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Abstract
Neurogenic bowel dysfunction ranks as one of the most frequent problems experienced by people with multiple sclerosis (MS); it is one of the first symptoms to appear at disease onset and continues throughout the course of the disease. This review, based on literature searches of Medline and PubMed, examines bowel dysfunction causes and cofactors (ie, impaired mobility, fatigue, depression and anxiety, childbirth) that occur over the course of the disease. Coverage includes management of bowel dysfunction with noninvasive methods, including diet and fluid intake, together with pharmacologic treatments for constipation and fecal incontinence as well as more advanced treatments (ie, biofeedback, abdominal massage, transanal irrigation, posterior tibial nerve stimulation), caregiver-provided treatments and extended care facilities. Bowel dysfunction problems and related cofactors impact quality of life throughout the MS disease course, requiring appropriate interventions to improve and/or maintain the quality of life of the individual with MS.
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Affiliation(s)
- Elsie E Gulick
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA (EEG)
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2
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Rajachandrakumar R, Finlayson M. Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e874-e897. [PMID: 34935217 DOI: 10.1111/hsc.13687] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Unpaid caregivers, typically family and friends, provide significant amounts of support to people with multiple sclerosis (MS). Understanding their experiences, needs and challenges is necessary to ensure that caregivers receive the support that they require to continue in their role. Our aim was to map the current state of knowledge about unpaid caregivers of people with MS and identify gaps in knowledge to guide future research and practice. We used scoping review methodology with three major health-related databases (MEDLINE, CINAHL, APA Psychinfo), searching in September 2019, April and October 2020 and October 2021. We selected peer-reviewed scientific articles reporting on primary studies of unpaid caregivers of people with MS, regardless of topic or research design. We extracted information on study aim, participant characteristics, measures used and key findings to generate major themes and identify knowledge gaps. We identified 108 published studies between 1992 and 2021 that met our criteria. Studies of spousal caregivers were most common. Studies focused primarily on measurement of caregiver burden or other negative consequences of caregiving. Thirteen studies addressed positive consequences of caregiving. Sixteen studies reported actual tasks performed by caregivers and seven reported outcomes of caregiver support interventions. Attention to diversity issues that may influence caregiving experiences and outcomes was rare. Overall, knowledge of MS caregiving is limited, particularly with respect to tasks performed by caregivers that may contribute to negative outcomes, diversity issues and effective approaches to remediate caregiver burden. Without this knowledge, finding ways to better support MS caregivers will be difficult.
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Affiliation(s)
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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3
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Tehranineshat B, Yektatalab S, Momennasab M, Bijani M, Mohammadi F. The Experiences of Multiple Sclerosis Patients' Family Caregivers at the First Hospitalization of Their Patients: A Qualitative Study. Patient Prefer Adherence 2020; 14:1159-1172. [PMID: 32764889 PMCID: PMC7367720 DOI: 10.2147/ppa.s257746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIM Being diagnosed with multiple sclerosis is usually accompanied by emotional trauma for patients and their families. The chronic, progressive, and unpredictable nature of the disease spells the patients' long-term need for care from their families. As soon as a diagnosis is made, family caregivers are faced with many challenges. The present study aims to identify family caregivers' experiences at the first hospitalization of their patients. MATERIALS AND METHODS The present study is a work of qualitative research and uses the conventional content analysis approach. It lasted from July 2019 to March 2020. The subjects were selected via purposeful sampling. To collect data, the researchers conducted in-depth, semi-structured interviews with 18 family caregivers of patients with multiple sclerosis. The collected data were analyzed using MAXQDA 2007. RESULTS Analysis of the data yielded three themes: peaceful environment, need for continuing full support, and religion-based coping strategies. CONCLUSION The findings of the present study can be used to develop support programs that address family caregivers' problems and needs to assist them in accepting and coping with the conditions of their patients, thereby increasing the quality of care provided to patients with multiple sclerosis.
