Comfort care in severely disabled multiple sclerosis patients

Experiences of quality of life in people with Multiple Sclerosis who are in a wheelchair

Aim

The study includes health‐related quality of life for people in Norway with multiple sclerosis who live at home and are in a wheelchair (N = 6). The purpose is to show how they experience living with a chronic disease such as MS and how they perceive their own situation. How they value their own health and what leads to positive consequences is central to this study.

Design

The study has a qualitative design to show what health‐related experiences they had while living with MS.

Method

The interviews were conducted in their home and later transcribed. An interview guide with open‐ended questions was used. The transcribed material was analysed with a thematic analysis.

Results

Key themes were being free and independent, threat to the self and one's identity, and adaptation to MS. Free and independent in everyday life was essential for all the informants. Being dependent on others for basic needs was something they sought to avoid. Adapting to the new situation of changing roles was a challenge that required a lot of them.

The Effectiveness of Self-care Program on the Life Quality of Patients with Multiple Sclerosis in 2015

This study aimed to investigate the effectiveness of self-care plan on the life quality of patients with Multiple sclerosis (MS). The samples in this study included all the patients with MS under medical coverage of Iranian Association of supporting patients with MS in Tehran in 2015 who were studied as Convenience sampling and based on the inclusion and exclusion criteria. In this study, Dr. Madani's self-care program as an intervention and The World Health Organization Quality of Life (WHOQOL)-BREF for assessment of consequences were used. Spss software using Wilcoxon and ANOVA tests were used to analyze the data. Values are significant at P value less than 0.05. Before the intervention, the quality of life was 59.91 ± 13.39 and after the intervention, it was 69.37 ± 11.73 and there was a significant difference between them (P value < 0.001). Also, there was a significant difference between the items of life quality-including the physical, psychological and social relationships and living environment items-before and after the interventions. Self-care program has an effect on the quality of life and physical, psychological and social relationships and living environment items.

Pilot assessment of a comfort scale in stroke patients

INTRODUCTION

Comfort/discomfort (C/D) is an important factor of quality of life (QoL). Brain damage is a major source of discomfort. We developed a questionnaire for assessing C/D in daily living situations and for identifying the main causes of any discomfort and presented its pilot assessment in a population of stroke patients.

METHODS

The scale is a questionnaire of the patient or caregiver that addresses (i) comfort/discomfort in 15 situations of daily living (including getting dressed, washing, lying in bed and sitting in a chair) and (ii) the roles of physical difficulties, psychological problems and a poorly adapted environment. We analysed its metrological qualities in a group of 62 stroke patients.

RESULTS

For the patients, the most uncomfortable activities were eating, dressing the lower body, urine and faeces elimination and walking, and the most significant factors of discomfort were motor impairments, fatigue, limb stiffness, joint pain, depression and anxiety. The reliability was fair for the overall score and for each C/D item and moderate for the impact of impairments on comfort/discomfort. We also found fair internal consistency and convergent validity against measures of functional status, QoL and burden of care. Sensitivity to change over a 6-week period was modest.

CONCLUSIONS

The scale can help to define difficulties in daily living situations and identify opportunities for intervention in stroke patients.

Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity?

Multiple sclerosis is a neurological disease that involves swallowing disorders. Many studies have shown an association between neurological and swallowing performance, but results have been conflicting.

Objective

To identify the frequency of dysphagia in patients with multiple sclerosis and neurological indicators that can represent the performance of swallowing.

Method

In this study (cross-sectional) 120 Multiple Sclerosis patients underwent Functional Assessment of Swallowing by flexible nasal-pharyngo-laryngoscopy and the results were compared with the scores of the rating scales: (Clinical Evolving Forms of Disease, Functional Disability Scale for and Scale Systems Extended Functional Disability [Kurtzke Expanded Disability Status Scale]).

Results

Dysphagia was found in 90% of patients. Among the clinical forms of the disease, the progressive forms (primary progressive and secondary progressive) were more frequently associated with severe dysphagia, while the relapsing-remitting form presented more often mild and moderate dysphagia. Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form. Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia.

Conclusion

Dysphagia is common in MS patients, especially in those with greater impairment of neurological functions.

Reliability and validity of trunk assessment for people with multiple sclerosis

BACKGROUND AND PURPOSE

Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS).

SUBJECTS

Thirty people with MS participated in the study.

METHODS

Interrater and test-retest reliability and construct validity were assessed.

RESULTS

Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established.

DISCUSSION AND CONCLUSION

The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS.

Neurorehabilitation in multiple sclerosis: foundations, facts and fiction

PURPOSE OF REVIEW

This review of recent work in the area of neurorehabilitation of multiple sclerosis patients surveys progress and underscores the need for further work to evaluate the effectiveness of treatments.

RECENT FINDINGS

Several recent review documents have summarized the current position regarding neurorehabilitation and symptomatic management in multiple sclerosis. They have highlighted the paucity of evidence underpinning current practice, thereby identifying the need for more scientifically sound studies in both neurorehabilitation and symptomatic treatment. However, as will be apparent from this review, there has been a welcome increase in studies evaluating both aspects of neurorehabilitation and specific areas such as the role of cannabinoids in spasticity and pain and new treatments for cognitive impairment.

SUMMARY

Overall, there is an encouraging trend both in questioning our current practice and in designing more scientifically sound trials incorporating new and more appropriate outcome measures. There is, however, much more to be done before we are in a position to provide the expert, comprehensive, joined-up, care that is required to meet the complex, ever-changing needs of patients with multiple sclerosis.