1
|
Fulton JPJ, Holt JKL, Mills RJ, Young CA. Rasch analysis of the modified Fatigue Severity Scale in neuromuscular disorders and comparison between sex, age and diagnoses. Muscle Nerve 2024. [PMID: 38953614 DOI: 10.1002/mus.28186] [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: 09/02/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION/AIMS Fatigue is a common and debilitating symptom encountered in the neuromuscular clinic. The 7-item Fatigue Severity Scale (FSS-7) is a Rasch-modified assessment validated in inflammatory neuropathies but not across a typical neuromuscular patient population. The aim of this study was to validate this measure in neuromuscular disorders and to compare between patient sex, age and diagnoses. METHODS The modified FSS-7 was mailed to patients recruited from a specialist neuromuscular clinic at the Walton Centre. Responses were subjected to Rasch analysis and descriptive statistics were performed on the Rasch converted data. RESULTS The mFSS-7 met the Rasch model expectations with an overall Chi-square probability of 0.4918, a strict unidimensional scale free from differential item functioning (DIF) that satisfied the model with substantial test-retest reliability using Lin's concordance correlation coefficient 0.71 (95% CI 0.63-0.77). A 15.7% ceiling effect was observed in this patient cohort. Post hoc analysis did not show any significant difference in fatigue between sex, age or neuromuscular diagnoses. DISCUSSION The self-completed Rasch mFSS-7 showed acceptable test-retest reliability across patients with varied disorders under follow-up in a specialist neuromuscular clinic. The ceiling effect constrains its use for those with the most severe fatigue. Future considerations could include assessment of the benefits of clinical interventions, particularly multidisciplinary team input or dedicated fatigue clinics.
Collapse
Affiliation(s)
- Joshua P J Fulton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - James K L Holt
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Roger J Mills
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Carolyn A Young
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Larsson BJ, Nordin K, Nygren I. Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory. J Neurol Sci 2023; 455:122780. [PMID: 37976792 DOI: 10.1016/j.jns.2023.122780] [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: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTS The aim of this study was to describe the presence of anxiety and depression among patients with Amyotrophic Lateral Sclerosis (ALS) and their relatives from diagnosis and during the disease progression. An additional aim was to explore if the patient's physical function correlated with the patients' or relatives' anxiety and depression. METHODS A prospective and longitudinal study, including 33 patients with ALS and their relatives who filled out the Hospital Anxiety and Depression Scale (HADS) at the time of diagnosis and over a period of two years. The patient's physical function was measured with the revised Amyotrophic Lateral Sclerosis Functional and Rating Scale (ALS FRS-R). RESULTS The results showed that many patients (45%) and relatives (58%) had symptoms of anxiety and that 13% of the patients and 29% of the relatives had symptoms of depression soon after the patient had been diagnosed with ALS. The prevalence of anxiety decreased over time in the group of patients but remained stable in the group of relatives. Relatives had more symptoms of anxiety compared to patients. There was a correlation between the patient's physical function and HADS in the group of relatives; however, no correlation was found in the group of patients. CONCLUSION The results showed that many patients and relatives suffered from symptoms of anxiety quite soon after their diagnosis, and that many relatives had symptoms of anxiety during the disease trajectory. This highlights the need to continuously measure patients' anxiety/depression level but also to pay attention to symptoms among relatives.
Collapse
Affiliation(s)
- Birgitta Jakobsson Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Beswick E, Forbes D, Johnson M, Newton J, Dakin R, Glasmcher S, Abrahams S, Carson A, Chandran S, Pal S. Non-motor symptoms in motor neuron disease: prevalence, assessment and impact. Brain Commun 2023; 6:fcad336. [PMID: 38162906 PMCID: PMC10754319 DOI: 10.1093/braincomms/fcad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
People with motor neuron disease often experience non-motor symptoms that may occur secondary to, or distinct from, motor degeneration and that may significantly reduce quality of life, despite being under-recognized and evaluated in clinical practice. Non-motor symptoms explored in this population-based study include pain, fatigue, gastrointestinal issues, poor sleep, low mood, anxiety, problematic saliva, apathy, emotional lability, cognitive complaints and sexual dysfunction. People registered on the Clinical Audit Research and Evaluation of motor neuron disease platform, the Scottish Motor Neuron Disease Register, were invited to complete a questionnaire on non-motor symptoms and a self-reported Amyotrophic Lateral Sclerosis Functional Rating Scale. The questionnaire comprised a pre-defined list of 11 potential non-motor symptoms, with the opportunity to list additional symptoms. A total of 120 individuals participated in this cross-sectional study, a 39% response rate of those sent questionnaires (n = 311); 99% of participants recruited (n = 120) experienced at least one non-motor symptom, with 72% (n = 120) reporting five or more. The symptoms most often reported were pain and fatigue (reported by 76% of participants, respectively). The symptoms reported to be most impactful were gastrointestinal issues (reported as 'severe' by 54% of participants who experienced them), followed by pain and problematic saliva (51%, respectively). Lower Amyotrophic Lateral Sclerosis Functional Rating Scale scores, indicating more advanced disease and being a long survivor [diagnosed over 8 years ago; Black et al. (Genetic epidemiology of motor neuron disease-associated variants in the Scottish population. Neurobiol Aging. 2017;51:178.e11-178.e20.)], were significantly associated with reporting more symptoms; 73% of respondents were satisfied with the frequency that non-motor symptoms were discussed in clinical care; 80% of participants indicated they believe evaluation of non-motor symptom is important to include as outcomes in trials, independent of their personal experience of these symptoms. The preferred method of assessment was completing questionnaires, at home. The overwhelming majority of people with motor neuron disease report non-motor symptoms and these frequently co-occur. Pain, fatigue, gastrointestinal issues, sleep, mood, anxiety, problematic saliva, apathy, emotional lability, cognitive complaints and sexual dysfunction are prevalent. People with motor neuron disease who had worse physical function and those who were long survivors were more likely to report more symptoms. Where reported, these symptoms are frequent, impactful and a priority for people with motor neuron disease in clinical care and trial design.
