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McDool E, Carlton J, Powell PA, Coates E, Knox L, Mayberry E, Appleby N, Griffiths AW, Hobson E, McDermott CJ. Measuring Health-Related Quality of Life in Amyotrophic Lateral Sclerosis: A Systematic Review and Conceptual Framework. Neurology 2024; 103:e209549. [PMID: 38870470 DOI: 10.1212/wnl.0000000000209549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The assessment of health-related quality of life (HRQoL) in patients with amyotrophic lateral sclerosis (ALS) is heterogeneous and inconsistent. The objectives of this study were (1) to develop a comprehensive conceptual framework of HRQoL in ALS and (2) map the content of existing patient-reported outcome measures (PROMs) used in ALS to this novel framework. METHODS Our model of HRQoL in ALS (Health-related Quality of life in Amyotrophic Lateral Sclerosis, QuALS) was developed from a systematic literature review and consultative input from key stakeholders (patients, carers, and health care professionals). Five electronic databases were searched in April 2022. Primary studies of any design that assessed HRQoL in ALS by using a multi-item PROM and/or qualitative methods were identified. Using an a priori framework, HRQoL themes were extracted and iteratively modified from the content of each PROM and qualitative study quotations identified in the literature. The conceptual framework was ratified by stakeholders with lived experience and clinical experts. The QuALS framework was used to map the content of identified PROMs and qualitative studies based on thematic coverage. RESULTS QuALS covers 3 high-level domains of HRQoL (physical, psychological, and social functioning) and consists of 7 themes (Activities; Physical Health; Autonomy; Cognition; Feelings and Emotions; Self-identity; Relationships), characterized by 42 subthemes. Of 8,220 studies identified, 274 were included in the review that informed QuALS. In these studies, 111 PROMs were used to assess at least 1 aspect of HRQoL, and 11 studies used qualitative methods. Of the 3 high-level domains, physical functioning was the most commonly assessed, particularly within ALS-specific PROMs where almost one-quarter of PROMs exclusively assessed physical functioning. None of the PROMs or qualitative studies identified assessed all aspects of HRQoL in the QuALS framework. DISCUSSION This study presents a new comprehensive conceptual framework of HRQoL in ALS (QuALS), informed by a robust systematic review of existing literature and stakeholder input, incorporating lived experience. QuALS provides a valuable resource for researchers and clinicians interested in taking a holistic approach to assessing and understanding the full impact of ALS on HRQoL and how this may be affected by treatments.
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Affiliation(s)
- Emily McDool
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Jill Carlton
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Philip A Powell
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Coates
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Liam Knox
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Emily Mayberry
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Niamh Appleby
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Alys W Griffiths
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Esther Hobson
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
| | - Christopher J McDermott
- From the Sheffield Centre for Health and Related Research (SCHARR) (E. McDool, J.C., P.A.P., E.C.), and Sheffield Institute for Translational Neuroscience (SITraN) (L.K., E. Mayberry, N.A., A.W.G., E.H., C.J.M.), University of Sheffield, Sheffield, United Kingdom
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Yu Y, Zeng L, Wu M, Li C, Qiu Y, Liu J, Yang F, Xia P. Exploring amyotrophic lateral sclerosis patients' experiences of psychological distress during the disease course in China: a qualitative study. BMJ Open 2024; 14:e082398. [PMID: 38851229 PMCID: PMC11163685 DOI: 10.1136/bmjopen-2023-082398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE This study aims to explore the psychological distress course of Chinese amyotrophic lateral sclerosis (ALS) patients after the onset of the disease and to provide targeted nursing guidance. DESIGN The interview content was analysed qualitatively. We used seven steps of Colaizzi's method to analyse the participants' data. SETTING Wuhan, China, Traditional Chinese Medicine Hospital. PARTICIPANTS A semistructured face-to-face interview were performed among 22 people with ALS from the motor neuron disease rehabilitation centre of a tertiary Chinese medicine hospital in China. RESULT This study included a total of 22 participants, from whom three main themes regarding the psychological distress trajectory of ALS patients were extracted from the interview data: 'Time begins to run out' include tormented and restless waiting and shock and doubt in ALS disease confirmation, 'Family out of control' include the burden of stigma and function loss, the burden of missing family roles, the burden of marriage's emotional needs and the burden of offspring health, 'Way forward' include struggle between live and death and struggle between quality of life and the value of life. CONCLUSION This study outlines the psychologically distressing journey of ALS patients. Studies have pointed out the need for targeted care to address patients' various sources of psychological distress to improve their quality of life and coping ability, increase their psychological resilience and reconstruct their life beliefs.
