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Rodríguez AA, García M, Martínez O, López-Paz JF, García I, Pérez-Nuñez P, Amayra I. Predictors of overload in parents of children with neuromuscular diseases. Front Neurol 2024; 15:1349501. [PMID: 38585358 PMCID: PMC10996859 DOI: 10.3389/fneur.2024.1349501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Parents of children with neuromuscular diseases experience multiple difficulties in their daily lives that affect their physical and psychological health. The risk factors for these health issues have not been sufficiently investigated. Therefore, the aim of this study was to analyze the potential predictors of overload in these parents, including QoL, somatic symptomatology, life satisfaction, psychological adjustment and certain sociodemographic variables. Methods A cross-sectional research study was conducted among parents who are caregivers for children with NMD in Spain. A convenience sample of 110 parents who were contacted by associations and hospitals was used. Variables were evaluated using the sociodemographic questionnaire, CarerQol-7D, PHQ-15, Barthel Index, Psychological Adaptation Scale, Zarit Overload Scale and Satisfaction with Life Scale. Results One of the most relevant findings of the present study is the identification of 3 overload groups (mild to moderate, moderate to severe, and severe overload) based on life satisfaction and somatic symptom scores within the predictive model of the discriminate analysis. Wilk's lambda of the discriminant function was 0.568, χ2 (2, n = 55) = 8.815, p < 0.001. Discussion This study presents a model that reveals the influence of unemployment, having a child with a severe level of dependency, the presence of somatic symptomatology and life satisfaction on caregiver overload. Likewise, the caregiver's self-esteem could be a protective factor against overload.
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Affiliation(s)
- A. A. Rodríguez
- Neuro-e-Motion Research Team, Faculty of Health Sciences, Department of Psychology, University of Deusto, Bilbao, Spain
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Manalel JA, Sumrall S, Davidson H, Grewal M, Granovetter MA, Koehly LM. Stress, coping, and positive aspects of caregiving among caregivers of children with rare disease. Psychol Health 2024; 39:216-232. [PMID: 35620936 PMCID: PMC9701241 DOI: 10.1080/08870446.2022.2057494] [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: 03/01/2021] [Revised: 02/22/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Caregivers of children with rare diseases often consider caregiving to be a rewarding experience, despite high levels of burden. The present study examined associations between caregiver stress and positive aspects of caregiving (PAC); investigated associations between interpersonal coping strategies and PAC; and determined whether coping strategies moderated associations between stressors and PAC. DESIGN Survey data came from a study on caregivers across different caregiving conditions, including caregivers of children diagnosed with inherited metabolic conditions (n = 167), undiagnosed diseases (n = 23), and caregivers of typically-developing children (n = 74). MAIN OUTCOME MEASURES Positive Aspects of Caregiving (PAC) scale. RESULTS Results from generalized linear models indicated that perceived burden was not associated with PAC. Venting was negatively associated with PAC (b= -0.09, p=.03), whereas emotional support was associated with increased PAC for caregivers of children with undiagnosed conditions (b = 0.15, p=.02). Care needs were associated with greater PAC among caregivers engaged in high levels of emotional support coping (b = 0.10, p=.01) and venting (b = 0.09, p=.03). CONCLUSION These findings illuminate important differences in PAC based on the caregiving condition, and aspects of the caregiver stress process model that might be universal to caregivers. Results inform stress process theory and highlight the potential of support-based interventions for promoting PAC. Supplemental data for this article is available online at.
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Affiliation(s)
- Jasmine A Manalel
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Sydney Sumrall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah Davidson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan Grewal
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Tsitsani P, Katsaras G, Soteriades ES. Barriers to and Facilitators of Providing Care for Adolescents Suffering from Rare Diseases: A Mixed Systematic Review. Pediatr Rep 2023; 15:462-482. [PMID: 37606447 PMCID: PMC10443320 DOI: 10.3390/pediatric15030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
Rare Diseases (RDs) in adolescents are characterized by low frequency and clinical heterogeneity, are chronic and deliberating and demand a multidisciplinary approach as well as costly and specialized treatments. Comprehending patients' and parents' needs through a mixed systematic review is essential for healthcare system planning. This mixed systematic review explored barriers to and facilitators of effective care for adolescents with RDs as perceived by patients and their parents. Three databases (2008-2023) were searched and twenty-five articles were selected and critically appraised with the Mixed Methods Appraisal Tool (MMAT; version 2018). The review followed a convergent integrated approach for data extraction according to Joanna Briggs Institute's (JBI) mixed method systematic review (MMSR) methodology. Subsequent reflexive thematic analysis categorized the barriers and facilitators into five levels (intrapersonal, interpersonal, institutional, community and public policy) following the conceptual framework of the socio-ecological model for healthcare promotion. Barriers on the institutional and public policy level stood out as the most frequently reported, resulting in unmet care needs and frustrating family dynamics. National and regional healthcare policies are rarely actually linked to pragmatic intervention programs with a measurable impact on patients' welfare. Targeted strategies involving primary care infrastructure and personnel for better coordination and management of the disease are discussed.
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Affiliation(s)
- Pelagia Tsitsani
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, 2220 Nicosia, Cyprus;
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece;
| | - Georgios Katsaras
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece;
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, 2220 Nicosia, Cyprus;
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Citarelli G, Garofalo C, Esposito MG, Torre V, Magliano L, Politano L. Impact of the COVID-19 pandemic on rehabilitation setting. Part 1: professionals' views on the changes in routine care provided by a rehabilitation centre for patients with muscle diseases. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:132-134. [PMID: 34632295 PMCID: PMC8489169 DOI: 10.36185/2532-1900-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 11/23/2022]
Abstract
The outbreak of COVID-19 has forced the health care system to undergo profound
rearrangements in services and facilities, especially during the periods of
lockdown. In this context, inpatient and outpatient services had to rethink and
reorganize their activities to meet the needs of severely disabled patients, as
those affected by Muscular Dystrophies (MDs). We present the preliminary results of a survey aiming to explore the staff views
on the changes in the care provided by the Gaetano Torre Rehabilitation Centre,
and, the impact of these changes on professionals, patients and their
families. The survey was carried out using an open-ended questionnaire including six-items,
on the practical and psychological aspects emerged during the pandemic in
relation to the healthcare services provided by the Centre and to the
patients/caregivers conditions. The participants, most of them physiotherapists,
highlighted 169 aspects emerging in the pandemic, 48.5% referring to the
resources used to cope with critical issues and 51.5% concerning the
difficulties encountered. Emotional aspects prevailed on practical aspects both
in resources (52.4 vs 47.6%) and in difficulties (57.5
vs 42.5%) categories. In particular, with regard to
patients’ resources, psychological benefits, despite the burden, were
greater than practical ones (87 vs 13%), in the form of
improved intra-family relationships, feeling more cared for, and satisfaction
for the received care. As for the patients’ relatives, the staff
indicated more resources than difficulties (72.8 vs 17.2%).