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Affiliation(s)
- Banafsheh Tehranineshat
- Community-Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrzad Yektatalab
- Community-Based Psychiatric Care Research Center, Department of Mental Health and Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Shahrzad Yektatalab Community-Based Psychiatric Care Research Center,Department of Mental Health and Psychiatric Nursing,School of Nursing and Midwifery,Shiraz University of Medical Sciences,Zand St., Nemazee Sq.,7193613119, Shiraz, Iran Email
| | - Marzieh Momennasab
- Community-Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center, Autism Spectrum Disorders Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
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4
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Bassi M, Cilia S, Falautano M, Grobberio M, Negri L, Niccolai C, Pattini M, Pietrolongo E, Quartuccio ME, Viterbo RG, Allegri B, Amato MP, Benin M, De Luca G, Gasperini C, Minacapelli E, Patti F, Trojano M, Delle Fave A. The caring experience in multiple sclerosis: Caregiving tasks, coping strategies and psychological well-being. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:236-246. [PMID: 31524966 DOI: 10.1111/hsc.12858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Informal caregivers play a crucial role in supporting persons with multiple sclerosis (MS), a neurodegenerative disease resulting in progressive worsening of physical and cognitive functioning. While research extensively showed that caregiving workload can be perceived as burdensome, little attention was devoted to the relation connecting workload and caregivers' well-being. Building on previous literature on stress and coping, the aim of this study was to test the mediational role of coping between caregivers' tasks and well-being. A group of 680 caregivers of persons with MS (M age = 46.45; 51.2% women) was recruited in eight Italian MS centres between June 2015 and December 2016. Caregiving tasks related to basic activities of daily living (ADL), instrumental ADL, psycho-emotional and social-practical care were assessed through the Caregiving Tasks in MS Scale; coping strategies (avoidance, criticism and coercion, practical assistance, supportive engagement, positive reframing) were investigated through the Coping with MS Caregiving Inventory; well-being was evaluated through the Psychological Well-Being Scales. Analyses substantiated a multi-mediation model including tasks in basic ADL, psycho-emotional and social-practical care, and the coping strategies avoidance, criticism/coercion, supportive engagement, positive reframing. Basic ADL care was negatively related to psychological well-being through lower use of supportive engagement and positive reframing. By contrast, psycho-emotional and social-practical tasks were both negatively and positively related to psychological well-being, through higher use of avoidance and criticism/coercion as well as supportive engagement and positive reframing. Findings suggest that caregiving tasks are not solely detrimental to well-being, but they may also provide a positive contribution through the adaptive coping strategies supportive engagement and positive reframing. Findings also highlighted task-specific areas that could be targeted in intervention in order to effectively lighten burden and promote well-being among caregivers.
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Affiliation(s)
- Marta Bassi
- Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, Milan, Italy
| | - Sabina Cilia
- Multiple Sclerosis Centre, University Polyclinic Hospital G. Rodolico, Catania, Italy
| | - Monica Falautano
- Psychology Service, Neurorehabilitation Unit, San Raffaele Hospital, Milan, Italy
| | - Monica Grobberio
- Lab of Clinical Neuropsychology, Psychology Unit, ASST Lariana, Como, Italy
| | - Luca Negri
- Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, Milan, Italy
| | | | - Marianna Pattini
- Multiple Sclerosis Centre, Neurology Unit, Hospital of Vaio-Fidenza, Vaio, Italy
| | - Erika Pietrolongo
- Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | | | - Rosa Gemma Viterbo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Beatrice Allegri
- Multiple Sclerosis Centre, Neurology Unit, Hospital of Vaio-Fidenza, Vaio, Italy
| | - Maria Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Miriam Benin
- Lab of Clinical Neuropsychology, Psychology Unit, ASST Lariana, Como, Italy
| | - Giovanna De Luca
- Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Claudio Gasperini
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Eleonora Minacapelli
- Psychology Service, Neurorehabilitation Unit, San Raffaele Hospital, Milan, Italy
| | - Francesco Patti
- Multiple Sclerosis Centre, University Polyclinic Hospital G. Rodolico, Catania, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, Università di Milano, Milan, Italy
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5
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Nelson LM, Wallin MT, Marrie RA, Culpepper WJ, Langer-Gould A, Campbell J, Buka S, Tremlett H, Cutter G, Kaye W, Wagner L, Larocca NG. A new way to estimate neurologic disease prevalence in the United States: Illustrated with MS. Neurology 2019; 92:469-480. [PMID: 30770422 PMCID: PMC6442012 DOI: 10.1212/wnl.0000000000007044] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Considerable gaps exist in knowledge regarding the prevalence of neurologic diseases, such as multiple sclerosis (MS), in the United States. Therefore, the MS Prevalence Working Group sought to review and evaluate alternative methods for obtaining a scientifically valid estimate of national MS prevalence in the current health care era. METHODS We carried out a strengths, weaknesses, opportunities, and threats (SWOT) analysis for 3 approaches to estimate MS prevalence: population-based MS registries, national probability health surveys, and analysis of administrative health claims databases. We reviewed MS prevalence studies conducted in the United States and critically examined possible methods for estimating national MS prevalence. RESULTS We developed a new 4-step approach for estimating MS prevalence in the United States. First, identify administrative health claim databases covering publicly and privately insured populations in the United States. Second, develop and validate a highly accurate MS case-finding algorithm that can be standardly applied in all databases. Third, apply a case definition algorithm to estimate MS prevalence in each population. Fourth, combine MS prevalence estimates into a single estimate of US prevalence, weighted according to the number of insured persons in each health insurance segment. CONCLUSIONS By addressing methodologic challenges and proposing a new approach for measuring the prevalence of MS in the United States, we hope that our work will benefit scientists who study neurologic and other chronic conditions for which national prevalence estimates do not exist.