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Affiliation(s)
- Yiqing Yu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Lijuan Zeng
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Man Wu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Chaoyang Li
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Yufei Qiu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Jiali Liu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, Hubei, China
| | - Peng Xia
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
- Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Wuhan, Hubei, China
- Hubei Academy of Traditional Chinese Medicine, Wuhan, Hubei, China
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Radakovic R, Radakovic C, Abrahams S, Simmons Z, Carroll A. Quality of life, cognitive and behavioural impairment in people with motor neuron disease: a systematic review. Qual Life Res 2024; 33:1469-1480. [PMID: 38345764 PMCID: PMC11116232 DOI: 10.1007/s11136-024-03611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Motor neuron disease (MND) is a neurodegenerative disease, progressively impacting function and self-perceived quality of life (QoL). Up to 50% of people with MND can present with cognitive and behavioural impairment, with an associated increase in caregiver burden or strain. However, there has been no systematic exploration of the relationship between QoL and cognitive or behavioural impairment in MND. The aim was to determine if there is a relationship between QoL and cognitive/behavioural impairment in MND, while also supplementarily looking to determine the types of cognitive/behavioural and QoL measures utilised in these studies. METHODS A systematic search was performed across multiple databases (PsychINFO, Embase, Medline, AMED) for research published up to the date of February 22, 2023. Studies utilising quantitative methods of measuring QoL, cognitive/behavioural functioning/impairment were included. Findings examining relationships between QoL-cognitive/behavioural impairment were extracted and synthesised. RESULTS A total of 488 studies were identified, with 14 studies included in the systematic review. All 14 studies were observational (11 cross-sectional, 3 longitudinal). 13 studies utilised MND non-specific measures, particularly in relation to QoL and cognitive impairment. Of 8 studies measuring behavioural impairment 62.5% (N = 5) found either a lower QoL difference or association. Only 33.3% (N = 4) of 12 studies measuring cognitive impairment found a lower QoL difference or association. CONCLUSIONS This systematic review shows that behavioural impairment may have an impact on QoL in MND. There is variability in types of assessments used to measure QoL and also cognitive/behavioural impairment, most of which are disease-non-specific. Recommendations for future research are to use comprehensive disease-specific, multidomain measures to further elucidate the QoL-cognitive/behavioural impairment relationship.
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Affiliation(s)
- Ratko Radakovic
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK.
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Amy Carroll
- Norfolk and Norwich University Hospital, Norwich, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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Mehta AK, Sarmet M, Maiser S, Meyer JA, Kolodziejczak S, Washington K, Simmons Z. Quality-of-life assessment instruments used across ALS clinics. Muscle Nerve 2023; 68:865-872. [PMID: 37823580 DOI: 10.1002/mus.27985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION/AIMS Instruments have been developed to assess quality of life (QoL) among people with amyotrophic lateral sclerosis (ALS). It is unclear whether these are utilized regularly in the clinical setting to guide individual patient care. In this study we aimed to understand the current use of instruments and existing barriers to assessing QoL in clinical ALS care. METHODS An anonymous survey developed by Northeast ALS (NEALS) Consortium Palliative Committee members was distributed to all multidisciplinary NEALS members. Data were summarized via calculation of descriptive statistics. ALS Center characteristics were compared using chi-square and Fisher exact tests for categorical variables. RESULTS Seventy-three (6.4%) of the 1132 NEALS members responded to the survey, representing 148 clinics, 49.3% of whom reported assessing QoL during clinic visits. The most used ALS-specific instruments were the ALS Assessment Questionnaire (19.4%) and Amyotrophic Lateral Sclerosis Specific Quality of Life scale (16.6%). Barriers reported were uncertainty regarding which instrument to use and length of visits. QoL assessment was not significantly correlated with length of clinic visit but with access to specialty palliative care. DISCUSSION QoL assessments are performed by some, but not all, ALS centers during clinical visits. Although this study did have a low number of responding centers, the percentage, the proportion is similar to that seen in earlier studies, which limits the findings' generalizability. The value of QoL assessments' impact on outcomes should be further investigated and, if warranted, creative ways sought to increase the frequency of their use, including patient self-assessments before clinic and/or the use of teleheath to reduce the length of clinic visits.