Among the former, 75% concerned the emotional sphere, such as the perception of
having a point of reference even in such a difficult time.
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Affiliation(s)
- Giulia Citarelli
- Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, Marano di Napoli, Naples, Italy
| | - Ciro Garofalo
- Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, Marano di Napoli, Naples, Italy
| | - Maria Grazia Esposito
- Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, Marano di Napoli, Naples, Italy
| | - Vito Torre
- Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, Marano di Napoli, Naples, Italy
| | - Lorenza Magliano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luisa Politano
- Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, Marano di Napoli, Naples, Italy
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Ortega J, Vázquez N, Flores C, Amayra I. Mental health and psychological adaptation on parents of children with neuromuscular diseases. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1961581] [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]
Affiliation(s)
- Javiera Ortega
- Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina [CONICET], Buenos Aires, Argentina
- Centro Investigaciones de Psicología y Psicopedagogía [CIPP], Facultad de Psicología y Psicopedagogía, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Natalia Vázquez
- Centro Investigaciones de Psicología y Psicopedagogía [CIPP], Facultad de Psicología y Psicopedagogía, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Fundación de Psicología Aplicada a Enfermedades Huérfanas [Fupaeh], Buenos Aires, Argentina
| | - Camila Flores
- Centro de Salud Mental N3 Arturo Ameghino, Buenos Aires, Argentina
| | - Imanol Amayra
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, España
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Otto AK, Soriano EC, Birmingham WC, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers. Ann Behav Med 2021; 56:405-413. [PMID: 34244701 DOI: 10.1093/abm/kaab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver's psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving. PURPOSE To examine the influence of psychosocial contextual variables on caregiver ambulatory BP. METHODS Participants were 81 spouse-caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time. RESULTS Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant. CONCLUSIONS Caregivers' psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Emily C Soriano
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | | | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,College of Medicine, University of Vermont, Burlington, VT, USA
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Porteous D, Davies B, English C, Atkinson J. An Integrative Review Exploring Psycho-Social Impacts and Therapeutic Interventions for Parent Caregivers of Young People Living with Duchenne's Muscular Dystrophy. CHILDREN (BASEL, SWITZERLAND) 2021; 8:212. [PMID: 33799499 PMCID: PMC7999999 DOI: 10.3390/children8030212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 12/28/2022]
Abstract
The purpose of this integrative review was to explore psycho-social impacts and therapeutic interventions for parent caregivers of young people living with Duchenne's Muscular Dystrophy (DMD). Electronic databases were searched for research publications between 2010 and 2020. This included Medline, CINAHL, PsycINFO, ERIC, ERC, and AMED. Four central themes emerged: Living with DMD; Knowing and telling; Transitioning; and Building resilience. The impact on parents caring for a child with DMD affected all aspects of their lives, changed over time, and had identifiable peak stress points. Unmet parental information and support needs left parents struggling in their role. Transition required changes to parenting behaviors and required adaptation and resilience. It is proposed that future investment should focus on anticipating family need, targeting intervention cognizant of predictable stress points and building resilience through social community. Parents may then be better positioned to support their child in looking forward.
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Affiliation(s)
- Debra Porteous
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne NE7 7XA, UK
| | - Barbara Davies
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne NE7 7XA, UK
| | - Christine English
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne NE7 7XA, UK
| | - Joanne Atkinson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne NE7 7XA, UK
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LoMauro A, Gandossini S, Russo A, Velardo D, Comi GP, Turconi AC, Bresolin N, Aliverti A, D'Angelo MG. A Multidisciplinary Evaluation of Patients with DMD in An Italian Tertiary Care Center. J Neuromuscul Dis 2020; 8:235-249. [PMID: 33361606 DOI: 10.3233/jnd-190417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With more widespread prolonged survival, Duchenne muscular dystrophy patients progressively experience multisystem complications. We retrospectively reviewed the charts of 132 Duchenne patients (112 alive/20 dead, age 3.5÷32.3 years) with the aims: 1) to provide a comprehensive description of the clinical status considering different aspects of the disease; 2) to propose a new scoring tool able to consider and pool together heterogeneous different functional. Five functions were analyzed: cardiac, respiratory, nutritional, ambulation and scoliosis. For each function, different items were considered and classified according to clinical severity (as indicated by international guidelines) and an incremental scoring was assigned. In addition, a global score incorporating all functions was defined. The scoring system confirmed that despite the significant protective role of steroids, all functions deteriorated with age. The severity of the global score became significantly higher since the age of 13 years. The severity of cardiac, respiratory and nutritional dysfunction was higher since 18 years. Deceased patients were characterized by significantly worse cardiac function, absence of steroid therapy and later use of respiratory assistive devices. The index proposed in this pilot study is a promising tool able to aggregate and correlate heterogeneous functions. It could become either an individual prognostic indicator of decline or a global score to evaluate changes in clinical trials therefore allowing multicenter studies, optimizing the management of both the primary and the secondary complications of the disease and understanding their relative impact.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - S Gandossini
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - A Russo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - D Velardo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
| | - G P Comi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan
| | - A C Turconi
- Scientific Institute, IRCCS E. Medea- via don Luigi Monza, Bosisio P (Lecco) Italy
| | - N Bresolin
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - M G D'Angelo
- Scientific Institute IRCCS E. Medea, Neuromuscular Unit, Bosisio Parini (Lecco) Italy
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Palacio Gonzalez C, Roman-Calderón JP, Limonero JT. The relationship between positive aspects of caring, anxiety and depression in the caregivers of cancer patients: The mediational role of burden. Eur J Cancer Care (Engl) 2020; 30:e13346. [PMID: 33037849 DOI: 10.1111/ecc.13346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/13/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to examine how the burden of caregivers of patients with an advanced oncological illness mediates the relationship between positive aspects of care, depression and anxiety. METHODS Quantitative study with a cross-sectional design. One hundred informal adult caregivers of patients with advanced oncological illness who attended the pain and palliative care unit or the psychological unit at the Instituto de Cancerologia Clinica las Americas (Medellin, Colombia) completed self-report assessments including positive aspects of care (PAC), burden and anxiety/depression measured using the HADS (Hospitalized Anxiety Depression Scale). The partial least squares Structural Equation Modelling (PLS-SEM) approach was selected to validate the hypotheses of the study. RESULTS Most of the participants were women (86%), with a mean age of 46.52 years (SD=15.05). Most of the participants reported experiencing both PAC and anxiety. They also scored low for burden. PAC exerted a negative effect on Burden, whereas Burden contributed positively to Anxiety and Depression. The indirect impact of PAC on Anxiety and Depression was significant p < .00. CONCLUSIONS Positive aspects of care in advanced cancer caregivers constitutes a protective factor against caregiver's burden, depression and anxiety. Health staff can promote caregivers' adaptation and wellbeing emphasizing these PAC.
