMID: 28456888 DOI: 10.1007/s13760-017-0787-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
It is known that quality of life in myasthenia gravis is positively correlated with subjective sleep quality, still no data is available regarding the relationship between QOL and polysomnographically detected sleep parameters and disorders. In this study, we tried to highlighten this relationship, by performing polysomnography. Sleep-related complaints were evaluated in face-to-face interviews with 19 clinically stable MG patients and 26 healthy controls. During the interviews questionnaires assessing sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, and Turkish version of the MG-QOL 15-item scale [(MG-QOL15(T)] were administered and then an overnight polysomnography was performed. Sleep disorders, especially obstructive sleep apnea and fatigue were higher, whereas subjective sleep duration was significantly lower, in patients than controls. Excessive daytime sleepiness and poor sleep quality were not different between patients and controls. Other than percentage of sleep stage III, which was negatively correlated with MG-QOL15(T) scores, neither other sleep parameters nor sleep disorders were correlated with MG-QOL15(T) scores. MG composite, subjective sleep duration, fatigue severity and Hamilton depression rating scale scores were found to be positively correlated with MG-QOL15(T) scores. It was shown that decreasing disease severity and enhancing psychological well-being will improve patients' quality of life. We recommend that our findings should be repeated in a large prospective cohort of MG patients.
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Lee I, Kaminski HJ, Xin H, Cutter G. Gender and quality of life in myasthenia gravis patients from the myasthenia gravis foundation of America registry. Muscle Nerve 2018; 58:90-98. [PMID: 29466829 DOI: 10.1002/mus.26104] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Quality of life (QOL) has been poorly characterized among patients with myasthenia gravis (MG) other than assessments performed within the clinical setting. METHODS Patients age ≥ 18 years who were diagnosed with MG and registered with the MG patient registry between July 1, 2013, and June 30, 2016, were included. Demographic information, disease related history, and QOL were compared between men and women using multivariable analysis. RESULTS A total of 1,315 subjects (827 women) were included. Women were significantly younger, had a younger age at symptom onset, and were more likely to have thymoma and thymectomy. The 15-item Myasthenia Gravis Quality of Life scale (MG-QOL15) was significantly worse in women. MG-QOL15 score was comparable between women who had thymectomy and men with or without thymectomy. DISCUSSION QOL among MG patients is worse in women compared with men, but this disparity is eliminated in women who have undergone thymectomy. Muscle Nerve, 2018.
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Affiliation(s)
- Ikjae Lee
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Henry J Kaminski
- Department of Neurology, The George Washington University, Washington, DC, USA
| | - Haichang Xin
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pinto S, de Carvalho M. Health Status Perspectives in Amyotrophic Lateral Sclerosis. NEURODEGENER DIS 2017; 17:323-329. [PMID: 29084402 DOI: 10.1159/000480638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS The global perception of the health status (HS) of amyotrophic lateral sclerosis (ALS) patients before the initial diagnosis has not been addressed previously. METHODS We recorded the following at the first visit, before diagnostic information: (1) visual analog scale (VAS) of the EQ-5D; (2) the revised ALS functional rating scale (ALSFRS- R), bulbar (ALSFRSb), upper limb (ALSFRSul), lower limb (ALSFRSll), and respiratory (RofALSFRS-R) subscores; and (3) forced and slow vital capacities. Correlations were tested by the Pearson correlation test. Variables were compared between groups defined by the VAS median value. p < 0.05 was considered significant. RESULTS Of the 156 patients included in the study (91 spinal-onset, 49 bulbar-onset, 16 axial/respiratory-onset; 95 men; mean onset age 63.9 ± 13 years; mean disease duration 18.4 ± 26.5 months), HS VAS was significantly lower in spinal-onset patients (p = 0.047), and particularly in spinal-onset women (p = 0.027). Disease duration had no influence. HS VAS was moderately correlated with ALSFRS, ALSFRSul and ALSFRSll (0.4 < r < 0.5, p < 0.01), weakly correlated with RofALSFRS-R in the whole population (r = 0.171, p < 0.05), and not correlated with ALSFRSb or the respiratory tests. ALSFRSb was similar between groups defined by the HS VAS median value, but the other scores were significantly lower for poorer HS values. CONCLUSION HS before diagnosis is mostly dependent on the perception of upper and lower limb function. A tool tailored to evaluate HS in bulbar-onset patients should be developed.