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Affiliation(s)
- Ambereen K Mehta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília, Brasília, Brazil
| | - Samuel Maiser
- Department of Neurology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Jenny A Meyer
- Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Sherry Kolodziejczak
- ALS Care Clinic/Cardiac Pulmonary Rehab/Therapy Services/Worker's Program, Crestwood Medical Center, Huntsville, Alabama, USA
| | - Karla Washington
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Zahir F, Hanman A, Yazdani N, La Rosa S, Sleik G, Sullivan B, Mehdipour A, Malouka S, Kuspinar A. Assessing the psychometric properties of quality of life measures in individuals with amyotrophic lateral sclerosis: a systematic review. Qual Life Res 2023:10.1007/s11136-023-03377-2. [PMID: 36881218 DOI: 10.1007/s11136-023-03377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults. There are many patient-reported outcome measures (PROMs) for measuring quality of life (QoL) and health-related QoL (HRQoL) within this population; however, there is limited consensus regarding which are most valid, reliable, responsive, and interpretable. This systematic review assesses the psychometric properties and interpretability of QoL and HRQoL PROMs for individuals with ALS. METHODS This review was conducted following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic reviews of PROMs. MEDLINE, EMBASE, and CINAHL databases were searched. Studies were included if their aim was to evaluate one or more psychometric properties or the interpretability of QoL or HRQoL PROMs in individuals with ALS. RESULTS We screened 2713 abstracts, reviewed 60 full-text articles, and included 37 articles. Fifteen PROMs were evaluated including generic HRQoL (e.g., SF-36), ALS-specific HRQoL (e.g., ALSAQ-40), and individualized QoL (e.g., SEIQoL) measures. Evidence for internal consistency and test-retest reliability were acceptable. For convergent validity, 84% of hypotheses were met. For known-groups validity, outcomes were able to distinguish between healthy cohorts and other conditions. Responsiveness results ranged from low to high correlations with other measures over 3-24 months. Evidence for content validity, structural validity, measurement error, and divergent validity was limited. CONCLUSION This review identified evidence in support of the ALSAQ-40 or ALSAQ-5 for individuals with ALS. These findings can guide healthcare practitioners when selecting evidence-based QoL and HRQoL PROMs for patients and provide researchers with insight into gaps in the literature.
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Affiliation(s)
- Faryal Zahir
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Alicia Hanman
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Nazmehr Yazdani
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Sabrina La Rosa
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Gemma Sleik
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Brooke Sullivan
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Ava Mehdipour
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Selina Malouka
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada.
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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A Clinical Decision Support System for the Prediction of Quality of Life in ALS. J Pers Med 2022; 12:jpm12030435. [PMID: 35330435 PMCID: PMC8955774 DOI: 10.3390/jpm12030435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS), also known as Motor Neuron Disease (MND), is a rare and fatal neurodegenerative disease. As ALS is currently incurable, the aim of the treatment is mainly to alleviate symptoms and improve quality of life (QoL). We designed a prototype Clinical Decision Support System (CDSS) to alert clinicians when a person with ALS is experiencing low QoL in order to inform and personalise the support they receive. Explainability is important for the success of a CDSS and its acceptance by healthcare professionals. The aim of this work isto announce our prototype (C-ALS), supported by a first short evaluation of its explainability. Given the lack of similar studies and systems, this work is a valid proof-of-concept that will lead to future work. We developed a CDSS that was evaluated by members of the team of healthcare professionals that provide care to people with ALS in the ALS/MND Multidisciplinary Clinic in Dublin, Ireland. We conducted a user study where participants were asked to review the CDSS and complete a short survey with a focus on explainability. Healthcare professionals demonstrated some uncertainty in understanding the system’s output. Based on their feedback, we altered the explanation provided in the updated version of our CDSS. C-ALS provides local explanations of its predictions in a post-hoc manner, using SHAP (SHapley Additive exPlanations). The CDSS predicts the risk of low QoL in the form of a probability, a bar plot shows the feature importance for the specific prediction, along with some verbal guidelines on how to interpret the results. Additionally, we provide the option of a global explanation of the system’s function in the form of a bar plot showing the average importance of each feature. C-ALS is available online for academic use.
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Schrempf T, Finsel J, Uttner I, Ludolph AC, Lulé D. Neuropsychological deficits have only limited impact on psychological well-being in amyotrophic lateral sclerosis. J Neurol 2021; 269:1369-1374. [PMID: 34215919 PMCID: PMC8857089 DOI: 10.1007/s00415-021-10690-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the association between neuropsychological deficits and psychological well-being in amyotrophic lateral sclerosis (ALS). METHODS Subjective (Schedule for the Evaluation of the Individual Quality of Life-Direct Weighting, SEIQoL-DW) and global quality of life (QoL; Anamnestic Comparative Self-Assessment, ACSA) as well as depression (ALS-Depression-Inventory, ADI-12) as indicators for psychological well-being were measured in 214 patients with ALS and correlated with neurocognitive performance assessed by the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Primary caregivers evaluated behaviour. Patients were classified to be cognitively (ALSci) or behaviourally impaired (ALSbi) according to Strong criteria. RESULTS ALSbi patients had poorer psychological well-being than patients without behavioural alterations, while the psychological well-being of patients with and without neurocognitive deficits was comparable. CONCLUSION The study provides evidence that minor neuropsychological deficits do not interfere with psychological well-being of ALS in contrast to alterations on behavioural level. Thus, abnormalities in individual cognitive domains have limited relevance for the patients' everyday life in comparison to the impact of behavioural alterations.