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Affiliation(s)
- Carolina Palacio Gonzalez
- Instituto de Cancerología, Clínica las Americas, Medellín, Colombia.,Research Group on Stress and Health, School of Psychology, Autonomous University of Barcelona, Barcelona, Spain.,Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana in Medellín, Medellín, Colombia
| | | | - Joaquín T Limonero
- Research Group on Stress and Health, School of Psychology, Autonomous University of Barcelona, Barcelona, Spain
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Glover S, Hendron J, Taylor B, Long M. Understanding carer resilience in Duchenne muscular dystrophy: A systematic narrative review. Chronic Illn 2020; 16:87-103. [PMID: 30049227 DOI: 10.1177/1742395318789472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives This review synthesizes recent research on resilience in those who care for a family member with Duchenne muscular dystrophy, identifying the challenges and potential factors moderating resilience. Methods This systematic narrative review is informed by searches on six bibliographic databases between January and June 2016. Forty-one articles were identified to meet the inclusion criteria, and findings were synthesised around three key themes. Results Those who care for someone with Duchenne muscular dystrophy have been described as resilient through building strength in facing the adversity of caring. The main predictors of carer resilience were the child’s level of disability, perception of the caring experience and family functioning. The outcomes of resilience were identified as better psychological and physical health as well as psychological adaption. Coping abilities and social support, influenced by individual and environmental factors contribute to resilience. Discussion Research suggested that some carers have the ability to build resilience over time, although limited understanding of coping with the emotional experience of Duchenne muscular dystrophy is conveyed. Social support appears to be a protective factor for Duchenne muscular dystrophy carers but further research is required on its relationship with resilience.
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Affiliation(s)
- Suzanne Glover
- School of Communication, Ulster University, Newtownabbey, Belfast
| | - Jill Hendron
- School of Communication, Ulster University, Newtownabbey, Belfast
| | - Brian Taylor
- School of Sociology and Applied Social Studies, Ulster University, Belfast
| | - Maggie Long
- School of Communication, Ulster University, Newtownabbey, Belfast
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11
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Mental health and coping strategies in families of children and young adults with muscular dystrophies. J Neurol 2020; 267:2054-2069. [PMID: 32222927 DOI: 10.1007/s00415-020-09792-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Living with a progressive disease as muscular dystrophy (MD) can be challenging for the patient and the entire family from both emotional and practical point of view. We aimed to extend our previously published data about mental health in patients with MDs, also investigating coping profiles of both themselves and their parents. Furthermore, we wanted to verify whether psychological adaptation of patients can be predicted by coping strategies, taking also into account physical impairment, cognitive level and socioeconomic status. METHODS 112 patients with MDs, aged 2-32 were included. Their emotional and behavioural features were assessed through parent- and self-report Achenbach System for Empirically Based Assessment questionnaires and Strength and Difficulties Questionnaires. Development and Well-Being Assessment or Autism Diagnostic Observation Schedule were administered to confirm suspected diagnoses. Coping profile of both parents and patients was assessed through the self-administered New Italian Version of the Coping Orientation to the Problems Experienced questionnaire and its relationship with emotional/behavioural outcome was examined in linear regression analyses. RESULTS High prevalence of intellectual disability and autism spectrum disorders was confirmed in Duchenne MD. Despite the high rate of internalizing symptomatology, we did not report higher rate of psychopathological disorders compared to general population. Parents tend to rely more on positive reinterpretation and less on disengagement coping. Avoidance coping, whether used by parents or patients, and ID, predicted increased emotional/behavioural problems. CONCLUSIONS Psychosocial interventions should address problems of anxiety and depression that people with MDs frequently experience, even through fostering parents' and childrens' engagement coping over disengagement coping.
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12
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The relationship between the positive aspects of caring and the personal growth of caregivers of patients with advanced oncological illness : Postraumattic growth and caregiver. Support Care Cancer 2019; 28:3007-3013. [PMID: 31823055 DOI: 10.1007/s00520-019-05139-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/16/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Examine the relationship between the positive aspects of care and the personal growth of caregivers of patients with advanced oncological illness. METHODS This research was a quantitative study with a transversal design. One hundred (100) informal caregivers filled out self-applied questionnaire on resilience, aspects of care, emotional distress, spirituality, and posttraumatic growth. Descriptive statistics were applied to the data, later correlation, and regression, and comparative analyses were conducted. RESULTS The participants were mainly women (86%) with an average care period of 12 months. The average age was 46.52 years. The highest scores were evidenced in positive aspects of caretaking, spirituality, personal growth, and distress, while the lowest score was seen in questions related to resilience. There was a negative inverse correlation among emotional distress, resilience, spirituality, and posttraumatic growth (p < .05) and a positive correlation among resilience, spirituality, posttraumatic growth, and the positive aspects of caretaking (p < .01). There were significant differences among the items related to emotional distress, resilience, and posttraumatic growth. The linear regression analysis showed that as resilience, spirituality, and the positive aspects of care increased, so did posttraumatic growth. SIGNIFICANT RESULTS To promote the perception of benefits among caregivers, resilience and the identification of meaning in the caregiving experience of patients with advanced oncological illness can be considered protective factors favoring adaptation and reducing negative moods.
