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Nadeem ZA, Ashraf H, Nadeem A, Kareem R, Ashfaq H, Majid Z, Ashraf A. Trends in mortality due to multiple sclerosis in the United States: A retrospective analysis from 1999 to 2020. Mult Scler Relat Disord 2024; 89:105765. [PMID: 39029341 DOI: 10.1016/j.msard.2024.105765] [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: 01/30/2024] [Revised: 04/30/2024] [Accepted: 07/07/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory condition with a prevalence of about 309.2 per 100,000 people in the United States. We aim to identify MS-related mortality trends in the USA from 1999 to 2020, stratified by age, sex, race, and geography, and its correlation with sunlight. METHODS Death certificates from the CDC-WONDER database were examined for adults aged ≥25 years. Crude rates (CR) and age-adjusted mortality rates (AAMRs) per 1,000,000 persons and annual percent change (APC) were calculated. We also retrieved data for daily sunlight from 1999 to 2011. RESULTS From 1999 to 2020, a total of 121,694 deaths occurred due to MS. The AAMR rose from 23.6 in 1999 to 29.7 in 2020 (APC 0.65), with a stable trend till 2018 (APC -0.22) followed by an abrupt increase towards 2020 (APC 9.27). Women had higher AAMR than men. Non-Hispanic (NH) Whites exhibited the highest AAMR (28.5), followed by NH Blacks (25.9), NH American Indians/Alaska Natives (9.6), Hispanics or Latino (6.8), and NH Asian or Pacific Islanders (1.9). AAMRs also varied substantially by region (Midwest: 32.4; Northeast: 26.9; West: 26.2; South: 19.4). States with the highest AAMRs were Montana, Wyoming, Colorado, and Oregon. The states with lower daily sunlight had higher AAMRs (r = -0.559, p = 0.000). AAMRs were comparable in urban (25) and rural (26.3) areas. Most deaths occurred in medical facilities (33.92 %) and nursing homes / long-term care (30.80 %), followed by home (27.79 %), and hospice (4.06 %). Adults ≥ 65 years depicted the highest mortality rates (CR 64.4) while adults aged 25 to 44 years showed the lowest rates (CR 4.6). CONCLUSION We found an overall stable trend in MS-related mortality rates in the US till 2018 with a sharp increase thereafter. We observed highest mortality among women and NH White adults, among residents of Midwest and Northeast regions, and among adults ≥ 65 years. Higher disease burden in recent years calls for devising timely policies focused on these high-risk populations.
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Affiliation(s)
- Zain Ali Nadeem
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Hamza Ashraf
- Department of Cardiology, Allama Iqbal Medical College, Pakistan
| | - Aimen Nadeem
- Department of Medicine, King Edward Medical University, Pakistan
| | - Rutaab Kareem
- Department of Medicine, King Edward Medical University, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Zuha Majid
- Department of Medicine, King Edward Medical University, Pakistan
| | - Ali Ashraf
- Government College University, Lahore, Pakistan
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Abou-Rass Z, Feldpausch J, Plummer P, Fritz NE. The Impact of COVID-19 on Fatigue in Multiple Sclerosis. Int J MS Care 2024; 26:149-154. [PMID: 38887278 PMCID: PMC11181025 DOI: 10.7224/1537-2073.2023-031] [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: 06/20/2024]
Abstract
BACKGROUND Although the COVID-19 quarantine required everyone to make lifestyle changes, it may have had especially profound implications for individuals who experience multiple sclerosis (MS)-related fatigue. Individuals with MS who suffer from fatigue are at risk of worsening symptoms and already predisposed to inactivity and social isolation. The objective of this study was to examine the impact of the COVID-19 national quarantine and related restrictions on mental, emotional, and physical fatigue in persons with MS in the United States. METHODS We conducted a survey open to all adults (>18 years) with MS within the United States. The survey gathered demographic information and asked how the COVID-19 pandemic impacted their physical, mental, and emotional fatigue. RESULTS The survey was completed by 600 individuals, 478 with relapsing MS and 122 with progressive MS. There was a significant 2-way interaction of time by fatigue type; both physical and emotional fatigue significantly increased during the pandemic (P <.01) and remained significantly higher after the pandemic than prior to the pandemic (P <.01). Mental fatigue increased significantly during the pandemic (P <.01) and although it remained higher, on average, after the pandemic, it was not significantly different from the level before the pandemic. CONCLUSIONS Individuals with MS experienced increases in physical, mental, and emotional fatigue over the course of the COVID-19 quarantine. Even after the lifting of quarantine restrictions, these levels have not returned to baseline. To adequately address fatigue, it is critical that health care professionals inquire about all types of fatigue in persons with MS.