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Affiliation(s)
- Till Schrempf
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Julia Finsel
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Štětkářová I, Ehler E. Diagnostics of Amyotrophic Lateral Sclerosis: Up to Date. Diagnostics (Basel) 2021; 11:diagnostics11020231. [PMID: 33546386 PMCID: PMC7913557 DOI: 10.3390/diagnostics11020231] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by gradual loss of upper and lower motor neurons and their pathways, usually without affecting the extraocular and sphincter muscles. The cause of the disease is not yet known. It is a chain of subsequent events, ending in programmed cell death in selective neuronal subpopulations. The prognosis for survival is rather short with a median of 2 to 4 years. Survival may be prolonged based on prompt diagnosis, ALS subtype and proper management with supportive treatment (tracheostomy, gastrostomy, etc.). According to the clinical picture, the typical form of ALS with upper and lower motoneuron involvement and progressive bulbar paralysis with bulbar muscle involvement is observed. The ALS form with progressive muscle atrophy, where only the lower motoneuron is affected, and primary lateral sclerosis with only upper motoneuron damage are rare. Familiar forms of ALS (FALS) associated with specific genes (the most common is C9orf72) have been discovered. FALS is usually associated with dementia (frontotemporal lobar dementia, FTLD), behavioral disorders, cognitive dysfunction and impairment of executive functions. The diagnosis of ALS is determined by excluding other conditions and utilizing clinical examinations, laboratory and genetic tests and nerve conduction/needle electromyography studies (EMG). Needle EMG records abnormal activities at rest and looks for neurogenic patterns during muscle contraction. Motor evoked potentials after transcranial magnetic stimulation remain the test of choice to identify impairment of upper motor neurons. New biochemical, neurophysiological and morphological biomarkers are extensively studied as early diagnostic and prognostic factors and have implications for clinical trials, research and drug development.
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Affiliation(s)
- Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Královské Vinohrady, 100 34 Prague, Czech Republic
- Correspondence: ; Tel.: +420-267162814
| | - Edvard Ehler
- Neurological Department, Faculty of Health Studies, Pardubice University and Pardubice Regional Hospital, 530 03 Pardubice, Czech Republic;
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Abstract
PURPOSE OF REVIEW In amyotrophic lateral sclerosis (ALS), sleep disruption is frequently present and substantially adds to disease burden. This review aims to summarize current knowledge on causes, pathophysiology, and treatment of sleep disturbances in ALS. RECENT FINDINGS Motor neuron degeneration and muscle weakness may lead to muscle cramps, pain, spasticity, immobilization, restless legs, sleep-disordered breathing, and difficulties to clear secretions. Furthermore, existential fears and depression may promote insomnia. Sleep-disordered breathing, and nocturnal hypoventilation in particular, requires ventilatory support which meaningfully prolongs survival and improves health-related quality of life albeit respiratory failure is inevitable. Early indication for non-invasive ventilation can be achieved by inclusion of capnometry in diagnostic sleep studies. Sleep disruption is extremely common in ALS and may arise from different etiologies. The absence of causative therapeutic options for ALS underlines the importance of symptomatic and palliative treatment strategies that acknowledge sleep-related complaints.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
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Associations of Patient Mood, Modulators of Quality of Life, and Pharmaceuticals with Amyotrophic Lateral Sclerosis Survival Duration. Behav Sci (Basel) 2020; 10:bs10010033. [PMID: 31936812 PMCID: PMC7016647 DOI: 10.3390/bs10010033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Associations of modulators of quality of life (QoL) and survival duration are assessed in the fatal motor neuron disease, Amyotrophic Lateral Sclerosis. Major categories include clinical impression of mood (CIM); physical health; patient social support; and usage of interventions, pharmaceuticals, and supplements. Associations were assessed at p < 0.05 and p < 0.001 significance thresholds using applicable methods (Chi-square, t-test, ANOVA, logistical regression, random forests, Fisher’s exact test) within a retrospective cohort of 1585 patients. Factors significantly correlated with positive (happy or normal) mood included family support and usage of bi-level positive airway pressure (Bi-PAP) and/or cough assist. Decline in physical factors like presence of dysphagia, drooling, general pain, and decrease in ALSFRS-R total score or forced vital capacity (FVC) significantly correlated with negative (depressed or anxious) mood (p < 0.05). Use of antidepressants or pain medications had no association with ALS patient mood (p > 0.05), but were significantly associated with increased survival (p < 0.05). Positive patient mood, Bi-PAP, cough assist, percutaneous endoscopic gastrostomy (PEG), and accompaniment to clinic visits associated with increased survival duration (p < 0.001). Of the 47 most prevalent pharmaceutical and supplement categories, 17 associated with significant survival duration increases ranging +4.5 to +16.5 months. Tricyclic antidepressants, non-opioids, muscle relaxants, and vitamin E had the highest associative increases in survival duration (p < 0.05). Random forests, which examined complex interactions, identified the following pharmaceuticals and supplements as most predictive to survival duration: Vitamin A, multivitamin, PEG supplements, alternative herbs, antihistamines, muscle relaxants, stimulant laxatives, and antispastics. Statins, metformin, and thiazide diuretics had insignificant associations with decreased survival.