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Pierce JS, Wasserman R, Enlow P, Aroian K, Lee J, Wysocki T. Benefit finding among parents of young children with type 1 diabetes. Pediatr Diabetes 2019; 20:652-660. [PMID: 31006941 PMCID: PMC7416424 DOI: 10.1111/pedi.12860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 12/30/2022] Open
Abstract
Benefit finding, perceived positive effects of adversity, has been associated with psychological well-being in people with chronic illnesses and with better adherence for adolescents with type 1 diabetes (T1D). Our qualitative research with parents of young children (< 6 years old) with T1D indicated that benefit finding (BF) is a common parental coping mechanism, but no tools exist to measure BF in parents. We determined psychometric properties of the Diabetes Benefit Finding Scale for Parents (DBFS-P), a 16-item questionnaire adapted from the validated adolescent version. Parents of young children with T1D (n = 172) were participants in a randomized trial of an online intervention. We examined the DBFS-P factor structure through principal component analysis (PCA); internal consistency through Cronbach's alpha; convergent validity via bivariate correlations between the DBFS-P and measures of parental depression, anxiety, T1D self-efficacy, and hypoglycemia fear; and discriminant validity via bivariate correlations between the DBFS-P and measures of parental somatization and child behavior problems. PCA revealed one factor (56.47% variance) with Cronbach's α = 0.95. Convergent validity of the DBFS-P was supported by significant correlations with parental depression (r = -0.35, P < 0.001), anxiety (r = -0.20, P = 0.008), T1D self-efficacy (r = 0.36, P < 0.001), and hypoglycemia fear (r = 0.27, P < 0.001). Non-significant correlations with parental somatization (r = -0.06, P = 0.42) and child behavior problems (r = -0.12, P = 0.14) support its discriminant validity. The DBFS-P demonstrated good psychometric properties as a tool for assessing BF among caregivers.
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Affiliation(s)
- Jessica S. Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida
| | - Rachel Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida
| | - Paul Enlow
- Center for Healthcare Delivery Science, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Karen Aroian
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Joyce Lee
- Division of Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Specialty Care, Jacksonville, Florida
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14
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Sætrang T, Bjørk IT, Capjon H, Rasmussen M. Parent-child communication and timing of interventions are challenges in the Duchenne muscular dystrophy care. Acta Paediatr 2019; 108:535-540. [PMID: 30118557 DOI: 10.1111/apa.14537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 08/04/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
AIM Duchenne muscular dystrophy (DMD) is an X-linked myopathy affecting one in 3600-6000 live male births. The aim of this study was to gain further insight into how parents experience caring for boys with DMD. METHODS Using a qualitative design, parents in 12 families with boys with DMD, whereof two pairs of siblings, were interviewed in 2014 and 2015. Participants were parents of boys followed at Oslo University Hospital or other hospitals in the south-eastern health region of Norway. Mean age of the boys was 13 years, range 7-17. RESULTS Parents expressed the importance of obtaining good information about the diagnosis, supplied with sensitivity for them as clients, and the parents must be involved in timing of interventions. Meeting with others in the same situation was highly appreciated. Many of the parents expressed their own need for support to cope with the difficult situation. Continuity of support in the boys' transition to adulthood was pointed out as important, as well as the need for professional help to talk to the boys about their diagnosis. CONCLUSION Our study suggests that professional teams should expand the parental perspective and emphasise a holistic approach in their work with patients with DMD.
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Affiliation(s)
- T Sætrang
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
| | - I T Bjørk
- Department of Nursing Science University of Oslo Oslo Norway
| | - H Capjon
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
| | - M Rasmussen
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
- Unit for Inborn and Hereditary Neuromuscular Disorders (EMAN) Department of Neurology Oslo University Hospital Oslo Norway
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15
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Colvin MK, Poysky J, Kinnett K, Damiani M, Gibbons M, Hoskin J, Moreland S, Trout CJ, Weidner N. Psychosocial Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S99-S109. [PMID: 30275254 DOI: 10.1542/peds.2018-0333l] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
In this article, we outline a comprehensive plan for the psychosocial management of patients with Duchenne muscular dystrophy (DMD) across the life span. In 2010, the Centers for Disease Control and Prevention sponsored the development of multidisciplinary management guidance for DMD, and in 2018, that guidance was updated. In the intervening years, a new emphasis was placed on studying and addressing the psychosocial issues that affect patients with DMD, driven in part by improved patient survival. Once viewed as ancillary to managing the significant medical needs of patients with DMD, it is now standard practice to integrate psychosocial management into the multidisciplinary management of the disease. It is also increasingly recognized that neurodevelopmental disorders in DMD occur at a higher rate than what was previously understood and that these disorders warrant early and intensive intervention. In this article, we expand on the content found in the 2018 DMD Care Considerations.
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Affiliation(s)
- Mary K Colvin
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;
| | | | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | - Mario Damiani
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | - Janet Hoskin
- University of East London, London, United Kingdom
| | | | | | - Norbert Weidner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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16
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Ishizaki M, Kobayashi M, Adachi K, Matsumura T, Kimura E. Female dystrophinopathy: Review of current literature. Neuromuscul Disord 2018; 28:572-581. [PMID: 29801751 DOI: 10.1016/j.nmd.2018.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/10/2018] [Accepted: 04/06/2018] [Indexed: 01/16/2023]
Abstract
Skeletal muscle or cardiac symptoms are known to appear in a certain proportion of female patients carrying the dystrophin gene mutation. There is limited high-quality evidence to guide the treatment of female carriers of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD). The available evidence is mainly based on expert opinions and clinical experience. To improve this situation, we reviewed 1002 reports published from 1967 to 2017 to assess the following themes: epidemiology, clinical symptoms, cardiomyopathy, burdens on parents or caregivers, pregnancy or delivery, and prognosis. We aimed to provide guidance for the provision of support, care, and education for patients, caregivers, and health care professionals. There were 271 reports before 1987, and 731 reports after 1987 when dystrophin was first recognized. In this review, we mainly selected 37 papers that were reported after 1987. In seven large research papers, the incidence of skeletal muscle damage among female carriers, including asymptomatic carriers, was reported as 2.5%-19%, and the incidence of dilated cardiomyopathy was 7.3%-16.7% for DMD and 0%-13.3% for BMD. We integrated and summarized the genetically definite manifesting carriers with skeletal muscle symptoms from 10 case series. In combined data, among 93 manifesting carriers, 16 (17.2%) presented with cardiac abnormalities. The frequency of manifesting carriers complicated by cardiomyopathy increased with age. Reports on cardiac magnetic resonance in female carriers and the burden on caregivers are increasing, whereas literatures concerning pregnancy, delivery, and prognosis in female carriers are limited. This represents a future direction for research.