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Affiliation(s)
- Susana Pinto
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Lee HL, Min JH, Seok JM, Cho EB, Cho HJ, Kim YD, Kim BJ. Physician- and self-assessed myasthenia gravis activities of daily living score. Muscle Nerve 2017; 57:419-422. [PMID: 28796382 DOI: 10.1002/mus.25764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The Myasthenia Gravis-Activities of Daily Living (MG-ADL) profile scale is a simple-to-use instrument. We aimed to validate this scale in the Korean language and compare physician- and self-assessed MG-ADL scores (pMG-ADL-K and sMG-ADL-K). METHODS pMG-ADL-K and sMG-ADL-K and MG Composite (MGC) scores were obtained from patients. The correlation between pMG-ADL-K and MGC and the relationship between the pMG-ADL-K and sMG-ADL-K were assessed using the Cronbach α and the Spearman coefficient. By intraclass correlation coefficient (ICC), the reliability of each sub-item of pMG-ADL-K and sMG-ADL-K was evaluated. RESULTS We included data from 40 patients. The pMG-ADL-K score showed a strong correlation with the MGC score (rho = 0.80, P < 0.01). The Cronbach α was 0.98 between pMG-ADL-K and sMG-ADL-K, and sub-items showed good consistency (ICC 0.684-0.985, P < 0.001). DISCUSSION The MG-ADL-K is a valid tool and the sMG-ADL-K shows excellent correlation with pMG-ADL-K. Both the pMG-ADL-K and sMG-ADL-K can be used to measure MG severity. Muscle Nerve 57: 419-422, 2018.
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Affiliation(s)
- Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun Bin Cho
- Department of Neurology, Changwon Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Hye Jin Cho
- Department of Neurology, The Catholic University of Korea, College of Medicine, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Yong-Dae Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
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A pilot case series of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life and mood in muscle disorders. COGNITIVE BEHAVIOUR THERAPIST 2017. [DOI: 10.1017/s1754470x17000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study aimed to demonstrate proof of concept and acceptability of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life (QoL) and mood for people with muscle disorders (MD). A case-series with an AB design was used to assess changes in primary (QoL) and secondary (depression and anxiety) outcome variables across the period of study. Change in the psychological process targeted by ACT – psychological flexibility – was also investigated, to allow insight into possible treatment mechanisms. Post-intervention, participants also completed a brief free-text evaluation. Relative to pre-intervention scores, four (of seven) participants showed varying degrees of improvement in all primary and secondary outcome variables and were thus considered responders. However, consistent concomitant improvements in psychological flexibility were not apparent. Participants reported a mostly positive experience of the intervention; all appeared to complete the intervention, and no adverse events were reported. Nonetheless, there was evidence that those with compromised concentration or who report good initial QoL and low levels of distress may derive less benefit. Although several methodological weaknesses limit the strength of our conclusions, this ACT-based guided self-help intervention shows encouraging utility for improving QoL and mood in MD.
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Aho AC, Hultsjö S, Hjelm K. Experiences of being parents of young adults living with recessive limb-girdle muscular dystrophy from a salutogenic perspective. Neuromuscul Disord 2017; 27:585-595. [DOI: 10.1016/j.nmd.2017.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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Bos I, Kuks JBM, Almansa J, Kremer HPH, Wynia K. Stability and relative validity of the Neuromuscular Disease Impact Profile (NMDIP). BMC Neurol 2017; 17:87. [PMID: 28490360 PMCID: PMC5426023 DOI: 10.1186/s12883-017-0866-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the stability and relative validity (RV) of the Neuromuscular Disease Impact Profile (NMDIP) using criterion-related groups. In a previous study the NMDIP-scales showed good internal consistency, convergent and discriminant validity. Known-groups analysis showed that the NMDIP discriminates between categories of extent of limitations. METHODS A cross-sectional postal survey study was performed on patients diagnosed with a NMD and registered at the Department of Neurology, University Medical Center Groningen, the Netherlands. Participants were asked to complete the preliminary NMDIP, the Medical Outcome study Short Form Questionnaire (SF-36), the World Health Organization Quality Of Life-abbreviation version (WHOQOL-bref), and two generic domain specific measures: the Groningen Activity Restriction Scale (GARS) and the Impact on Participation and Autonomy Questionnaire (IPAQ). The variables 'Extent of Limitations' and 'Quality of Life' were used to create criterion-related groups. Stability over time was tested using the Wilcoxon Signed Rank Test for paired samples and the intraclass correlation coefficients for repeated measures. RV was examined by comparing the ability of NMDIP with generic multidimensional health impact measures, and domain specific measures in discriminating between criterion-related subgroups using the Kruskal-Wallis H-test. RESULTS Response rate was 70% (n = 702). The NMDIP-scales showed sufficient stability over time, and satisfactory or strong RV. In general, the NMDIP scales performed as well as or better than the concurrent measurement instruments. CONCLUSIONS The NMDIP proved to be a valid and reliable disease-targeted measure with a broad scope on physical, psychological and social functioning.
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Affiliation(s)
- Isaäc Bos
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Jan B M Kuks
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Josué Almansa
- Department of Health Sciences, Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hubertus P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.,Department of Health Sciences, Community and Occupational Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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