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Gayoso MV, Domingues FS, França Junior MC, Felgoise SH, Oliveira ASB, de Barros GAM. Cross-cultural adaptation and validation for the Brazilian population of the instrument Amyotrophic Lateral Sclerosis-Specific Quality of Life-Short Form (ALSSQOL-SF). Qual Life Res 2019; 29:805-813. [PMID: 31664605 DOI: 10.1007/s11136-019-02342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aims to produce and validate the version of the instrument Amyotrophic Lateral Sclerosis-Specific Quality of Life-Short Form (ALSSQOL-SF) into Portuguese, adapted to the Brazilian cultural context. METHODOLOGY It is a cross-cultural adaptation and validation study, carried out in two Brazilian Public Universities, in the period from March, 2017, to November, 2018, according to the six steps guidelines of cultural and linguistic adaptation proposed by Beaton et al. (Spine 25(24):3186-3191, 2000). The World Health Organization Quality of Life (WHOQOL-BREF) and the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) were used for perform the validation. In order to analyze the correlations between the ALSSQOL-SF, WHOQOL-BREF, and ALSFRS-R scores, Spearman's correlation coefficients were calculated. The project was approved by the Research Ethics Committee of the two participating institutions. RESULT All steps of the transcultural adaptation process were performed without intercurrence. The pilot test had the participation of 30 individuals, and the "Questionário Breve Específico de Qualidade de Vida para Pacientes com ELA (QVELA-20/Br)" tool was developed. During the validation phase, 100 patients were included, most of them were male (58%) with a median age of 59 years. The created version of the questionnaire are positively and strongly correlated with the WHOQOL-BREF and positively and weakly correlated with ALSFRS-R, as expected. CONCLUSION The study produced and validated a version of the instrument ALSSQOL-SF into Portuguese that is adapted to the Brazilian cultural context.
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Affiliation(s)
- Maisa Vitória Gayoso
- Anesthesiology Department, São Paulo State University (UNESP), Medical School, Av. Prof. Mário Rubens Guimarães Montenegro s/n, Botucatu, SP, 18618687, Brazil
| | - Flávia Seullner Domingues
- Anesthesiology Department, São Paulo State University (UNESP), Medical School, Av. Prof. Mário Rubens Guimarães Montenegro s/n, Botucatu, SP, 18618687, Brazil
| | | | - Stephanie H Felgoise
- Department of Clinical Psychology, School of Professional & Applied Psychology, Philadelphia, PA, USA
| | - Acary Souza Bulle Oliveira
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Guilherme Antonio Moreira de Barros
- Anesthesiology Department, São Paulo State University (UNESP), Medical School, Av. Prof. Mário Rubens Guimarães Montenegro s/n, Botucatu, SP, 18618687, Brazil.
