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Podda J, Tacchino A, Ponzio M, Di Antonio F, Susini A, Pedullà L, Battaglia MA, Brichetto G. Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study. JMIR Form Res 2024; 8:e56074. [PMID: 38900535 PMCID: PMC11224705 DOI: 10.2196/56074] [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: 01/10/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. OBJECTIVE This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. METHODS DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app's reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. RESULTS The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. CONCLUSIONS The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Federica Di Antonio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Alessia Susini
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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Jellinger KA. Depression and anxiety in multiple sclerosis. Review of a fatal combination. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02792-0. [PMID: 38869643 DOI: 10.1007/s00702-024-02792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Ponzio M, Podda J, Pignattelli E, Verri A, Persechino B, Vitturi BK, Bandiera P, Manacorda T, Inglese M, Durando P, Battaglia MA. Work Difficulties in People with Multiple Sclerosis. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10149-9. [PMID: 37921967 DOI: 10.1007/s10926-023-10149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features. METHODS A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties. RESULTS The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work. CONCLUSION Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
- Department of Research, Italian Multiple Sclerosis Foundation, via Operai 40, 16149, Genoa, Italy.
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Elena Pignattelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
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Šilić P, Motl RW, Duffecy J. Multiple Sclerosis and Anxiety: Is there an untapped opportunity for exercise? Mult Scler Relat Disord 2023; 73:104698. [PMID: 37058904 DOI: 10.1016/j.msard.2023.104698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/22/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Anxiety symptoms and anxiety disorders are prevalent and burdensome, yet poorly managed in multiple sclerosis (MS). Indeed, anxiety disorders occur in 22% of people with MS, and anxiety can negatively impact physical function, cognition, and quality of life. Currently, there are no treatment guidelines available for anxiety in MS, based on limited information regarding the efficacy of pharmacotherapy and psychotherapy. Exercise training may be a promising avenue for treatment of anxiety in MS, and this is based, in part, on a wealth of evidence in the general population of adults. This review provides an overview of anxiety and evidence from meta-analyses and systematic reviews for current treatments options in the general population and MS. We further make a case for exercise as a novel treatment approach that requires focal examination in persons with MS. METHODS We conducted a scoping review of available research, including systematic reviews and meta-analyses, on anxiety and its prevalence, predictors, consequences, and treatments in MS. We then noted limitations with existing evidence regarding treatment options, and then provided a backdrop based on evidence from the general population for the novel proposition of exercise as treatment of anxiety in MS. RESULTS Pharmacotherapy and psychotherapy treatments of anxiety may be efficacious, but come with significant limitations, especially for persons with MS. Exercise is a promising novel avenue for treatment of anxiety in MS, and has a positive side-effect profile. CONCLUSION Anxiety is under-investigated and poorly treated in MS. There is a paucity of evidence for the relationship between exercise training and anxiety in MS, but the evidence in the general population supports the urgent need for systematic examination of the efficacy of exercise in treating anxiety symptoms and disorders in persons with MS.