Collapse
Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Deborah Forbes
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Micheala Johnson
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Rachel Dakin
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Stella Glasmcher
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
- Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, the University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Conroy E, Vélez-Gómez B, O'Brien D, Heverin M, Hardiman O, Mcdermott C, Galvin M. IMPACT-ALS: summary of results from a European survey of people living with ALS. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-10. [PMID: 37661426 DOI: 10.1080/21678421.2023.2249515] [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: 12/13/2022] [Revised: 06/19/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The IMPACT-ALS survey collected the experiences of people living with ALS (plwALS) across nine European countries. We aimed to better understand the functional burden of ALS to ensure the experiences of plwALS inform the development of person-centered therapies. METHODS The content was informed by the US IMPACT-ALS survey, with adjustments relevant to the European population. Questionnaires consisted of four modules, each of which was pilot tested in advance of distribution. Data were captured using the Qualtrics software and were analyzed in SPSS. RESULTS 857 respondents completed the survey, with a participation rate ranging from 0.2% to 6.3% across the nine participating countries. The majority were male and aged 55-74 years old. In the previous 2 weeks, symptoms experienced included weakness (81%), fatigue (61%), speech impairment (38%), pain (27%), and depression and other mood changes (23%). Eighty-two percent of respondents reported fears, of which the most common were leaving family too soon (68%) and death from respiratory failure (50%). Lifestyle changes since diagnosis were reported by 89% of respondents, with less time spent doing most daily activities but more time on the internet (81%), reading (56%) and communicating with family and friends (55%). Stopping progression of ALS was the most desired impact for a new therapy for 68% respondents. CONCLUSIONS The European IMPACT-ALS survey has generated insights into the complex experiences of plwALS. The data provide unique patient perspectives on common symptoms, fears, functional limitations, lifestyle changes, and wishes for future therapies that will enhance patient-centric care in ALS.
Collapse
Affiliation(s)
- Eilis Conroy
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Beatriz Vélez-Gómez
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain, and
| | - David O'Brien
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Mark Heverin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Christopher Mcdermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Miriam Galvin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
6
|
Gwathmey KG, Corcia P, McDermott CJ, Genge A, Sennfält S, de Carvalho M, Ingre C. Diagnostic delay in amyotrophic lateral sclerosis. Eur J Neurol 2023; 30:2595-2601. [PMID: 37209406 DOI: 10.1111/ene.15874] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease, and the time from symptom onset to diagnosis remains long. With the advent of disease-modifying treatments, the need to identify and diagnose ALS in a timely fashion has never been greater. METHODS We reviewed the literature to define the severity of ALS diagnostic delay, the various factors that contribute to this delay (including patient and physician factors), and the role that site of symptom onset plays in a patient's diagnostic journey. RESULTS Diagnostic delay is influenced by general practitioners' lack of recognition of ALS due to disease rarity and heterogenous presentations. As a result, patients are referred to non-neurologists, have unnecessary diagnostic testing, and may ultimately be misdiagnosed. Patient factors include their illness behavior-which impacts diagnostic delay-and their site of symptom onset. Limb-onset patients have the greatest diagnostic delay because they are frequently misdiagnosed with degenerative spine disease or peripheral neuropathy. CONCLUSION Prompt ALS diagnosis results in more effective clinical management, with earlier access to disease-modifying therapies, multidisciplinary care, and, if desired, clinical trial involvement. Due to lack of commercially available ALS biomarkers, alternative strategies to identify and triage patients who likely have ALS must be employed. Several diagnostic tools have been developed to encourage general practitioners to consider ALS and make an urgent referral to ALS specialists, bypassing unnecessary referrals to non-neurologists and unnecessary diagnostic workup.