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Validity and Reliability of the Turkish Version of the Amyotrophic Lateral Sclerosis Assessment Questionnaire. J Neurosci Nurs 2019; 51:253-258. [PMID: 31469706 DOI: 10.1097/jnn.0000000000000466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to adapt the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ), developed for the evaluation of quality of life in amyotrophic lateral sclerosis (ALS) patients, into the Turkish society. METHODS This methodological study was conducted in 92 ALS patients registered in 2 chapters (Istanbul and Izmir) of Turkish ALS-Motor Neuron Diseases Association. The expert opinion and forward-backward translation methods were applied for the linguistic validity of the ALSAQ (long and short versions: ALSAQ-40 and ALSAQ-5, respectively). RESULTS In the analysis of internal consistency, the Cronbach's α reliability coefficient was .96 for the total scale, whereas it was between .88 and .98 for the 5 dimensions. The dimensions of the long form were correlated with the items of the short form. CONCLUSION The Turkish versions of the ALSAQ short and long forms are valid and reliable tools to be used in the assessment of the quality of life in ALS patients.
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Boentert M. Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives. Nat Sci Sleep 2019; 11:97-111. [PMID: 31496852 PMCID: PMC6701267 DOI: 10.2147/nss.s183504] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease inevitably leading to generalized muscle weakness and premature death. Sleep disturbances are extremely common in patients with ALS and substantially add to the burden of disease for both patients and caregivers. Disruption of sleep can be caused by physical symptoms, such as muscle cramps, pain, reduced mobility, spasticity, mucus retention, and restless legs syndrome. In addition, depression and anxiety may lead to significant insomnia. In a small subset of patients, rapid eye movement (REM) sleep behavioral disorder may be present, reflecting neurodegeneration of central nervous system pathways which are involved in REM sleep regulation. With regard to overall prognosis, sleep-disordered breathing (SDB) and nocturnal hypoventilation (NH) are of utmost importance, particularly because NH precedes respiratory failure. Timely mechanical ventilation is one of the most significant therapeutic measures to prolong life span in ALS, and transcutaneous capnometry is superior to pulse oxymetry to detect NH early. In addition, it has been shown that in patients on home ventilatory support, survival time depends on whether normocapnia, normoxia, and elimination of apneic events during sleep can be reliably achieved. Several studies have investigated sleep patterns and clinical determinants of sleep disruption in ALS, but exact prevalence numbers are unknown. Thus, constant awareness for sleep-related symptoms is appropriate. Since no curative treatment can be offered to affected patients, sleep complaints should be thoroughly investigated in order to identify any treatable etiology and improve or stabilize quality of life as much as possible. The use of hypnotics should be confined to palliation during the terminal phase and refractory insomnia in earlier stages of the disease, taking into account that most compounds potentially aggravate SDB.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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Moore A, Young CA, Hughes DA. Economic Studies in Motor Neurone Disease: A Systematic Methodological Review. PHARMACOECONOMICS 2017; 35:397-413. [PMID: 27975196 DOI: 10.1007/s40273-016-0478-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Motor neurone disease (MND) is a devastating condition which greatly diminishes patients' quality of life and limits life expectancy. Health technology appraisals of future interventions in MND need robust data on costs and utilities. Existing economic evaluations have been noted to be limited and fraught with challenges. OBJECTIVE The aim of this study was to identify and critique methodological aspects of all published economic evaluations, cost studies, and utility studies in MND. METHODS We systematically reviewed all relevant published studies in English from 1946 until January 2016, searching the databases of Medline, EMBASE, Econlit, NHS Economic Evaluation Database (NHS EED) and the Health Economics Evaluation Database (HEED). Key data were extracted and synthesised narratively. RESULTS A total of 1830 articles were identified, of which 15 economic evaluations, 23 cost and 3 utility studies were included. Most economic studies focused on riluzole (n = 9). Six studies modelled the progressive decline in motor function using a Markov design but did not include mutually exclusive health states. Cost estimates for a number of evaluations were based on expert opinion and were hampered by high variability and location-specific characteristics. Few cost studies reported disease-stage-specific costs (n = 3) or fully captured indirect costs. Utilities in three studies of MND patients used the EuroQol EQ-5D questionnaire or standard gamble, but included potentially unrepresentative cohorts and did not consider any health impacts on caregivers. CONCLUSION Economic evaluations in MND suffer from significant methodological issues such as a lack of data, uncertainty with the disease course and use of inappropriate modelling framework. Limitations may be addressed through the collection of detailed and representative data from large cohorts of patients.
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Affiliation(s)
- Alan Moore
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, LL57 2PZ, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, LL57 2PZ, UK.