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Affiliation(s)
- Petra Šilić
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor Street, AHSB 545, Chicago, IL 60612, United States.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor Street, AHSB 545, Chicago, IL 60612, United States
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois Chicago, 912 S. Wood Street, MC 913, Chicago, IL 60612, United States
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Menculini G, Gentili L, Gaetani L, Mancini A, Sperandei S, Di Sabatino E, Chipi E, Salvadori N, Tortorella A, Parnetti L, Di Filippo M. Clinical correlates of state and trait anxiety in multiple sclerosis. Mult Scler Relat Disord 2023; 69:104431. [PMID: 36470171 DOI: 10.1016/j.msard.2022.104431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anxiety represents one of the most prevalent psychiatric symptoms in multiple sclerosis (MS), impacting the overall disease burden and quality of life. This psychopathological feature can be expressed as state (S-ANX) and trait (T-ANX) anxiety, but few studies specifically evaluated these two components in MS. The present study was aimed at investigating the prevalence and specific correlates of S-ANX and T-ANX in a cohort of people with MS (PwMS). METHODS 88 in- and out-patients with MS were consecutively recruited. S-ANX and T-ANX were evaluated with the two subscales of the State and Trait Anxiety Inventory. Bivariate analyses were performed to compare PwMS who displayed clinically significant S-ANX and T-ANX and those who did not. Two logistic regression models were run in order to identify variables significantly associated with S-ANX and T-ANX. RESULTS S-ANX and T-ANX presented a prevalence of 42% and 45.5%, respectively. S-ANX was more frequent in subjects hospitalized due to recent MS onset. PwMS and S-ANX more frequently had a recent relapse, as well as evidence of disease activity on brain magnetic resonance imaging. Subjects with T-ANX were more often females and displayed higher severity of fatigue. Depressive features at the Beck Depression Inventory were more severe in both S-ANX and T-ANX subjects. PwMS with S-ANX reported a higher prevalence of T-ANX and vice versa. At the logistic regressions, depression severity displayed a significant association with S-ANX and T-ANX. We also detected positive associations between S-ANX and inpatient status, as well as between T-ANX and female sex. CONCLUSION Both S-ANX and T-ANX are highly prevalent features in PwMS. These two components of anxiety should be adequately identified and discriminated in the clinical practice. The higher severity of depression in PwMS with clinically significant anxiety should not be neglected.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Lucia Gentili
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Andrea Mancini
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Silvia Sperandei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Elena Di Sabatino
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Elena Chipi
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Nicola Salvadori
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia Italy
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Zhang X, Song Y, Wei Z, Chen X, Zhuang X, Yi L. The prevalence and risk factors of anxiety in multiple sclerosis: A systematic review and meta-analysis. Front Neurosci 2023; 17:1120541. [PMID: 37139531 PMCID: PMC10149809 DOI: 10.3389/fnins.2023.1120541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Patients with multiple sclerosis (MS) suffer from repetitive neurological deterioration, while anxiety may play a significant role in the disease's progression. Objective To explore the prevalence of anxiety in MS and to investigate the risk factors related to anxiety in MS patients. Methods An analysis of four databases, PubMed, Web of Science, EMBASE, and Cochrane Library, has been conducted to determine the prevalence or risk factors for anxiety in MS published before May 2021. Results In total, 32 studies were found to be eligible. Anxiety prevalence was estimated to be 36% based on the pooled estimates [the 95% confidence interval (CI) = [0.30-0.42], I 2 = 98.4%]. Significant risk factors for developing of anxiety were as follows: age at survey [the weighted mean difference (WMD) = 0.96, 95% CI = [0.86-1.06], I 2 = 43.8%], female [the odd ratio (OR) = 1.78, 95% CI = [1.38-2.30], I 2 = 0%], living together (OR 2.83, 95% CI = [1.74-4.59], I 2 = 0%), past psychiatric history (OR 2.42, 95% CI = [1.56-3.75], I 2 = 0%), depression (OR 7.89, 95% CI = [3.71-16.81], I 2 = 0%), not taking MS medication (OR 2.33, 95% CI = [1.29-4.21], I 2 = 77.8%), relapsing-remitting MS (RRMS) (OR 1.50, 95% CI = [0.94-2.37], I 2 = 53.5%), and baseline Expanded Disability Status Scale (EDSS) (OR 0.84, 95% CI = [0.48-1.21], I 2 = 62.2%). Conclusion An estimated 36% of people with MS suffer from anxiety. And anxiety rates in MS patients are significantly associated with age, gender, living together, prior psychiatric history, depression, drug compliance, RRMS, and baseline EDSS. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=287069, identifier CRD42021287069.
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Affiliation(s)
- Xiaoyun Zhang
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ying Song
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhiqiang Wei
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiao Chen
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaojia Zhuang
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Yi
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Li Yi,
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Podda J, Uccelli MM, Tacchino A, Pedullà L, Monti Bragadin M, Alberto Battaglia M, Brichetto G, Ponzio M. Predictors of Mood Disorders in Parents With Multiple Sclerosis: The Role of Disability Level, Coping Techniques, and Perceived Social Support. Int J MS Care 2022; 24:224-229. [DOI: 10.7224/1537-2073.2021-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
Being a parent can be demanding and stressful, especially for people with chronic diseases such as multiple sclerosis (MS). Parenting can be disrupted by flare-ups, disease worsening, and other MS symptoms, including mobility problems, pain, fatigue, and cognitive impairment. Mood disorders, such as depression and anxiety, have been found to occur at much higher rates in people with MS than in the general population. Surprisingly, less is known about which factors may predict mood disorders in parents with MS. This study aims to identify potential demographic, clinical, and self-reported predictors that contribute to mood disorders measured by the Hospital Anxiety and Depression Scale.
