Health-related quality of life in patients with spinocerebellar ataxia

Health-Related Quality of Life in Patients with Inherited Ataxia in Ireland

Inherited cerebellar ataxias (CA) are heterogeneous progressive neurological conditions associated with significant functional limitations. This study aimed to assess the implications of inherited CA on patients' self-reported quality of life (QoL) and impairments in work and activities. 129 individuals with ataxia responded to a survey focused on QoL. Health-related QoL was measured using the RAND 36-Item Short Form Survey. An adaptation of the validated Work Productivity and Activity Impairment questionnaire was used to assess the effect of health on work productivity and ability to perform activities over the past week. Nine percent of respondents were currently employed. Individuals with inherited ataxia experienced significant activity impairment, and 75% required professional or informal care. Health-related quality of life (HRQoL) was significantly worse in all areas for the individuals with inherited ataxia compared with Irish population normative values. Participants with Friedreich's ataxia (n = 56) demonstrated worse physical functioning then those with undetermined ataxia (n = 55). Female gender, younger age at symptom onset, current employment, retirement due to age or ataxia, and living in a long-term care facility were associated with higher sub-scores in different domains of HRQoL, while disease duration correlated with worse physical functioning sub-scores. This study is the first cross-sectional study on HRQoL in patients with inherited ataxia in Ireland. It highlights high rates of unemployment, difficulty with daily activities and physical functioning limitations, which is worse than comparative international studies. Given the limited therapeutic options currently available, optimising HRQoL is an important aspect of managing ataxia.

Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke

Background

Coordination impairments are under-evaluated in patients with stroke due to the lack of validated assessments resulting in an unclear relationship between coordination deficits and functional limitations.

Objective

Determine the construct validity of the new clinical upper-limb (UL) Interlimb Coordination test (ILC2) in individuals with chronic stroke.

Methods

Thirteen individuals with stroke, ≥40 years, with ≥30° isolated supination of the more-affected (MAff) arm, who could understand instructions and 13 healthy controls of similar age participated in a cross-sectional study. Participants performed synchronous bilateral anti-phase forearm rotations for 10 seconds in 4 conditions: self-paced internally-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Primary (continuous relative phase-CRP, cross-correlation, lag) and secondary outcome measures (UL and trunk kinematics) were compared between groups.

Results

Participants with stroke made slower UL movements than controls in all conditions, except EP1. Cross-correlation coefficients were lower (i.e., closer to 0) in stroke in IP1, but CRP and lag were similar between groups. In IP1 and matched-speed conditions (IP1 for healthy and IP2 for stroke), stroke participants used compensatory trunk and shoulder movements. The synchronicity sub-scale and total scores of ILC2 were related to temporal coordination in IP2. Interlimb Coordination test total score was related to greater shoulder rotation of the MAff arm. Interlimb Coordination test scores were not related to clinical scores.

Conclusion

Interlimb Coordination test is a valid clinical measure that may be used to objectively assess UL interlimb coordination in individuals with chronic stroke. Further reliability testing is needed to determine the clinical utility of the scale.

Cost of Cerebellar Ataxia in Hong Kong: A Retrospective Cost-of-Illness Analysis

Background: Cerebellar ataxia affects the coordination and balance of patients. The impact of this disease increases burden in patients, caregivers and society. Costs and the burden of this disease have not been investigated in Hong Kong.

Objectives: (1) To estimate the socioeconomic cost of cerebellar ataxia in Hong Kong for the base year 2019, (2) to assess the health-related quality of life (HRQoL) and severity of ataxia, and (3) to establish the correlation between the severity and cost of cerebellar ataxia and to examine the correlation between the severity of cerebellar ataxia and HRQoL.

Methods: A retrospective cross-sectional study was conducted amongst 31 patients with cerebellar ataxia. Cost-related data were obtained through self-reported questionnaires. The severity of ataxia was assessed using the Scale for Assessment and Rating of Ataxia, and HRQoL was assessed using the Short Form (36) Health Survey (SF-36). Pearson correlation was used for normally distributed data, whereas Spearman correlation was used otherwise.

Results: The mean severity of ataxia was 21 out of 40. The average direct and indirect costs of a patient with ataxia in 6 months were HKD 51,371 and HKD 93,855, respectively. The mean difference between the independent to minimally dependent in activities of daily living (ADL) group and the moderate to maximally dependent in ADL group for direct and indirect costs was HKD 33,829 and HKD 51,444, respectively. Significant expenditure was related to production lost (42%), caregiver salary (17%), and in-patient care (16%). The physical functioning (r = −0.58) and general health (r = −0.41) of SF-36 were negatively correlated with disease severity (p < 0.05). A significant, positive correlation was found between disease severity and direct cost (Spearman's rho = 0.39) and the cost of hiring a caregiver (Spearman's rho = 0.43).

Conclusion: The mean cost for 6 months for patients with cerebellar ataxia in Hong Kong is HKD 146,832. Additional support, including employment, access to specialist consultants, informal home care and community participation, are some areas that should be addressed. Future study on a larger population with a prospective design is necessary to confirm the aforementioned claims.