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Nazemi M, Raad MH, Arzoomanian CS, Ghasemzadeh A. Fatigue and Depression in Iranian Amyotrophic Lateral Sclerosis Patients in Tehran in 2012. Electron Physician 2016; 8:2194-8. [PMID: 27123230 PMCID: PMC4844488 DOI: 10.19082/2194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a progressive and rapid course. Fatigue and depression are common among ALS patients. The aim of this study was to determine the relationship between depression and fatigue in Iranian ALS patients. Methods In this 2012 cross-sectional study, 40 ALS patients, including 22 females and 18 males, were selected through consecutive relapsing-remitting, and 40 age- and gender-matched health controls (HCs) were recruited from Loghman Hakim Hospital in Tehran, Iran. The Persian version of the Fatigue Severity Scale (FSS-Per) questionnaire and depression substance of Hospital Anxiety and Depression Scale (HADS) were used to assess fatigue and depression. Data were analyzed using the Kolmogorov-Sminov Test, Levene’s test, Independent Samples t-test, and Pearson product-moment correlation coefficient. Results We identified a significant and positive relationship between fatigue and depression in patients with ALS (p=0.000). Furthermore, the scores of fatigue and depression in ALS patients were higher than in non-ALS patients. Conclusion The results indicated that there was a relationship between fatigue and depression in ALS patients and that early intervention services can improve these symptoms. Further studies are suggested to investigate the direction of such relationship.
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Affiliation(s)
- Maryam Nazemi
- Master in Personality Psychology, Education and Psychology Faculty, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Marjan Hassani Raad
- Master in General Psychology, Education and Psychology Faculty, Islamic Azad University, Tehran Science and Research Branch, Tehran, Iran
| | - Christineh Serob Arzoomanian
- Master in Clinical psychology, Education and Psychology Faculty, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Azizreza Ghasemzadeh
- Lecturer in Rehabilitation Science, University of Applied Sciences, Tehran Welfare Organization, Tehran, Iran
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Londral A, Pinto A, Pinto S, Azevedo L, De Carvalho M. Quality of life in amyotrophic lateral sclerosis patients and caregivers: Impact of assistive communication from early stages. Muscle Nerve 2015; 52:933-41. [DOI: 10.1002/mus.24659] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Ana Londral
- Translational Clinical Physiology Unit, Instituto de Medicina Molecular, Avenida Professor Egas Moniz; University of Lisbon; 1649-028 Lisbon Portugal
| | - Anabela Pinto
- Department of Medical Rehabilitation; Hospital de Santa Maria-Centro Hospitalar Lisboa Norte (CHLN); Lisbon Portugal
| | - Susana Pinto
- Translational Clinical Physiology Unit, Instituto de Medicina Molecular, Avenida Professor Egas Moniz; University of Lisbon; 1649-028 Lisbon Portugal
| | - Luis Azevedo
- Center of Acquisition and Signal Processing, Instituto Superior Técnico; University of Lisbon; Lisbon Portugal
| | - Mamede De Carvalho
- Department of Neurosciences; Hospital de Santa Maria-CHLN; Lisbon Portugal
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Pagnini F. Psychological wellbeing and quality of life in amyotrophic lateral sclerosis: A review. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 48:194-205. [DOI: 10.1080/00207594.2012.691977] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mora JS, Salas T, Fajardo ML, Iváñez L, Rodríguez-Santos F. Self perceived emotional functioning of spanish patients with amyotrophic lateral sclerosis: a longitudinal study. Front Psychol 2013; 3:609. [PMID: 23316181 PMCID: PMC3539828 DOI: 10.3389/fpsyg.2012.00609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/20/2012] [Indexed: 12/13/2022] Open
Abstract
Background: ALS is a neurodegenerative disease of the entire motor system that most frequently ends with respiratory arrest in few years. Its diagnosis and the rapid progression of the motor dysfunctions produce a continued emotional impact. Studies on this impact are helpful to plan adequate psychotherapeutic strategies. Objective: To assess and analyze: First: How the patients with ALS perceive their emotional health. Second: The emotional impact of their physical disabilities. Third: The physical disabilities with highest emotional impact. Fourth: The feelings with highest emotional impact. Methods: Up to 110 Spanish patients with ALS were assessed less than 1 year from diagnosis, then twice more at 6 month intervals, using the ALS Quality of Life Assessment Questionnaire (ALSAQ-40) validated for use in Spanish. Descriptive analysis and correlation between variables were obtained. Results: Worries about the future, of lack of freedom, and of being a burden were prevalent feelings. On average depression was felt only “sometimes.” Only 25% of the variations in the emotional state were explained by changes in the physical state at first evaluation, and 16% at the last one. Emotional functioning correlated significantly with the physical disabilities at first and second evaluation, less so at third. Communication disabilities always had the highest impact. Depression at first evaluation and hopelessness at the next two evaluations had the highest emotional impact. Hopelessness did not correlate with any physical disability at the third evaluation. On the whole, emotional dysfunction was self perceived as intermediate (between none and worst), and remained stable at 1 year follow up, in both bulbar and spinal onset patients. Conclusions: Physical dysfunctions per se have a limited role in patients´ emotional distress. Communication disabilities, as well as feelings of depression at early stages of illness, and of hopelessness later on, had the most impact. This requires their careful therapeutic attention. On average, Spanish patients with ALS cope with their disease, overcoming depression, which is not felt often, and with just mid levels of emotional dysfunction.