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Affiliation(s)
- Lorene M Nelson
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY.
| | - Mitchell T Wallin
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Ruth Ann Marrie
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - W J Culpepper
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Annette Langer-Gould
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Jon Campbell
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Stephen Buka
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Helen Tremlett
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Gary Cutter
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Wendy Kaye
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Laurie Wagner
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Nicholas G Larocca
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
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Petrikis P, Baldouma A, Katsanos AH, Konitsiotis S, Giannopoulos S. Quality of Life and Emotional Strain in Caregivers of Patients with Multiple Sclerosis. J Clin Neurol 2019; 15:77-83. [PMID: 30618220 PMCID: PMC6325374 DOI: 10.3988/jcn.2019.15.1.77] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose This study aimed was to measure the quality of life, fatigue, stress, and depression in a consecutive sample of caregivers of multiple sclerosis (MS) patients. Methods We included data from 131 consecutive caregivers of MS patients [age=51.2±12.8 years (mean±SD), males=53.4%, duration of caregiving=10.0±6.3 years]. We assessed the quality of life, fatigue, stress, and depression of the caregivers using the 36-item Short Form Health Survey, Krupp Fatigue Severity Scale, Kingston Caregiver Stress Scale, and Hamilton Scale for Depression, respectively. The disability status of the patients was assessed using the Kurtzke Expanded Disability Status Scale. We used linear regression models to identify possible correlations between all of the aforementioned scales, while multivariable logistic regression models were employed to assess the correlations of caregiver fatigue with caregiver characteristics and patient disability. Results The linear regression analyses revealed that caregiver fatigue was positively associated with stress and negatively correlated with both physical health status and mental health status. Caregiver stress was positively associated with depression and negatively correlated with both physical health status and mental health status. Depression was negatively correlated with both caregiver physical health status and mental health status. In multivariable logistic regression analysis, caregiver fatigue was found to be independently associated with education status [odds ratio (OR)=0.61, 95% CI=0.37 to 0.99], history of chronic disease (OR=5.52, 95% CI=1.48 to 20.55), other chronic diseases in the family (OR=7.48, 95% CI=1.49 to 37.47), and the disability status of the patient (OR=1.36, 95% CI=1.03 to 1.80). Conclusions Fatigue, stress, and depression in caregivers of MS patients are negatively correlated with their physical health status and mental health status. Caregiver fatigue is independently associated with education status, history of chronic disease, other chronic disease in the family, and patient disability.
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Affiliation(s)
- Petros Petrikis
- Psychiatric Clinic, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Anastasia Baldouma
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece.,Neurosurgical Research Institute, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece.,Neurosurgical Research Institute, School of Medicine, University of Ioannina, Ioannina, Greece
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7
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Fabius CD, Thomas KS, Zhang T, Ogarek J, Shireman TI. Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis. BMC Health Serv Res 2018; 18:773. [PMID: 30314479 PMCID: PMC6186063 DOI: 10.1186/s12913-018-3584-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS. METHODS We used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures. RESULTS Black HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest. CONCLUSIONS Findings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.