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Affiliation(s)
- Zade Abou-Rass
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI
| | - Jennie Feldpausch
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI
- From the Department of Health Care Sciences, Wayne State University, Detroit, MI
| | - Prudence Plummer
- From the Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA
| | - Nora E. Fritz
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI
- From the Department of Health Care Sciences, Wayne State University, Detroit, MI
- From the Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA
- From the Department of Neurology, Wayne State University, Detroit, MI
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Meltzer E, Charron O, Wozny J, Onuorah H, Montague A, Kline AC, Largent A, Krause TM, Freeman L. Indirect impact of the COVID-19 pandemic on the care and outcomes of people with MS: A combined survey and insurance claims study. Mult Scler Relat Disord 2023; 80:105085. [PMID: 37931487 DOI: 10.1016/j.msard.2023.105085] [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: 03/28/2023] [Revised: 09/08/2023] [Accepted: 10/15/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND In the context of the COVID-19 pandemic, people with multiple sclerosis (pwMS) have been particularly vulnerable to adverse outcomes due to increased risk of severe infection and/or widespread disruptions in care. The CopeMS study led by The University of Texas at Austin and the MS Association of America investigates the long-term impact of the COVID-19 pandemic on healthcare access, disease modifying therapy (DMT) utilization and outcomes of pwMS. METHODS This retrospective cohort analysis used Optum's de-identified Clinformatics® Data Mart Database (CDM), a large de-identified administrative healthcare claims database to identify pwMS who were continuously enrolled from 01/01/2019 to 12/31/2020 and assessed changes in the utilization of DMTs and healthcare services during the COVID-19 pandemic compared to the year prior. Additionally, a national survey of pwMS and healthcare providers (HCPs) was conducted to further understand the indirect impact of the pandemic on healthcare resource utilization (HCRU), outcomes and prescription patterns. RESULTS Out of 529 pwMS in our national survey, over 47 % reported that their overall health and neurologic symptoms had deteriorated during the COVID-19 pandemic, with increased anxiety, and inability to maintain exercise habits as leading perceived causes for worsening. Survey respondents reported widespread disruption of MS-related services during the pandemic. In the Optum database, we identified 39,209 pwMS validating inclusion criteria. We observed a decrease in the utilization of MS-related services in 2020 compared to 2019. Significantly fewer pwMS had visits with their neurologist, primary care provider, physical or occupational therapist despite an increased utilization of telemedicine services. Fewer pwMS had magnetic resonance imaging (MRI) studies of the brain or spinal cord during the pandemic. Only 22.2 % of HCPs surveyed agreed that the perceived risk of more severe COVID-19 infection on a specific DMT influenced their therapeutic decisions. In the Optum database, individuals with an established diagnosis of MS prior to 2019 saw decreases in utilization of platform and moderate efficacy DMTs. In this group, those over the age of 55 saw a decrease in utilization of B-cell therapies (rate ratio 0.79, CI 0.75-0.83), whereas individuals under the age of 55 saw an increase in utilization of B-cell therapies (rate ratio 1.10, CI 1.03-1.17). We did not see any difference in rates of starting DMTs in persons diagnosed in 2019 prior to the pandemic and those diagnosed in 2020. Compared to 2019, B-cell therapies were prescribed more frequently in pwMS diagnosed in 2020 who were younger than 55 or commercially insured (rate ratio 1.35, CI 1.11-1.63). CONCLUSION The COVID-19 pandemic was associated with perceived worsening of neurological symptoms in pwMS. Despite the expansion of telemedicine, we observed decreased access to healthcare services important to the comprehensive care of pwMS. Additionally, we observed changes in DMT utilization in pwMS during the pandemic, particularly in older adults with an established diagnosis of MS.
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Affiliation(s)
- Ethan Meltzer
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX 78701, USA
| | - Odelin Charron
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX 78701, USA
| | - Joe Wozny
- Center for Healthcare Data, School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Helen Onuorah
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Avery Largent
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX 78701, USA
| | - Trudy Millard Krause
- Center for Healthcare Data, School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX 78701, USA.