Collapse
Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Philippe Corcia
- CRMR SLA, CHU Tours, Tours, France
- UMR1253 iBrain UMR, Université de Tours, INSERM, Tours, France
| | - Chris J McDermott
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Angela Genge
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mamede de Carvalho
- Institute of Physiology, Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Tennant A, Küçükdeveci AA. Application of the Rasch measurement model in rehabilitation research and practice: early developments, current practice, and future challenges. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1208670. [PMID: 37529206 PMCID: PMC10387545 DOI: 10.3389/fresc.2023.1208670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
The application of the Rasch measurement model in rehabilitation is now well established. Both its dichotomous and polytomous forms provide for transforming ordinal scales into interval-level measures, consistent with the requirements of fundamental measurement. The growth of applying the model in rehabilitation spans 30 years, during which both the protocol has steadily developed and several software packages have emerged that provide for analysis, together with the "R" language that has an increasing set of codes for applying the model. This article reviews that development and highlights current practice requirements, including those for providing the relevant information for the methods, and what is expected of the analysis. In addition, this provides a worked example and looks at the remaining issues and current developments of its application.
Collapse
Affiliation(s)
- Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Ayse A. Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
8
|
Muscolo GG, Di Pede F, Solero L, Nicolì A, Russo A, Fiorini P, Chiò A, Calvo A, Canosa A. Conceptual design of a biped-wheeled wearable machine for ALS patients. J Neurol 2023; 270:3632-3636. [PMID: 37010628 DOI: 10.1007/s00415-023-11678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Affiliation(s)
| | - Francesca Di Pede
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Luca Solero
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Angelo Nicolì
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alessandra Russo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Paolo Fiorini
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Adriano Chiò
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
- Neuroscience Institute of Turin (NIT), Turin, Italy
| | - Andrea Calvo
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
- Neuroscience Institute of Turin (NIT), Turin, Italy
| | - Antonio Canosa
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
- SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy.
| |
Collapse
|
9
|
Maier A, Münch C, Meyer T. Der Einsatz von Patient-reported Outcome Measures (PROM) und die
Perspektive digitaler Biomarker bei der Amyotrophen
Lateralsklerose. KLIN NEUROPHYSIOL 2023. [DOI: 10.1055/a-2019-3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
ZusammenfassungDie systematische Erfassung des klinischen Zustands sowie der Erfahrung mit
Behandlung oder Versorgung durch einen strukturierten Bericht des Patienten wird
als „Patient-reported Outcome Measures“ (PROM) bezeichnet. Bei
der Amyotrophen Lateralsklerose (ALS) haben sich PROM insbesondere zur
Dokumentation funktioneller Defizite, z. B. mit der ALS-Funktionsskala,
und weiterer komplexer Symptome im Rahmen von klinischer Forschung etabliert. In
der Behandlungspraxis werden PROM dazu genutzt, den Verlauf und die Prognose der
Erkrankung einzuschätzen. Mit PROM werden neue biologische Biomarker
(z. B. Neurofilamente) und digitale Biomarker (z. B. durch den
Einsatz von Sensorik) auf ihre patientenzentrierte Relevanz evaluiert. Durch die
digitale Anwendung von PROM und die Verknüpfung mit digitalen Biomarkern
kann eine engmaschigere Erhebung von zu Hause aus erfolgen und damit die
Datenqualität erhöht werden. Patienten können selbst den
Gesundheitszustand monitorieren sowie Behandlungs- und Versorgungsergebnisse
dokumentieren. Damit nehmen sie zunehmend eine aktive Rolle in der individuellen
Behandlung und Versorgung ein.