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Affiliation(s)
- Masatoshi Ishizaki
- Department of Neurology, National Hospital Organization, Kumamoto Saishunso Hospital, Kumamoto, Japan.
| | - Michio Kobayashi
- Department of Neurology, National Hospital Organization, Akita National Hospital, Akita, Japan
| | - Katsuhito Adachi
- Department of Internal Medicine, National Hospital Organization, Tokushima National Hospital, Tokushima, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization, Toneyama National Hospital, Osaka, Japan
| | - En Kimura
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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17
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Lue YJ, Chen SS, Lu YM. Factors affecting the health-related quality of life of caregivers of patients with muscular dystrophy. J Neurol 2018; 265:1548-1556. [PMID: 29700644 DOI: 10.1007/s00415-018-8878-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 01/16/2023]
Abstract
Muscular dystrophy (MD) is a group of progressive muscle weakness diseases. The caregiver burden, increasing as the disease progresses, can be associated with impaired health-related quality of life (HRQOL). The aims of this study were to investigate the HRQOL in caregivers of patients with MD and identify the factors associated with HRQOL. A cross-sectional assessment of caregiver HRQOL was performed with the Short Form-36 and compared with norms. The factors affecting HRQOL were investigated by patient and caregiver characteristics. The Muscular Dystrophy Functional Rating Scale was used to assess the functional status (mobility, basic activities of daily living, arm function, and impairment) of patients. The demographic data and social interaction activities of caregivers were assessed. Caregivers (n = 62) had poor HRQOL. Caregiver HRQOL was associated with the patient's functional status, especially in the domains of Vitality and Mental Health. Numerous visits by neighbors and close friends of the caregiver family indicated better HRQOL (in the body pain, general health, vitality, role emotion and mental health domains). Caregiver HRQOL was associated with caregiver education level, while patient age, caregiver age, length of caregiving, and family income were not. These findings demonstrate that caregivers have poor HRQOL, and the mental domain of quality of life is associated with the patient's functional status, social interaction, and caregiver education level. We suggest that rehabilitation programs focus on caregiver HRQOL, promote the patient's functional status with assistive technology, enhance professional caring techniques, and encourage participation in social groups to improve caregiver HRQOL.
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Affiliation(s)
- Yi-Jing Lue
- Department of Physical Therapy, College of Health Sciences, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Rd., Kaohsiung, 80708, Taiwan. .,Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Shun-Sheng Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Mou Lu
- Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pediatric and Spinal Orthopedics, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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18
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Andrews JG, Wahl RA. Duchenne and Becker muscular dystrophy in adolescents: current perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:53-63. [PMID: 29588625 PMCID: PMC5858539 DOI: 10.2147/ahmt.s125739] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are life-limiting and progressive neuromuscular conditions with significant comorbidities, many of which manifest during adolescence. BMD is a milder presentation of the condition and much less prevalent than DMD, making it less represented in the literature, or more severely affected individuals with BMD may be subsumed into the DMD population using clinical cutoffs. Numerous consensus documents have been published on the clinical management of DMD, the most recent of which was released in 2010. The advent of these clinical management consensus papers, particularly respiratory care, has significantly increased the life span for these individuals, and the adolescent years are now a point of transition into adult lives, rather than a period of end of life. This review outlines the literature on DMD and BMD during adolescence, focusing on clinical presentation during adolescence, impact of living with a chronic illness on adolescents, and the effect that adolescents have on their chronic illness. In addition, we describe the role that palliative-care specialists could have in improving outcomes for these individuals. The increasing proportion of individuals with DMD and BMD living into adulthood underscores the need for more research into interventions and intracacies of adolescence that can improve the social aspects of their lives.
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Affiliation(s)
| | - Richard A Wahl
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
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19
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Negri L, Piazza G, Sartori RDG, Cocchi MG, Delle Fave A. The adult carer quality of life questionnaire (AC-QoL): comparison with measures of burden and well-being, and Italian validation. Disabil Rehabil 2018; 41:1207-1216. [PMID: 29316811 DOI: 10.1080/09638288.2017.1423519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Family caregivers are essential assets in the rehabilitation process, and their psychophysical health should represent a concern for healthcare services. This study aims to investigate the psychometric properties of the Adult Carer Quality of Life Questionnaire, Italian version, and its convergent-discriminant validity with measures of caring burden, resilience, health, and well-being. MATERIALS AND METHODS Participants were 591 parents (89.2% females; aged 25-69) of children treated as outpatients in 14 centers of "Istituto Medea - La Nostra Famiglia", an Italian rehabilitation institution. They completed: Adult Carer Quality of Life Questionnaire, a 40-item scale assessing care-related challenges, resources, and benefits; Caregiver Burden Inventory; Resilience Scale for Adults; Satisfaction With Life Scale; Health Survey SF-36. The psychometric properties of the Adult Carer Quality of Life Questionnaire were investigated through exploratory and confirmatory factor analyses and reliability evaluation; correlation coefficients assessed convergent and discriminant validity with burden and well-being measures. RESULTS The original eight-factor structure of the Adult Carer Quality of Life Questionnaire showed good adequacy and internal consistency; convergent and discriminant validity with measures of burden, resilience, satisfaction, physical and mental health were satisfactory. CONCLUSIONS The Italian version of the Adult Carer Quality of Life Questionnaire is a reliable and valid instrument to assess caregivers' perceived challenges and resources. As a parsimonious and easily administrable tool, it can be used to evaluate caregivers' quality of life and related interventions. Implications for Rehabilitation Family caregivers are essential assets for the rehabilitation process, and their challenges and resources need to be considered by healthcare services. Information on caregivers' frailties to be reduced and strengths to be empowered allows to design interventions promoting well-being and social integration of people with disabilities and their families. The Adult Carer Quality of Life is a comprehensive measure of burden and well-being dimensions that can be easily administered to caregivers of any age.