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Ricci P, Pallocci M, Treglia M, Ricci S, Ferrara R, Zanovello C, Passalacqua P, Damato FM. The Effect of Physical Exercise during COVID-19 Lockdown. Healthcare (Basel) 2023; 11:1618. [PMID: 37297758 PMCID: PMC10252320 DOI: 10.3390/healthcare11111618] [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: 03/22/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The COVID-19 pandemic has exerted an effect on the general population that went over every expectation. To explore the effect of physical exercise (PE) during the national lockdown in Italy, a survey was drawn up and administered to a sample composed of 208 subjects. The questionnaire comprised 81 multiple-choice items, including sociodemographic data, health-related questions, and assessment of physical exercise, satisfaction with life, depression, and personality. The purpose of this study is to explore the role of physical exercise during the outbreak following the present hypothesis: first, if a link exists between the time spent on physical exercise during the lockdown and the perceived health condition, depressive and somatic symptomatology, and life satisfaction; second, to find associations among the SF-12 component summaries and the other psychological outcomes; and finally, to explore how physical and psychological variables are predictive of PCS-12 and MCS-12. The results showed that both vigorous and moderate physical exercise was strongly correlated with psychological variables, with statistically significant negative correlations found between age and physical exercise. Additionally, significant positive correlations were observed between physical exercise and mental health indices, such as MCS-12 and SWLS, whereas negative correlations were found with BDI, PCS-12, and SOM-H. The correlation analysis also revealed that physical and individual mental health summaries were associated with psychological outcomes, with statistically significant negative correlations found between PCS-12 and MCS, PCS-12 and SOM-H, and MCS-12 and BDI scores. Regression analysis showed that physical activities and psychological status both had a direct influence on perceived mental and physical well-being during the lockdown, accounting for 56.7% and 35.5% of the variance, respectively. The p-values for the significant correlations ranged from <0.05 to <0.01. Overall, these findings highlight the importance of physical exercise and psychological well-being in maintaining good health during the pandemic.
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Affiliation(s)
- Pasquale Ricci
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics (S.A.I.M.L.A.L.), Legal Medicine Section, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Serafino Ricci
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics (S.A.I.M.L.A.L.), Legal Medicine Section, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Rosaria Ferrara
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics (S.A.I.M.L.A.L.), Legal Medicine Section, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Claudia Zanovello
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Pierluigi Passalacqua
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Felice Marco Damato
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics (S.A.I.M.L.A.L.), Legal Medicine Section, “Sapienza” University of Rome, 00185 Rome, Italy
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Dos Santos FC, Candotti CT, Rodrigues LP. Reliability of the Five Times Sit to Stand Test performed remotely by multiple sclerosis patients. Mult Scler Relat Disord 2023; 73:104654. [PMID: 37060677 DOI: 10.1016/j.msard.2023.104654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Multiple Sclerosis, known main cause of non-traumatic neurological disability in adults, leads to changes in muscle strength, especially in the lower limbs. Assessing muscle strength in these patients is thus essential and can be achieved by the Five Times Sit to Stand Test (FTSST), commonly performed in person. Due to the COVID-19 pandemic and social distancing measured adopted, Brazilian physiotherapists turned to remote monitoring and assessment, supported by Resolution n° 516/2020, which required proving the reliability of tests. Given this scenario, this study sought to evaluate the intra- and inter-rater reliability of the Five Times Sit to Stand Test performed remotely and synchronously by multiple sclerosis patients. METHODS A sample of 33 individuals with relapsing-remitting Multiple Sclerosis (18 women and 15 men, mean age 43.7 ± 13.4 years) were remotely and synchronously by video call. Inter-rater reliability was evaluated by analyzing FTSST execution time, in seconds, timed by two different raters on the same video call. In turn, intra-rater reliability was assessed by analyzing the execution time recorded in two different video calls made by the same rater, within a 24-28-h interval. Descriptive and inferential data analysis were performed using SPSS 20.0 software. Means and standard deviation were calculated for descriptive statistic. Intraclass correlation coefficient (ICC), with a 0.05 significance level, standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for inferential analysis. RESULTS Data analysis showed excellent ICC values and low SEM and MDC values regarding inter-rater reliability (ICC: 0.993 (0.986-0.996); p-value: <0.001; SEM: 0.6 s; MDC: 1.6 s) and intra-rater reliability (ICC: 0.962 (0.925-0.981); p-value: <0.001; SEM: 1.4 s; MDC: 3.8 s). CONCLUSION Based on these values, FTSST performed remotely and synchronously by relapsing-remitting Multiple Sclerosis patients is reliable and can be used both by different raters, for assessment, or by the same rater, in pre- and post-test situations.
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Affiliation(s)
- Felipe Colmeneiro Dos Santos
- Undergraduate of the Physiotherapy Course, Escola de Educação Fìsica, terapia e Dança, Universidade Federal do Rio Grande do Sul, Rua Felizardo, 750. Bairro Jardim Botânco. Porto Alegre, RS CEP 90690-200, Brasil
| | - Cláudia Tarragô Candotti
- Professor of the Physiotherapy Course, Escola de Educação Fìsica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul. Rua Felizardo, 750. Bairro Jardim Botânco. Porto Alegre, RS CEP 90690-200, Brasil
| | - Luciano Palmeiro Rodrigues
- Professor of the Physiotherapy Course, Escola de Educação Fìsica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul. Rua Felizardo, 750. Bairro Jardim Botânco. Porto Alegre, RS CEP 90690-200, Brasil.