Collapse
Affiliation(s)
- André Maier
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
| | - Christoph Münch
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin,
Germany
| | - Thomas Meyer
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin,
Germany
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
| | | |
Collapse
|
11
|
Alencar MA, Soares BL, Rangel MFDA, Abdo JS, Almeida RAPD, Araújo CMD, Souza LCD, Gomes GDC. Fatigue in amyotrophic lateral sclerosis and correlated factors. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1045-1051. [PMID: 36535289 PMCID: PMC9770075 DOI: 10.1055/s-0042-1758563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that leads to muscle weakness and paralysis. Fatigue is a disabling symptom, frequently reported in ALS, but remains under-investigated in this population. Thus, an accurate investigation of this symptom and possible associated factors in this clinical condition is needed to assist in the establishment of an adequate treatment approach. OBJECTIVE To investigate the presence of fatigue in individuals with ALS and possible factors correlated with this symptom. METHODS Sixty-five individuals with sporadic ALS participated in the present study. Demographic, clinical, and functional aspects were investigated. Evaluations involved the Fatigue Severity Scale (FSS), ALS Functional Scale (ALSRFS-R), and Quality of Life (QoL) questionnaire (ALSAQ-40). Descriptive and correlation analyses were performed with SPSS statistical program for Windows version 19.0 (IBM Corp., Armonk, NY, USA). RESULTS Among the 65 individuals evaluated, 44.6% (n = 29) presented fatigue based on the FSS. The mean fatigue intensity was 5.4 ± 1.2 and only 10.4% used a specific medication for fatigue. Differences between the groups with and without fatigue were found regarding sex (p = 0.049), pain intensity (p = 0.026), functioning (p = 0.004), disease severity (p = 0.029), and QoL (p = 0.000). Fatigue was correlated with pain intensity (r = 0.425; p = 0.001), muscle strength (r = - 0.356; p = 0.004), functioning (r = - 0.363; p = 0.003), and QoL (r = 0.481; p = 0.000). No correlations were found with age, time since diagnosis, cramps, or other mobility parameters. CONCLUSIONS Fatigue is a common symptom among individuals with ALS and may be present in all stages of the disease. This symptom was correlated with worse functioning, poorer QoL, greater pain intensity, disease severity, muscle weakness, and the female sex in individuals with ALS.
Collapse
Affiliation(s)
- Mariana Asmar Alencar
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil.,Address for correspondence Mariana Asmar Alencar
| | - Bruna Laura Soares
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil.
| | | | - Juliana Silva Abdo
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil.
| | | | - Caroline Martins de Araújo
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociência, Belo Horizonte MG, Brazil.
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociência, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Belo Horizonte MG, Brazil.
| | - Gisele de Cássia Gomes
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil.
| |
Collapse
|
12
|
Lapin B, Mate K, Li Y, Thakore N. Subjective health perception prioritizes psychological well-being over physical function in advanced ALS: A multigroup structural equation modeling analysis. J Neurol Sci 2022; 442:120442. [PMID: 36201964 DOI: 10.1016/j.jns.2022.120442] [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: 06/17/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite declining physical function, individuals with ALS report relative preservation of overall health perception, or health-related quality of life (HRQoL). This paradoxical finding is attributed to psychological adaptation to deficits. OBJECTIVE The aim of this cross-sectional study was to examine reprioritization of factors that determine HRQoL with disease progression. METHODS As standard care, patients with ALS self-reported ALSFRS-R (measure of bulbar, motor, and respiratory function), PHQ-9 (measure of depression), and EQ-5D-3L (utility index that includes a visual analog scale asking about health perception [EQ-VAS]). ALS was staged by the FT9 method and classified into early (stages 0-2) and late (stages 3-4) disease. Multigroup structural equation modeling was used to evaluate weights of physical (PHY) and psychological well-being (PSY) for early and late disease, on EQ-VAS (as a measure of overall HRQoL). RESULTS There were 578 patients (mean age 61.5 ± 11.9, 59% male) with ALS: 423 (73%) early and 155 (27%) late disease. A measurement model was established with good model fit (RMSEA = 0.076, CFI = 0.943, SRMR = 0.045). In adjusted models, standardized weights of PHY and PSY on HRQoL in early disease were 0.34 (standard error = 0.06) and 0.24 (0.06) respectively, whereas for late disease they were 0.39 (0.07) and 0.42 (0.07). Importantly, PHY and PSY were significantly correlated in early but not in late disease. CONCLUSIONS Our study found health perception is more representative of psychological well-being and less representative of physical function across the disease progression. Greater allocation for psychological health would be the most effective strategy to maximize subjective health status as ALS advances.
Collapse
Affiliation(s)
- Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States of America.
| | - Kedar Mate
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Nimish Thakore
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, United States of America
| |
Collapse
|
13
|
Hardy M, Castle C, Jackson C. Embedded Psychiatric Services in a Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Assessment of Patient Needs and Perceptions. J Neuropsychiatry Clin Neurosci 2022; 34:53-59. [PMID: 34763523 DOI: 10.1176/appi.neuropsych.21040092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is often associated with a range of difficult neuropsychiatric symptoms and conditions, including depression, apathy, pseudobulbar affect, and frontotemporal dementia (FTD). Despite the potential role for psychiatrists in the treatment of ALS, they are not typically involved in the ALS clinical team. The investigators describe a quality improvement intervention providing embedded psychiatric services within a multidisciplinary clinic (MDC). METHODS A psychiatrist working within an ALS MDC evaluated patients (N=116) over a 1-year period. The clinic assessed the prevalence of neuropsychiatric symptoms and conditions in patients with ALS (depression, anxiety, pseudobulbar affect, and cognitive impairment, including FTD) using standardized screening methods. Fifty-five patients and 47 family members completed surveys about perceptions of their need for psychiatric care, their experience of meeting with a psychiatrist, and their desire for future access to psychiatric care. RESULTS Prevalence rates for neuropsychiatric symptoms were 14.9% for depression, 11.3% for anxiety, 19% for cognitive impairment (including FTD, 8.6%), and 36.2% for pseudobulbar affect; 62.0% of patients were being prescribed at least one psychotropic medication. Both patients and family members reported that meeting with a psychiatrist was helpful, that the treatment provided was helpful, and that they would prefer continued availability of psychiatric services in the future. The presence of cognitive impairment and use of antidepressants increased the likelihood of patients reporting a benefit from psychiatric care. CONCLUSIONS Patients with ALS report a benefit from increased access to psychiatric services. The inclusion of a psychiatrist within the ALS MDC model should be considered to improve quality of care for this patient population.