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Affiliation(s)
- Jesús S Mora
- ALS Unit, Department of Neurology, Hospital Carlos III Madrid, Spain
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Tramonti F, Bongioanni P, Di Bernardo C, Davitti S, Rossi B. Quality of life of patients with amyotrophic lateral sclerosis. PSYCHOL HEALTH MED 2012; 17:621-8. [DOI: 10.1080/13548506.2011.651149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Cella D, Lai JS, Nowinski CJ, Victorson D, Peterman A, Miller D, Bethoux F, Heinemann A, Rubin S, Cavazos JE, Reder AT, Sufit R, Simuni T, Holmes GL, Siderowf A, Wojna V, Bode R, McKinney N, Podrabsky T, Wortman K, Choi S, Gershon R, Rothrock N, Moy C. Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology 2012; 78:1860-7. [PMID: 22573626 DOI: 10.1212/wnl.0b013e318258f744] [Citation(s) in RCA: 436] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To address the need for brief, reliable, valid, and standardized quality of life (QOL) assessment applicable across neurologic conditions. METHODS Drawing from larger calibrated item banks, we developed short measures (8-9 items each) of 13 different QOL domains across physical, mental, and social health and evaluated their validity and reliability. Three samples were utilized during short form development: general population (Internet-based, n = 2,113); clinical panel (Internet-based, n = 553); and clinical outpatient (clinic-based, n = 581). All short forms are expressed as T scores with a mean of 50 and SD of 10. RESULTS Internal consistency (Cronbach α) of the 13 short forms ranged from 0.85 to 0.97. Correlations between short form and full-length item bank scores ranged from 0.88 to 0.99 (0.82-0.96 after removing common items from banks). Online respondents were asked whether they had any of 19 different chronic health conditions, and whether or not those reported conditions interfered with ability to function normally. All short forms, across physical, mental, and social health, were able to separate people who reported no health condition from those who reported 1-2 or 3 or more. In addition, scores on all 13 domains were worse for people who acknowledged being limited by the health conditions they reported, compared to those who reported conditions but were not limited by them. CONCLUSION These 13 brief measures of self-reported QOL are reliable and show preliminary evidence of concurrent validity inasmuch as they differentiate people based upon number of reported health conditions and whether those reported conditions impede normal function.
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Affiliation(s)
- D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive disorder characterized by degeneration of motor neurons. Given the severe nature of ALS, many believed that patients would suffer from a high level of depression and a low quality of life. However, research into the psychological health of patients with ALS has shown that this is not the case. This article reviews the state of current knowledge as it pertains to the psychological health of ALS patients in four broad areas: quality of life, personality characteristics, emotional reactions, and end-of-life choices.
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Winter Y, Schepelmann K, Spottke AE, Claus D, Grothe C, Schröder R, Heuss D, Vielhaber S, Tackenberg B, Mylius V, Reese JP, Kiefer R, Schrank B, Oertel WH, Dodel R. Health-related quality of life in ALS, myasthenia gravis and facioscapulohumeral muscular dystrophy. J Neurol 2010; 257:1473-81. [DOI: 10.1007/s00415-010-5549-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/21/2010] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
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Abstract
HRQOL assessment in patients with rare diseases can help to identify health needs, to evaluate the impact of disease and treatments, and to assess the evolution in health status through the natural history of disease. Several studies have shown that although some rare diseases do not necessarily affect life expectancy, the majority lead to physical, emotional and/or psychosocial limitations with a wide range of disabilities. Reliability as well as content, criterion, and construct validity, and also responsiveness should be taken into account in selecting the instrument to be used assessing individuals with rare diseases. The use of proxy-report may be essential in some cases where the patient is cognitively impaired or unable to communicate. Criteria for selecting a HRQOL instrument, as well as the more common strategies proposed help interpret scores on HRQOL instruments are addressed in the chapter. Given the impact of rare diseases on the quality of life of both patients and carers, it is likely that interest in its measurement will continue to increase among professionals, patients, and the general public. Improving the quality of life of people with rare diseases should be one of the most important goals of any health care intervention or multidisciplinary approach.
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