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Affiliation(s)
- Chanee D Fabius
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA.,Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
| | - Tingting Zhang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
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8
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Younus Z, Vaughn CB, Sanai SA, Kavak KS, Gupta S, Nadeem M, Teter BE, Noyes K, Zivadinov R, Edwards K, Coyle PK, Goodman A, Weinstock-Guttman B. Fatigue and Mood States in Nursing Home and Nonambulatory Home-Based Patients with Multiple Sclerosis. Int J MS Care 2017; 19:297-302. [PMID: 29270087 DOI: 10.7224/1537-2073.2016-058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis (MS) is a chronic, progressively disabling condition of the central nervous system. We sought to evaluate and compare mood states in patients with MS with increased disability residing in nursing homes and those receiving home-based care. Methods We conducted a cross-sectional analysis of the New York State Multiple Sclerosis Consortium to identify patients with MS using a Kurtzke Expanded Disability Status Scale (EDSS) score of 7.0 or greater. The nursing home group was compared with home-based care patients regarding self-reported levels of loneliness, pessimism, tension, panic, irritation, morbid thoughts, feelings of guilt, and fatigue using independent-samples t tests and χ2 tests. Multivariate logistic regression analyses were used to investigate risk-adjusted differences in mood states. Results Ninety-four of 924 patients with EDSS scores of at least 7.0 lived in a nursing home (10.2%). Nursing home patients were less likely to use disease-modifying therapy and had higher mean EDSS scores compared with home-based patients. However, nursing home patients were less likely than home-based patients to report fatigue (odds ratio [OR] for no fatigue, 3.8; 95% CI, 2.1-7.2), feeling tense (OR for no tension, 1.7; 95% CI, 1.1-2.7), and having feelings of pessimism (OR for no pessimism, 1.8; 95% CI, 1.2-2.8). Conclusions The nursing home patients with MS were less likely to report fatigue, pessimism, and tension than those receiving home-based care. Further studies should examine ways of facilitating a greater degree of autonomy and decision-making control in MS patients receiving home-based care.
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Pahlavanzadeh S, Dalvi-Isfahani F, Alimohammadi N, Chitsaz A. The effect of group psycho-education program on the burden of family caregivers with multiple sclerosis patients in Isfahan in 2013-2014. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:420-5. [PMID: 26257794 PMCID: PMC4525337 DOI: 10.4103/1735-9066.161000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lack of adequate training and support of primary caregivers of multiple sclerosis (MS) patients is the major factor in causing stress, anxiety, and increase of burden. Therefore, the treatment team members such as psychiatric nurses can help these vulnerable people overcome psychiatric pressures effectively not only through their care and referral role but also through their supportive characteristic, which helps the patients improve their clinical status, together with their social, familial, and work adaptation. Therefore, the researcher tried to identify the effect of a group psycho-education program on the burden family caregivers with MS patients. MATERIALS AND METHODS This is a two-group three-stage clinical trial. The researcher referred to the heads of neurology clinics to present the purpose of the study and to start the sampling. The neurology clinics of AL Zahra University Hospital, and also a Private Neurology Clinic were selected to collect the data of the study. The subjects were randomly selected, and then, assigned to two groups of study and control. RESULTS Independent t-test showed a significant reduction in family caregivers' burden immediately after and 1-month after intervention in the study group, compared to control. Repeated measure ANOVA showed a significant reduction in caregivers' burden mean score in the study group (P < 0.001). CONCLUSIONS As group psycho-education reduced family caregivers' burden, it is recommended to develop and design other programs for the family caregivers of the patients with MS.
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Affiliation(s)
- Saeid Pahlavanzadeh
- Nursing and midwifery care research center, Faculty of nursing and midwifery, Isfahan University of medical sciences, Isfahan, Iran
| | - Fariba Dalvi-Isfahani
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Department of adult Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Chitsaz
- Department of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Abstract
About 30% of people with multiple sclerosis require some form of supportive assistance at home, and 80% of that assistance is usually provided by spouses or partners. So, the explanation and understanding of patients' experiences of support received from their spouses enable spouses and healthcare professionals to reform their actions toward positive support. This study aimed to explore the experiences of people with multiple sclerosis regarding support from their spouses. A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis who were chosen through purposeful sampling from multiple sclerosis associations of Isfahan and Tehran (Iran). Data were collected through nonstructured interviews from September 2011 to August 2012. Four themes and nine subthemes emerged through data analysis. The main themes were play a supportive role, establish a friendly and comfortable relationship, help patient to fight the disease, and help to maintain and to improve patients' functional ability. The results could help in improving the quality of spouses' support in people with multiple sclerosis. Moreover, it could aid in determining the educational needs of patients as supported persons and spouses as supporters. The results could lead to increased knowledge of healthcare experts about the issue of how Iranian people with multiple sclerosis are being supported by their wives/husbands. Furthermore, it would help them to design caring models to promote successful supporting strategies for patients.
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Patterns of Objective and Subjective Burden of Informal Caregivers in Multiple Sclerosis. Behav Neurol 2015; 2015:648415. [PMID: 26078487 PMCID: PMC4452831 DOI: 10.1155/2015/648415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/30/2015] [Indexed: 01/24/2023] Open
Abstract
Background. Home
care for patients with Multiple Sclerosis (MS)
relies largely on informal caregivers (ICs).