Collapse
Affiliation(s)
- Morgan Hardy
- Departments of Psychiatry (Hardy, Castle), Neurology (Jackson), and Otolaryngology (Jackson), University of Texas Health Science Center, San Antonio
| | - Caitlin Castle
- Departments of Psychiatry (Hardy, Castle), Neurology (Jackson), and Otolaryngology (Jackson), University of Texas Health Science Center, San Antonio
| | - Carlayne Jackson
- Departments of Psychiatry (Hardy, Castle), Neurology (Jackson), and Otolaryngology (Jackson), University of Texas Health Science Center, San Antonio
| |
Collapse
|
14
|
Aust E, Linse K, Graupner ST, Joos M, Liebscher D, Grosskreutz J, Prudlo J, Meyer T, Günther R, Pannasch S, Hermann A. Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin. J Neurol 2022; 269:5910-5925. [PMID: 35790562 PMCID: PMC9553779 DOI: 10.1007/s00415-022-11238-0] [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: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
For both patients with amyotrophic lateral sclerosis (ALS) and their next of kin (NOK), the maintenance of quality of life (QoL) and mental health is particularly important. First studies suggest significant discrepancies between QoL reports by patients and NOK, but little is known for advanced ALS stages. To address this issue, we screened 52 ALS patients in incomplete locked-in state (iLIS). Final results were obtained for 15 couples of iLIS patients and NOK. We assessed patients’ and NOK’s subjective QoL, depression and anxiety and NOK’s caregiver burden. Gaze controlled questionnaires allowed direct assessment of patients. Patients and NOK self-reported comparable, mostly moderate to high levels of QoL. Of note, NOK indicated stronger anxiety symptoms. Higher anxiety levels in NOK were associated with stronger caregiver burden and reduced QoL. No significant misjudgment of patient’s QoL by the NOK was evident, while patients overestimated NOK’s global QoL. However, NOK with severe caregiver burden and depression symptoms gave poorer estimations of patients’ QoL. This relationship is relevant, considering NOK’s impact on life critical treatment decisions. While the daily time NOK and patient spend together was positively correlated with NOK’s QoL and mental health, this was not reversely found for the patients. Our results suggest that NOK adapt less successfully to the disease and concomitant experience of loss and point to an urgent need for specialized psychosocial support. The findings emphasize the importance of direct psychological wellbeing assessment of both patients and NOK in clinical practice, enabled by eye-tracking technology for patients in iLIS.
Collapse
Affiliation(s)
- Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sven-Thomas Graupner
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | - Daniel Liebscher
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | | | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sebastian Pannasch
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany ,Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany ,Translational Neurodegeneration Section “Albrecht Kossel,” Department of Neurology, University Medical Center Rostock, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| |
Collapse
|
15
|
Alencar MA, Silva IMMD, Hilário SM, Rangel MFDA, Abdo JS, Araújo CMD, Souza LCD. Quality of life, disability, and clinical variables in amyotrophic lateral sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 80:255-261. [PMID: 34932653 DOI: 10.1590/0004-282x-anp-2021-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that results in a progressive increase in dysfunctions, limitations and restrictions over time, which can impact on quality of life (QoL). Therefore, expanding knowledge on QoL and possible factors associated with ALS can enable the development of actions to ensure greater wellbeing for the population. OBJECTIVE To investigate QoL in ALS and determine associations with demographic, functional and clinical aspects. METHODS Forty-five individuals with ALS (56.4±11.1 years) participated in the study. Demographic, clinical and functional aspects were investigated. Functioning and QoL were assessed using disease-specific tools (ALS Functional Ranting Scale-Revised/ALSFRS-R and ALS Assessment Questionnaire/ALSAQ-40). Fatigue was assessed using the Fatigue Severity Scale. Descriptive, correlation and stepwise multiple linear regression analyses were performed with the aid of the SPSS. RESULTS The mean ALSAQ-40 score was 279.0±118.3. QoL was significantly worse among women (p=0.001) and poor QoL was associated with the inability to walk (p=0.014), pain (p=0.021) and disease severity (p≤0.002). QoL was strongly correlated with the ALSFRS-R score (r=-0.82). Moderate to weak correlations were found for mobility [turning in bed (r=-0.62), locomotion (r=-0.33) and sit to stand (r=-0.40)], strength (r=-0.49), fatigue (r=0.35) and pain (r=-0.32) (p<0.03). The regression analysis revealed that the ALSFRS-R score (β=-0.76; p=0.00) and fatigue (β=0.20; p=0.04) were predictors of QoL. CONCLUSIONS QoL was worse in women, older people, severe stages of ALS, patients with impaired mobility, those with a poorer physical performance and those who reported pain. Functional status and fatigue are predictors of QoL in ALS.