Methods:
A total of 285 parents with MS completed an anonymous online questionnaire combining sociodemographic, clinical, and family characteristics and scales, validated in Italian, related to coping strategies and social support. Associations between each variable and mood disorders were assessed using univariate and multivariate logistic regression analyses.
Results:
Disability level, emotional and dysfunctional coping strategies, and perceived social support were significant predictors of mood disorders in parents with MS.
Conclusions:
These findings confirm the importance of identifying risk factors for mood disorders in parents with MS so that early intervention can minimize mood disruptions caused by the disease.
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Affiliation(s)
- Jessica Podda
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michele Messmer Uccelli
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- The Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy (MAB)
| | - Giampaolo Brichetto
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
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A Comparison of Anxiety Symptoms and Correlates of Anxiety in People with Progressive and Relapsing-Remitting Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103918. [DOI: 10.1016/j.msard.2022.103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
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AlSaeed S, Aljouee T, Alkhawajah NM, Alarieh R, AlGarni H, Aljarallah S, Ayyash M, Abu-Shaheen A. Fatigue, Depression, and Anxiety Among Ambulating Multiple Sclerosis Patients. Front Immunol 2022; 13:844461. [PMID: 35422797 PMCID: PMC9004709 DOI: 10.3389/fimmu.2022.844461] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory disease associated with adverse effects: including depression, anxiety, fatigue, which may affect physical activity and the quality of life (QoL) among patients with MS (pwMS). Objective This study aims to assess the prevalence of depression, anxiety, and fatigue among pwMS who have no physical disability in Saudi Arabia, and demonstrate any correlation between these factors and physical activity as well as the QoL. Methods A cross-sectional study was conducted in the Neuroimmunology outpatient clinics in King Fahad Medical City (KFMC) and King Saud University Medical City (KSUMC) in Riyadh City, KSA. The Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels. The HADS scores were then categorized into three levels according to the total points: normal (0–7 points), borderline (7–10 points), and anxiety/depression (11 – 21 points). The Arabic version of the Fatigue Severity Scale (FSS) was used to measure fatigue (cut-off point ≥5). The physical activity was measured by the Arabic version of the short form of the International Physical Activity Questionnaire (IPAQ), which measure time spent walking, moderate- and vigorous-intensity physical activity of at least 10 minutes duration. The QoL was also measured by the Arabic version of the EuroQOL five-dimensional (EQ-5D-3L) instrument (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Results A total of 323 pwMS participated in this study, 83 had scores that indicated anxiety (25.7%) and 44 had depression (13.6%). The majority of patients had scores with the normal range of depression and anxiety (70% and 57% respectively). The mean of EuroQol Group visual analogue scale (EQ-VAS) score was 80.43 (SD=19.8). 156 (48.3%) out of 323 pwMS reported fatigue while the remainder had no fatigue (n=167, 51.7%). The results indicate that only 143 patients (44.3%) had participated in vigorous physical activity during the last 70 days, with a median of 3 days per week (IQR= 5–3) and a median of 60 minutes per day 0 (Interquartile range: IQR = 60–30). Only 149 patients (49.2%) had patricpated in moderate physical activities during the previous week with a median of 3 days per week (IQR = 5–3) and a median of 40 minutes per day (IQR = 60–30). 194 patients had participated in walking activities (60.0%) with a median of 5 days per week (IQR = 7–3) and a median of 45 minutes per day (IQR = 60–30). The results revealed that fatigue was positively correlated with depression (r = 0.407, p-value < 0.001) and anxiety (r = 0.289, p-value < 0.001). Conclusion The current study shows depression, anxiety, and fatigue tend to be correlated and clustered together among pwMS in our cohort. However, fatigue is not associated with the intensity of physical activity undertaken. The results of this study are important for the improvement of the clinical management of MS patients.