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Affiliation(s)
- Luca Negri
- a Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università degli Studi di Milano , Milano , Italia.,b IRCCS Eugenio Medea - La Nostra Famiglia , Bosisio Parini , Italia
| | - Gianna Piazza
- b IRCCS Eugenio Medea - La Nostra Famiglia , Bosisio Parini , Italia
| | - Raffaela D G Sartori
- b IRCCS Eugenio Medea - La Nostra Famiglia , Bosisio Parini , Italia.,c Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco" , Università degli Studi di Milano , Milano , Italia
| | - Mario G Cocchi
- b IRCCS Eugenio Medea - La Nostra Famiglia , Bosisio Parini , Italia
| | - Antonella Delle Fave
- a Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università degli Studi di Milano , Milano , Italia.,b IRCCS Eugenio Medea - La Nostra Famiglia , Bosisio Parini , Italia
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20
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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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21
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Politano L, Scutifero M, Patalano M, Sagliocchi A, Zaccaro A, Civati F, Brighina E, Vita G, Messina S, Sframeli M, Elena Lombardo M, Scalise R, Colia G, Catteruccia M, Berardinelli A, Motta MC, Gaiani A, Semplicini C, Bello L, Astrea G, Ricci G, Grazia D'Angelo M, Vita G, Pane M, D'Amico A, Balottin U, Angelini C, Battini R, Magliano L. Integrated care of muscular dystrophies in Italy. Part 1. Pharmacological treatment and rehabilitative interventions. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2017; 36:19-24. [PMID: 28690390 PMCID: PMC5479104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes the pharmacological therapies and rehabilitative interventions received by 502 patients with Muscular Dystrophies, evaluated in relation to patient's socio-demographic and clinical variables, and geographical areas. Data were collected by the MD-Socio-Demographic and Clinical Schedule (MD-SC-CS) and by the Family Problems Questionnaire (FPQ). The most part of the enrolled patients were in drug treatment. The number of the medications increased in relation to patient's age, disability degree and duration of illness and was higher among patients with Duchenne Muscular Dystrophy (DMD) compared with Becker (BMD) or Limb-Girdle Muscular Dystrophies (LGMD). Steroids (deflazacort or prednisone) were the drug most frequently used, followed by cardiologic and bone metabolism drugs. In general, patients using steroids were younger and had a shorter duration of illness; patients using cardiac drugs and dietary supplements were older and had a longer duration of illness. Rehabilitative interventions were provided to about 70% (351/502) of patients, mainly DMD. Of these, physiotherapy was the more frequent treatment (96.6%) and was prevalently performed in rehabilitative centres (about 70% of patients) and at home in only 30%. Hydrokinetic-therapy was practiced by 6.8% of patients. Respiratory rehabilitation was provided to 47.0% of patients (165/351) and assisted mechanical ventilaventilation to 13.1% (46). The amount of rehabilitative interventions increased in relation to the patient's age, level of disability and duration of illness. Compared to Central and Northern Italy, in Southern Italy there was a higher attention to cardiological impairment as shown by a higher number of patients receiving heart drugs. No statistically significant differences concerning the possibility to have access to rehabilitative interventions were noted among the three geographical areas. However, patient living in Southern Italy tend to receive rehabilitation more often at home.
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Affiliation(s)
- Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli" (former denomination: Second University of Naples), Italy;,Address for correspondence: Luisa Politano, Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli", Primo Policlinico, piazza Miraglia, 80138 Naples, Italy. E-mail:
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli" (former denomination: Second University of Naples), Italy
| | - Melania Patalano
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
| | | | - Antonella Zaccaro
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
| | - Federica Civati
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | - Erika Brighina
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | | | | | | | | | - Roberta Scalise
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Maria Catteruccia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Angela Berardinelli
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Maria Chiara Motta
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Luca Bello
- Department of Neurosciences, University of Padova, Italy
| | - Guja Astrea
- Developmental Neuroscience, IRCCS Stella Maris, Pisa Italy
| | - Giulia Ricci
- Developmental Neuroscience, IRCCS Stella Maris, Pisa Italy
| | - Maria Grazia D'Angelo
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | | | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Umberto Balottin
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Lorenza Magliano
- Department of Psychology, Campania University "Luigi Vanvitelli", Italy
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22
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Magliano L, Politano L. Family context in muscular dystrophies: psychosocial aspects and social integration. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2016; 35:96-99. [PMID: 28344439 PMCID: PMC5343746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Muscular dystrophies (MDs) are degenerative diseases which may led to marked functional impairment and reduced life expectancy. Being caregivers of a loved one with MD may be both a rewarding and a demanding experience that may have relevant impact on the quality of life of the whole family. In this short review we summarize the main findings of the first survey on family context in MD in Italy. The study was carried out on 502 key-relatives of patients suffering from Duchenne, Becker, or Limb-Girdle MD, aged between 4 and 25 years, and attending one of 8 participating Centers, all over 2012. The results revealed that practical difficulties were mainly related to relatives' involvement in helping the patient in moving and in relative's constraints of leisure activities. Furthermore, feelings of loss and perception of patient's condition as having negative effects on the family life were the psychological consequences more frequently complained. However, despite the difficulties, 88% of the key-relatives acknowledged the caregiving as a positive experience. In fact 94% of the respondents stated they could rely on friends in case of own physical illness, and 88% in case of psychological stress. Burden was found higher among relatives of patients with lower functional autonomy and longer duration of illness, and among relatives with lower professional and social support. Conversely, the positive aspects of the caregiving were more frequently acknowledged by those who received higher level of professional help and psychological social support. These results reveal that the caregiving experience has a positive impact on key-relatives quality of life despite the practical demands, and that the support of professionals is essential to help families in identifying the benefits of this experience without denying its difficulties.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Campania University "Luigi Vanvitelli", Caserta, Italy;,Address for correspondence: Lorenza Magliano, Department of Psychology, Campania University "Luigi Vanvitelli", viale Ellittico, 31, 81100 Caserta, Italy. E-mail: ; Luisa Politano, Cardiomiologia e Genetica Medica, Primo Policlinico, piazza Miraglia, 80138 Napoli. E-mail:
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli", Naples, Italy,Address for correspondence: Lorenza Magliano, Department of Psychology, Campania University "Luigi Vanvitelli", viale Ellittico, 31, 81100 Caserta, Italy. E-mail: ; Luisa Politano, Cardiomiologia e Genetica Medica, Primo Policlinico, piazza Miraglia, 80138 Napoli. E-mail:
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23
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Family caregivers of individuals with spinal cord injury: exploring the stresses and benefits. Spinal Cord 2016; 54:732-6. [PMID: 27001130 DOI: 10.1038/sc.2016.25] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional, focus group. OBJECTIVES To explore positive and negative issues reported by family caregivers of people with spinal cord injury (SCI) to develop a relevant and valid tool to assess caregiver distress and benefit for this unique population. METHODS Seventy-three family caregivers of people with SCI participated in 16 focus groups. We audio-recorded all focus group discussions and transcribed the recordings verbatim. Qualitative analysis of the transcripts was performed to identify major themes and subthemes relating to family caregiving activities. RESULTS Positive themes were disproportionately limited in comparison with negative themes. Positives included changes in self-awareness, enhanced family cohesiveness and feeling appreciated. Negative themes included physical and emotional strain, dissatisfaction with hired carers and strain on family relationships. Health-related themes included fatigue and lack of sleep. Caregivers identified sources of strength that helped them manage stresses including faith and support from friends and co-workers. CONCLUSION The numerous themes help lay the groundwork to develop a valid and reliable assessment tool to assist health-care providers in treatment planning and the provision of long-term assistance to people with SCI by enhancing areas of strengths and addressing factors that contribute to burden and distress for family caregivers.