Collapse
Affiliation(s)
- Mariana Asmar Alencar
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil
| | | | | | | | - Juliana Silva Abdo
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brazil
| | - Caroline Martins de Araújo
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociência, Belo Horizonte MG, Brazil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociência, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Belo Horizonte MG, Brazil
| |
Collapse
|
16
|
Exploring the enablers and barriers to social prescribing for people living with long-term neurological conditions: a focus group investigation. BMC Health Serv Res 2021; 21:1230. [PMID: 34774034 PMCID: PMC8590354 DOI: 10.1186/s12913-021-07213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with Long Term Neurological Conditions (LTNCs) value peer support and social activities. Psychological support and wellbeing enables them to manage their condition. Social prescribing is a formal process of referring patients to a link worker to co-design a plan to improve their health and wellbeing. Intervention involves supporting participation in activities based within the individual’s local community. This study aimed to explore the barriers and enablers to accessing social prescribing for people living with LTNCs (plwLTNCs). Methods A total of four focus groups were carried out with 17 participants, including different neurological conditions such as multiple sclerosis, Fragile X Syndrome, epilepsy, and traumatic brain injury. Two participants were family carers and supported people living with epilepsy and motor neurone disease. Findings were analysed using thematic analysis. Results Five themes were identified: (1) Lack of knowledge; (2) Service provision difficulties; (3) Benefits of social prescribing activities; (4) Physical barriers and (5) Psychological barriers. There was a lack of knowledge about social prescribing and what it actually was. Participants anticipated service provision difficulties relating to funding, link workers need for knowledge of LTNC’s and for activities to be varied and individualised. The potential benefits of social prescribing activities were recognised across the groups especially its potential to tackle loneliness and to offer plwLTNC’s purpose. Participants highlighted a number of physical barriers such as transport and accessibility; and psychological barriers such as anxiety and stigma. Conclusion Social prescribing aims to address the health inequalities of those living with long-term conditions, however currently it is likely to exclude plwLTNCs. Recommendations for practice and future research are made. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07213-6.
Collapse
|
17
|
Young C, Ealing J, McDermott C, Williams T, Al-Chalabi A, Majeed T, Roberts R, Mills R, Tennant A. Fatigue and anxiety mediate the effect of dyspnea on quality of life in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:390-398. [PMID: 34709092 DOI: 10.1080/21678421.2021.1990343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Dyspnea (or breathlessness) due to progressive neuromuscular respiratory failure is common in amyotrophic lateral sclerosis (ALS). It is associated with anxiety, depression and reduced quality of life (QoL). For effective treatment, it is essential to understand the relationships between dyspnea, anxiety, depression and QoL.Methods: The UK Trajectories of Outcomes in Neurological Conditions-ALS study (TONiC-ALS) collected self-report measures from patients with ALS. Ordinal scales were transformed to interval-scaled estimates by the Rasch Measurement model. They were subsequently included in a series of path models where the focal relationships were dyspnea to QoL and dyspnea to depression.Results: Path analyses using 1022 participants showed that 60.5% of the variance of QoL was explained by fatigue, anxiety, dyspnea and disability. For depression, 54.1% of the variance was explained by a model of these factors. Dyspnea played an important but mostly indirect role in influencing QoL and depressive symptoms. Disability was dominated by all other factors in the model.Discussion: Dyspnea in ALS influences quality of life and depression largely through indirect effects, principally acting via anxiety and fatigue. Recognition of this is essential for clinicians to understand where to intervene for greatest benefit. Researchers must be aware that studies of the effect of dyspnea on QoL and depression require path models, measuring both direct and indirect effects, as the impact of dyspnea is likely to be significantly miscalculated if only direct effects are assessed.