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Affiliation(s)
- Safanah AlSaeed
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tamadher Aljouee
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Rola Alarieh
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hanan AlGarni
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohsen Ayyash
- School of Mathematical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G, Ponzio M. Mind wandering in people with Multiple Sclerosis: A psychometric study. Mult Scler Relat Disord 2022; 58:103521. [DOI: 10.1016/j.msard.2022.103521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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Lucas L, Parker J. Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study. Arch Physiother 2022; 12:2. [PMID: 35012683 PMCID: PMC8750848 DOI: 10.1186/s40945-021-00124-z] [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: 05/13/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.
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Affiliation(s)
- Lauren Lucas
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffiled, UK. .,Present address: Salford Royal NHS Foundation Trust; Community Stroke and Neuro Rehab Team, Sandringham House, Salford, M5 4DG, UK. .,Present address: School of Human Sciences, University of Derby, Derby, UK.
| | - Jack Parker
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffiled, UK.,Present address: School of Human Sciences, University of Derby, Derby, UK
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Gil-González I, Pérez-San-Gregorio MÁ, Conrad R, Martín-Rodríguez A. Predicting improvement of quality of life and mental health over 18-months in multiple sclerosis patients. Mult Scler Relat Disord 2021; 53:103093. [PMID: 34175814 DOI: 10.1016/j.msard.2021.103093] [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: 02/23/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurodegenerative disease that can negatively affect functioning across a wide spectrum of domains. This study aims to investigate the development of mental health and quality of life in MS patients over 18-months and to identify predictive factors. METHOD 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women, on average 12.1 years since diagnosis) participated in the study. Health-related quality of life (HRQOL) and mental health were assessed by the 12-Item Short Form Health Survey (SF-12) and the General Health Questionnaire-28 (GHQ-28) twice over an 18-months follow up period. RESULTS HRQOL and mental health significantly improved in almost all domains, except for a worsening of vitality. Mental and physical HRQOL improved by a large effect size. Binomial logistic regression models showed that disability status (Expanded Disability Status Scale) predicted both components of HRQOL and age the physical component of HRQOL. Sex, educational level, and disease duration predicted mental health. CONCLUSIONS Our findings confirm the possibility of a significant large-sized improvement of HRQOL in the course of 18-months even 12 years after MS diagnosis on average. The study showed the importance of sociodemographic as well as clinical variables to predict HRQOL and mental health. Further longitudinal research is needed to better understand their impact on patients' outcomes.
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Affiliation(s)
- Irene Gil-González
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Camilo José Cela Street, Seville 41018, Spain.
| | - María Ángeles Pérez-San-Gregorio
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Camilo José Cela Street, Seville 41018, Spain
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Camilo José Cela Street, Seville 41018, Spain
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Podda J, Ponzio M, Pedullà L, Monti Bragadin M, Battaglia MA, Zaratin P, Brichetto G, Tacchino A. Predominant cognitive phenotypes in multiple sclerosis: Insights from patient-centered outcomes. Mult Scler Relat Disord 2021; 51:102919. [PMID: 33799285 DOI: 10.1016/j.msard.2021.102919] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since combining information from different domains could be useful to increase prediction accuracy over and above what can be achieved at the level of single category of markers, this study aimed to identify distinct and predominant subtypes, i.e., cognitive phenotypes, in people with multiple sclerosis (PwMS) considering both cognitive impairment and mood disorders. METHODS A latent class analysis (LCA) was applied on data from 872 PwMS who were tested with Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT) and Hospital Anxiety and Depression Scale (HADS). Furthermore, the distribution of demographic (i.e., age, gender, years of education) and clinical characteristics (i.e., disease duration, disease course, disability level) was examined amongst the identified phenotypes. RESULTS Based on model fit and parsimony criteria, LCA identified four cognitive phenotypes: 1) only memory difficulties (n = 247; 28.3%); 2) minor memory and language deficits with mood disorders (n = 185; 21.2%); 3) moderate memory, language and attention impairments (n = 164; 18.8%); 4) severe memory, language, attention, information processing and executive functions difficulties (n = 276; 31.7%). CONCLUSIONS Since less is known about the progressive deterioration of cognition in PwMS, a taxonomy of distinct subtypes that consider information from different clustered domains (i.e., cognition and mood) represents both a challenge and opportunity for an advanced understanding of cognitive impairments and development of tailored cognitive treatments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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