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24
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Landfeldt E, Lindgren P, Bell CF, Guglieri M, Straub V, Lochmüller H, Bushby K. Quantifying the burden of caregiving in Duchenne muscular dystrophy. J Neurol 2016; 263:906-915. [PMID: 26964543 PMCID: PMC4859858 DOI: 10.1007/s00415-016-8080-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 11/25/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a rare pediatric neuromuscular disease associated with progressive muscle degeneration and extensive care needs. Our objective was to estimate the caregiver burden associated with DMD. We made cross-sectional assessments of caregiver health-related quality of life (HRQL) and burden using the EuroQol EQ-5D, a Visual Analogue Scale (VAS), the SF-12 Health Survey, and the Zarit Caregiver Burden Interview (ZBI) administered online. Results were stratified by disease stage (early/late ambulatory/non-ambulatory) and caregivers’ rating of patients’ health and mental status. In total, caregivers to 770 patients participated. Mean EQ-5D utility ranged between 0.85 (95 % CI 0.82–0.88) and 0.77 (0.74–0.80) across ambulatory classes and 0.88 (0.85–0.90) and 0.57 (0.39–0.74) across caregivers’ rating of patients’ health and mental status. Mean VAS score was 0.74 (0.73–0.75), mean SF-12 Mental Health Component Summary score 44 (43–45), and mean ZBI score 29 (28–30). Anxiety and depression, recorded in up to 70 % of caregivers depending on patients’ health and mental status, was significantly associated with annual household cost burden (>$5000 vs. <$1000, odds ratio 1.76, 95 % CI 1.18–2.63) and hours of leisure time devoted to informal care per week (25–50 vs. <25 h 2.01, 1.37–2.94; >50 vs. <25 h 3.35, 2.32–4.83) (p < 0.007). We show that caring for a person with DMD can be associated with a substantial burden and impaired HRQL. Our findings suggest that caregivers to patients with DMD should be screened for depression and emphasize the need for a holistic approach to family mental health in the context of chronic childhood disease.
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Affiliation(s)
- Erik Landfeldt
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-17177, Stockholm, Sweden.
- OptumInsight, Klarabergsviadukten 90, SE-11164, Stockholm, Sweden.
| | - Peter Lindgren
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, SE-17177, Stockholm, Sweden
| | - Christopher F Bell
- GlaxoSmithKline, 5 Moore Drive, PO Box 13398, Research Triangle Park, Durham, NC, 27709-3398, USA
| | - Michela Guglieri
- Newcastle University John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Volker Straub
- Newcastle University John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Hanns Lochmüller
- Newcastle University John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Katharine Bushby
- Newcastle University John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
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Fujino H, Saito T, Matsumura T, Shibata S, Iwata Y, Fujimura H, Shinno S, Imura O. How Physicians Support Mothers of Children with Duchenne Muscular Dystrophy. J Child Neurol 2015; 30:1287-94. [PMID: 25564482 DOI: 10.1177/0883073814558334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/26/2014] [Indexed: 11/15/2022]
Abstract
Communicating about Duchenne muscular dystrophy and its prognosis can be difficult for affected children and their family. We focused on how physicians provide support to the mothers of children with Duchenne muscular dystrophy who have difficulty communicating about the condition with their child. The eligible participants were certified child neurologists of the Japanese Society of Child Neurology. Participants responded to questionnaires consisting of free descriptions of a vignette of a child with Duchenne muscular dystrophy and a mother. We analyzed 263 responses of the participants. We found 4 themes on advising mothers, involving encouraging communication, family autonomy, supporting family, and considering the child's concerns. These results provide a better understanding of the communication between physicians and family members who need help sharing information with a child with Duchenne muscular dystrophy. These findings will assist clinical practitioners in supporting families and the affected children throughout the course of their illness.