Collapse
Affiliation(s)
- Carolyn Young
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - John Ealing
- Salford Royal Foundation Trust, Manchester, UK
| | | | - Tim Williams
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | | | - Roger Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
18
|
Murray D, Rooney J, Al-Chalabi A, Bunte T, Chiwera T, Choudhury M, Chio A, Fenton L, Fortune J, Maidment L, Manera U, Mcdermott C, Meldrum D, Meyjes M, Tattersall R, Torrieri MC, Van Damme P, Vanderlinden E, Wood C, Van Den Berg LH, Hardiman O. Correlations between measures of ALS respiratory function: is there an alternative to FVC? Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:495-504. [PMID: 34590504 DOI: 10.1080/21678421.2021.1908362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: An ongoing longitudinal study in six European sites includes a 3-monthly assessment of forced vital capacity (FVC), slow vital capacity (SVC), peak cough flow (PCF), and Sniff nasal inspiratory pressure (SNIP). The aim of this interim analysis was to assess the potential for SNIP to be a surrogate for aerosol generating procedures given COVID-19 related restrictions. Methods: This was a prospective observational study. Patients attending six study sites with King's Stage 2 or 3 ALS completed baseline FVC/SVC/SNIP/PCF and repeated assessments 3 monthly. Data were collected from March 2018 to March 2020, after which a COVID-19 related study suspension was imposed. Correlations between the measures were calculated. A Bayesian multiple outcomes random-effects model was constructed to investigate rates of decline across measures. Results: In total, 270 cases and 828 assessments were included (Mean age 65.2 ± 15.4 years; 32.6% Female; 60% Kings stage 2; 81.1% spinal onset). FVC and SVC were the most closely correlated outcomes (0.95). SNIP showed the least correlation with other metrics 0.53 (FVC), 0.54 (SVC), 0.60 (PCF). All four measures significantly declined over time. SNIP in the bulbar onset group showed the fastest rate of decline. Discussion: SNIP was not well correlated with FVC and SVC, probably because it examines a different aspect of respiratory function. Respiratory measures declined over time, but differentially according to the site of onset. SNIP is not a surrogate for FVC and SVC, but is a complementary measure, declining linearly and differentiating spinal and bulbar onset patients.
Collapse
Affiliation(s)
- Deirdre Murray
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
| | - James Rooney
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Amar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Tommy Bunte
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theresa Chiwera
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Mutahhara Choudhury
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Adriano Chio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, Azienda Ospedale Università Città della Salute e della Scienza, Turin, Italy
| | - Lauren Fenton
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Jennifer Fortune
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Lindsay Maidment
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Umberto Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Chris Mcdermott
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Dara Meldrum
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Myrte Meyjes
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel Tattersall
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
| | - Maria Claudia Torrieri
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Philip Van Damme
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and.,KU Leuven, Department of Neuroscience, Leuven Brain Institute and VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Elien Vanderlinden
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and
| | - Claire Wood
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
19
|
Chiò A, Canosa A, Calvo A, Moglia C, Cicolin A, Mora G. Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:1419-1440. [PMID: 34554894 DOI: 10.1080/14737175.2021.1984883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The burden of non-motor symptoms is a major determinant of quality of life and outcome in amyotrophic lateral sclerosis (ALS) and has profound negative effect also on caregivers. AREAS COVERED Non-motor symptoms in ALS include cognitive impairment, neurobehavioral symptoms, depression and anxiety, suicidal ideation, pain, disordered sleep, fatigue, weight loss and reduced appetite, and autonomic dysfunctions. This review summarizes the measures used for the assessment of non-motor symptoms and their properties and recaps the frequency and progression of these symptoms along the course of ALS. EXPERT OPINION Non-motor symptoms in ALS represent a major component of the disease and span over several domains. These symptoms require a high level of medical attention and should be checked at each visit using ad hoc questionnaires and proactively treated. Several instruments assessing non-motor symptoms have been used in ALS. Specific screening questionnaires for non-motor symptoms can be used for monitoring patients during telehealth visits and for remote surveillance through sensors and apps installed on smartphones. Novel trials for non-motor symptoms treatment specifically designed for ALS are necessary to increase and refine the therapeutic armamentarium. Finally, scales assessing the most frequent and burdensome non-motor symptoms should be included in clinical trials.
Collapse
Affiliation(s)
- Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Alessandro Cicolin
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Sleep Medicine Center, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Gabriele Mora
- Neurorehabilitation Department, Ics Maugeri Irccs, Institute of Milan, Milan, Italy
| |
Collapse
|
20
|
Young C, Pinto S, Grosskreutz J, Hardiman O, Clawson LL, Cudkowicz ME, Andrews JA. Medical therapies for amyotrophic lateral sclerosis-related respiratory decline: an appraisal of needs, opportunities and obstacles. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:66-75. [PMID: 34392765 DOI: 10.1080/21678421.2021.1920981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A roundtable convened in July 2020 examined issues concerning respiratory support in amyotrophic lateral sclerosis (ALS), with reference to the potential for an early-phase orally administered medication that might either postpone the introduction of noninvasive ventilation (NIV) and/or enhance the benefits to be gained from it. Attention was also given to the impact of the COVID-19 pandemic on usual practice in the assessment and management of ALS-related respiratory difficulties. Implementation of NIV marks a step-change in clinical status for patients and a major increase in burden for caregivers. All means to ease this transition should be explored: an oral therapy that supported respiratory function and patients' independence and sense of well-being would aid discussions to facilitate the eventual successful introduction of NIV. Assessment of a candidate oral therapy that might support respiratory function in ALS patients would be aided by the development of improved patient-reported outcome measures for robust quantification of treatment effect and quality of life. Such instruments could also be used to monitor patients' status during the COVID-19 pandemic, averting some of the risks of face-to-face assessment plus the patient burden and costs of traditional methods. Several oral candidate therapies have recently failed to meet their primary endpoints in clinical trials. However, understanding of the underlying physiology and appropriate trial design have grown and will inform future developments in this field.