Methods. We assessed ICs
objective burden (Resource Utilization in
Dementia measuring informal care time (ICT)) and
ICs subjective burden (Zarit Burden Inventory (ZBI)). Results. ICs
(N = 99)
were spouses (70%), mean age 52 years,
assisting disabled patients with a mean EDSS
(Expanded Disability Status Scale) of 5.5, with
executive dysfunction (mean DEX (Dysexecutive questionnaire) of 25) and a duration of MS
ranging from 1 to 44 years. Objective burden was
high (mean ICT = 6.5 hours/day), mostly
consisting of supervision time. Subjective
burden was moderate (mean ZBI = 27.3).
Multivariate analyses showed that both burdens
were positively correlated with higher levels of
EDSS and DEX, whereas coresidency and IC's
female gender correlated with objective burden
only and IC's poor mental health status with
subjective burden only. When considering MS
aggressiveness, it appeared that both burdens
were not correlated with a higher duration of MS
but rather increased for patients with severe
and early dysexecutive function and for patients
classified as fast progressors according to the
Multiple Sclerosis Severity Score.
Conclusion. Evaluation of MS
disability course and IC's personal
situation is crucial to understand the burden
process and to implement adequate interventions
in MS.
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Campbell JD, Ghushchyan V, Brett McQueen R, Cahoon-Metzger S, Livingston T, Vollmer T, Corboy J, Miravalle A, Schreiner T, Porter V, Nair K. Burden of multiple sclerosis on direct, indirect costs and quality of life: National US estimates. Mult Scler Relat Disord 2013; 3:227-36. [PMID: 25878010 DOI: 10.1016/j.msard.2013.09.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/21/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND MS imposes a significant burden on patients, caregivers, employers, and the healthcare system. OBJECTIVE To comprehensively evaluate the US MS burden using nationally representative data from the Medical Expenditure Panel Survey. METHODS We identified non-institutionalized patients aged ≥18 with MS (ICD-9 code 340) from 1998 to 2009 and compared them to individuals without an MS diagnosis (non-MS) during the interview year. The cohorts were compared using multivariate regression on direct costs, indirect costs (measured in terms of employment status, annual wages, and workdays missed), and health-related quality of life (HRQoL; measured using Short Form 12, SF-6 Dimensions, and quality-adjusted life years [QALYs]). RESULTS MS prevalence was 572,312 (95% CI: 397,004, 747,619). Annual direct costs were $24,327 higher for the MS population (n=526) vs. the non-MS population (n=270,345) (95% CI: $22,320, $26,333). MS patients had an adjusted 3.3-fold (95% CI: 2.4, 4.5) increase in the odds of not being employed vs. non-MS individuals and a 4.4-fold higher adjusted number of days in bed (95% CI 2.97, 6.45). On average, MS patients lost 10.04 QALYs vs. non-MS cohort. CONCLUSIONS MS was associated with higher healthcare costs across all components, reduced productivity due to unemployment and days spent in bed, and lower HRQoL.
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Affiliation(s)
- Jonathan D Campbell
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | - Vahram Ghushchyan
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | - R Brett McQueen
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | | | | | - Timothy Vollmer
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA.
| | - John Corboy
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA.
| | - Augusto Miravalle
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA.
| | - Teri Schreiner
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA.
| | | | - Kavita Nair
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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Is There Extra Cost of Institutional Care for MS Patients? Mult Scler Int 2013; 2013:713627. [PMID: 24163769 PMCID: PMC3791799 DOI: 10.1155/2013/713627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/06/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022] Open
Abstract
Throughout life, patients with multiple sclerosis (MS) require increasing levels of support, rehabilitative services, and eventual skilled nursing facility (SNF) care. There are concerns that access to SNF care for MS patients is limited because of perceived higher costs of their care. This study compares costs of caring for an MS patient versus those of a typical SNF patient. We merged SNF cost report data with the 2001–2006 Nursing Home Minimum Data Set (MDS) to calculate percentage of MS residents-days and facility case-mix indices (CMIs). We estimated the average facility daily cost using hybrid cost functions, adjusted for facility ownership, average facility wages, CMI-adjusted number of SNF days, and percentage of MS residents-days. We describe specific characteristics of SNF with high and low MS volumes and examine any sources of variation in cost. MS patients were no longer more costly than typical SNF patients. A greater proportion of MS patients had no significant effect on facility daily costs (P = 0.26). MS patients were more likely to receive care in government-owned facilities (OR = 1.904) located in the Western (OR = 2.133) and Midwestern (OR = 1.3) parts of the USA (P < 0.05). Cost of SNF care is not a likely explanation for the perceived access barriers that MS patients face.
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Current World Literature. Curr Opin Neurol 2011; 24:300-7. [DOI: 10.1097/wco.0b013e328347b40e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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