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Affiliation(s)
- Haruo Fujino
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Saki Shibata
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Yuko Iwata
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Harutoshi Fujimura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Susumu Shinno
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan Shinno Clinic, Nara, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
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26
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Magliano L, Patalano M, Sagliocchi A, Scutifero M, Zaccaro A, D'angelo MG, Civati F, Brighina E, Vita G, Vita GL, Messina S, Sframeli M, Pane M, Lombardo ME, Scalise R, D'amico A, Colia G, Catteruccia M, Balottin U, Berardinelli A, Chiara Motta M, Angelini C, Gaiani A, Semplicini C, Bello L, Battini R, Astrea G, Politano L. Burden, professional support, and social network in families of children and young adults with muscular dystrophies. Muscle Nerve 2015; 52:13-21. [PMID: 25363165 PMCID: PMC5029774 DOI: 10.1002/mus.24503] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/11/2022]
Abstract
Introduction: This study explores burden and social and professional support in families of young patients with muscular dystrophies (MDs) in Italy. Methods: The study was carried out on 502 key relatives of 4‐ to 25‐year‐old patients suffering from Duchenne, Becker, or Limb‐Girdle MD who were living with at least 1 adult relative. Results: A total of 77.1% of relatives reported feelings of loss, 74.0% had feelings of sadness, and 59.1% had constraints in leisure activities. Burden was higher among relatives of patients with higher disability and who spent more daily hours in caregiving. Practical difficulties were higher among relatives who perceived lower help in patient emergencies and less practical support by their social network. Psychological burden was higher in those relatives who were unemployed, those with poorer support in emergencies, and those with lower social contacts. Conclusions: Caring for patients with MDs may be demanding for relatives even in the early stages of these disorders, especially when social support is poor and the patient's disability increases. Muscle Nerve52: 13–21, 2015
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Melania Patalano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Alessandra Sagliocchi
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Antonella Zaccaro
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Maria Grazia D'angelo
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Federica Civati
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Erika Brighina
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Gian Luca Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Sonia Messina
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Maria Sframeli
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | | | - Roberta Scalise
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Umberto Balottin
- Department of Brain and Behavioural Sciences - Child Neuropsychiatry Unit, University of Pavia, Italy
| | | | | | | | | | | | - Luca Bello
- Department of Neurosciences, University of Padova, Italy
| | | | - Guja Astrea
- Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
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27
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Aho AC, Hultsjö S, Hjelm K. Young adults' experiences of living with recessive limb-girdle muscular dystrophy from a salutogenic orientation: an interview study. Disabil Rehabil 2015; 37:2083-91. [PMID: 25582030 DOI: 10.3109/09638288.2014.998782] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe young adults' experiences of living with recessive limb-girdle muscular dystrophy (LGMD2) from a salutogenic orientation. METHODS A qualitative explorative interview study, including 14 participants aged 20-30 years, was performed focusing on comprehensibility, manageability and meaningfulness in daily life. Content analysis was used for data analysis. RESULT Living with LGMD2 not only implies learning to live with the disease and the variations between good and bad periods but also means trying to make sense of a progressive disease that brings uncertainty about future health, by striving to make the best of the situation. Disease progression involves practical and mental struggle, trying to maintain control over one's life despite vanished physical functions that require continual adjustments to the body. Restrictions in a double sense were described, not only due to the disease but also due to poor comprehension of the disease in society. Lack of knowledge about LGMD2 among professionals often results in having to fight for the support needed. CONCLUSION In order to manage daily life, it is important to be seen and understood as an individual in contacts with professionals and in society in general, to have informal social support and meaningful activities as well as access to personal assistance if necessary. IMPLICATIONS FOR REHABILITATION Recessive limb-girdle muscular dystrophy (LGMD2) is a group of progressive disorders, which manifest in physical and psychological consequences for the individual. According to the salutogenic orientation, people need to find life comprehensible, manageable and meaningful, i.e. to achieve a sense of coherence (SOC), but living with LGMD2 may recurrently challenge the individual's SOC. Through the holistic view of the individual's situation that the salutogenic orientation provides, professionals may support the individual to strengthen SOC and thereby facilitate the movement towards health.
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Affiliation(s)
- Anna Carin Aho
- a Department of Health and Caring Sciences , Linnaeus University , Växjö , Sweden
| | - Sally Hultsjö
- b Psychiatric Clinic, County Hospital , Ryhov, Jönköping , Sweden , and
| | - Katarina Hjelm
- c Department of Social and Welfare Studies , Campus Norrköping, Linköping University , Linköping , Sweden
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28
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MAGLIANO LORENZA, D'ANGELO MARIAGRAZIA, VITA GIUSEPPE, PANE MARIKA, D'AMICO ADELE, BALOTTIN UMBERTO, ANGELINI CORRADO, BATTINI ROBERTA, POLITANO LUISA. Psychological and practical difficulties among parents and healthy siblings of children with Duchenne vs. Becker muscular dystrophy: an Italian comparative study. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2014; 33:136-43. [PMID: 25873782 PMCID: PMC4369844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study explored the burden in parents and healthy siblings of 4-17 year-old patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies, and whether the burden varied according to clinical aspects and social resources. Data on socio-demographic characteristics, patient's clinical history, parent and healthy children burden, and on parent's social resources were collected using self-reported questionnaires administered to 336 parents of patients with DMD (246) and BMD (90). Parents of patients with DMD reported higher burden than those of patients with BMD, especially concerning feeling of loss (84.3% DMD vs. 57.4% BMD), stigma (44.2% DMD vs. 5.5% BMD) and neglect of hobbies (69.0% DMD vs. 32.5% BMD). Despite the burden, 66% DMD and 62.4% BMD parents stated the caregiving experience had a positive impact on their lives. A minority of parents believed MD has a negative influence on the psychological well-being (31.0% DMD vs. 12.8% BMD), and social life of unaffected children (25.7% vs. 18.4%). In the DMD group, burden correlated with duration of illness and parent age, and burden was higher among parents with lower social contacts and support in emergencies. In DMD, difficulties among healthy children were reported as higher by parents who were older, had higher burden and lower social contacts. In both groups, burden increased in relation to patient disability. These findings underline that the psychological support to be provided to parents of patients with MD, should take into account clinical features of the disease.
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Affiliation(s)
- LORENZA MAGLIANO
- Department of Psychology, Second University of Naples (SUN), Naples, Italy;,Address for correpondence: Lorenza Magliano, Department of Psychology, Second University of Naples, viale Ellittico 31, 81100 Caserta, Italy. E-mail:
| | - MARIA GRAZIA D'ANGELO
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | - GIUSEPPE VITA
- Department of Neurosciences, University of Messina, Messina, Italy
| | - MARIKA PANE
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - ADELE D'AMICO
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - UMBERTO BALOTTIN
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - CORRADO ANGELINI
- Department of Neurosciences, University of Padova, Padua, Italy and IRCSS San Camillo, Lido, Venice, Italy
| | - ROBERTA BATTINI
- Developmental Neuroscience, IRCCS Stella Maris, University of Pisa, Pisa, Italy
| | - LUISA POLITANO
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Naples, Italy
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