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van de Venis L, van de Warrenburg B, Weerdesteyn V, Geurts ACH, Nonnekes J. Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial. Neurorehabil Neural Repair 2023; 37:27-36. [PMID: 36695288 PMCID: PMC9896539 DOI: 10.1177/15459683221147839] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES In people with hereditary spastic paraplegia (HSP), reduced gait adaptability is common and disabling. Gait impairments result from lower extremity spasticity, muscle weakness, and impaired proprioception. The aim of this study was to assess the efficacy of a 5-week gait-adaptability training in people with pure HSP. METHOD We conducted a randomized clinical trial with a cross-over design for the control group, and a 15-week follow-up period after training. Thirty-six people with pure HSP were randomized to 5 weeks of (i) gait-adaptability training (10 hours of C-Mill training-a treadmill equipped with augmented reality) or (ii) a waiting-list control period followed by 5 weeks gait-adaptability training. Both groups continued to receive usual care. The primary outcome was the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcome measures consisted of clinical balance and gait assessments, fall rates, and spatiotemporal gait parameters assessed via 3D motion analysis. RESULTS The gait-adaptability training group (n = 18) did not significantly decrease the time required to perform the obstacle subtask compared to the waiting-list control group (n = 18) after adjusting for baseline differences (mean: -0.33 seconds, 95% CI: -1.3, 0.6). Similar, non-significant results were found for most secondary outcomes. After merging both groups (n = 36), the required time to perform the obstacle subtask significantly decreased by 1.3 seconds (95% CI: -2.1, -0.4) directly following 5 weeks of gait-adaptability training, and this effect was retained at the 15-week follow-up. CONCLUSIONS We found insufficient evidence to conclude that 5 weeks of gait-adaptability training leads to greater improvement of gait adaptability in people with pure HSP.
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Affiliation(s)
- Lotte van de Venis
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Lotte van de Venis, Radboud University
Medical Center, PO Box 9101, Reinier Postlaan 4, 6500 HB Nijmegen, The
Netherlands.
| | - Bart van de Warrenburg
- Department of Neurology, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Research, Sint Maartenskliniek,
Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Department of Rehabilitation, Sint
Maartenskliniek, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Department of Rehabilitation, Sint
Maartenskliniek, Nijmegen, The Netherlands
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The late onset of emotional distress in people with progressive multiple sclerosis during the Covid-19 pandemic: longitudinal findings from the CogEx study. J Neurol 2022; 269:6202-6210. [PMID: 35939096 PMCID: PMC9358370 DOI: 10.1007/s00415-022-11295-5] [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: 05/05/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 10/26/2022]
Abstract
OBJECTIVE An earlier follow-up study from the CogEx rehabilitation trial showed little change in symptoms of depression, anxiety and psychological distress during the first COVID-19 lockdown compared to pre-pandemic measurements. Here, we provide a second follow-up set of behavioral data on the CogEx sample. METHODS This was an ancillary, longitudinal follow-up study in CogEx, a randomized controlled trial of exercise and cognitive rehabilitation in people with progressive MS involving 11 centres in North America and Europe. Only individuals impaired on the Symbol Digit Modalities Test (SDMT) were included. Participants repeated the COVID Impact survey administered approximately a year later and completed self-report measures of depression, anxiety and MS symptoms that had been obtained at the trial baseline and during the first COVID Impact survey. Participants who completed the second COVID Impact follow-up were included. To identify predictors of the participants' ratings of their mental and physical well-being, step-wise linear regression was conducted. RESULTS Of the 131 participants who completed the first COVID impact survey, 74 participants completed the second follow-up survey (mean age 52 (SD = 6.4) years, 62.2% female, mean disease duration 16.4 (SD = 9.0) years, median EDSS 6.0). Pandemic restrictions prevented data collection from sites in Denmark and England (n = 57). The average time between measurements was 11.4 (SD = 5.56) months. There were no significant differences in age, sex, EDSS, disease course and duration between those who participated in the current follow-up study (n = 74) and the group that could not (n = 57). One participant had COVID in the time between assessments. Participants now took a more negative view of their mental/psychological well-being (p = 0.0001), physical well-being (p = 0.0009) and disease course (p = 0.005) compared to their last assessment. Depression scores increased on the HADS-depression scale (p = 0.01) and now exceeded the clinically significant threshold of ≥ 8.0 for the first time. Anxiety scores on the HADS remained unchanged. Poorer mental well-being was predicted by HADS depression scores (p = 0.012) and a secondary-progressive disease course (p = 0.0004). CONCLUSIONS A longer follow-up period revealed the later onset of clinically significant depressive symptoms on the HADS and a decline in self-perceptions of mental and physical well-being associated with the COVID-19 pandemic relative to the first follow-up data point. TRIAL REGISTRATION The trial was registered on September 20th 2018 at www. CLINICALTRIALS gov having identifier NCT03679468. Registration was performed before recruitment was initiated.
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