Collapse
Affiliation(s)
- Carolyn Young
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Susana Pinto
- Translational and Clinical Physiology Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | | | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Lora L Clawson
- Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore, MD , USA
| | | | - Jinsy A Andrews
- Neurological Institute of New York, Columbia University, New York, NY, USA
| |
Collapse
|
21
|
Benbrika S, Doidy F, Carluer L, Mondou A, Pélerin A, Eustache F, Viader F, Desgranges B. Longitudinal Study of Cognitive and Emotional Alterations in Amyotrophic Lateral Sclerosis: Clinical and Imaging Data. Front Neurol 2021; 12:620198. [PMID: 34305771 PMCID: PMC8296637 DOI: 10.3389/fneur.2021.620198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Extra-motor manifestations occur in 50% of patients with amyotrophic lateral sclerosis (ALS). These mainly concern cognition, emotional processing and behavior. Depression and anxiety are less frequent. Little is known about how these manifestations change as the disease progresses. Similarly, although cortical thinning has been well-documented at disease onset, there are scant data about cortical thinning over time and how this correlates with extra-motor manifestations. The present study therefore assessed cognitive, emotional and psychological state and cortical thinning in a group of patients with ALS at baseline and after a follow-up period. Methods: We assessed executive functions, facial emotion recognition, depressive and anxious symptoms, and cortical thinning in 43 patients with ALS at baseline, comparing them with 28 healthy controls, and 21 of them 9 months later. We looked for links among the extra-motor manifestations and correlations with cortical thickness. Results: At baseline, patients had poor executive function and recognition of complex emotions from the eyes, and more anxious and depressive symptoms than controls. At follow-up, only inhibition abilities had worsened. Cortical thinning was observed in bilateral pre-central regions and other parts of the cerebral cortex at baseline. Over time, it worsened in motor and extra-motor areas. Executive functions correlated with thinning in the middle and inferior frontal gyrus and orbitofrontal cortex. Conclusions: During follow-up, there was little deterioration in extra-motor manifestations and psychological state, despite continuing cortical thinning. Patients with affective Theory of Mind (ToM) changes seemed less depressed than the others. Impaired mental flexibility was subtended by prefrontal regions with cortical thinning.
Collapse
Affiliation(s)
- Soumia Benbrika
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Franck Doidy
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Laurence Carluer
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Audrey Mondou
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Alice Pélerin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Béatrice Desgranges
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| |
Collapse
|
22
|
de Almeida FEO, do Carmo Santana AK, de Carvalho FO. Multidisciplinary care in Amyotrophic Lateral Sclerosis: a systematic review and meta-analysis. Neurol Sci 2021; 42:911-923. [PMID: 33443670 DOI: 10.1007/s10072-020-05011-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) has been the most recommended approach for symptom management in amyotrophic lateral sclerosis (ALS) but there is conflicting evidence about its effectiveness on survival and quality of life (QoL) of ALS patients. We conducted a systematic review to determine the effects of multidisciplinary care compared to general neurological care in survival and quality of life of ALS patients. A comprehensive literature search using Scopus, MEDLINE-PubMed, Cochrane, Web of Science, PEDro, and Science Direct was undertaken. Studies related to multidisciplinary care or general neurological care in ALS patients that assessed survival and quality of life and were published in the period up to and including January 2020 were included. A total of 1192 studies were initially identified, but only 6 were included. All studies that investigated survival showed and advantage of MDC over NC, and this benefit was even greater for bulbar onset patients. A meta-analysis was performed and showed a mean difference of 141.67 (CI 95%, 61.48 to 221.86), indicating that patients who received MDC had longer survival than those who underwent NC (p = 0.0005). Concerning QoL, only one study found better mental health scores related to QoL for patients under MDC. Multidisciplinary care is more effective than general neurology care at improving survival of patients with ALS, but only improves mental health outcomes related to quality of life of these patients.
Collapse
Affiliation(s)
| | | | - Fernanda Oliveira de Carvalho
- Sergipe University Hospital of Universidade Federal de Sergipe-UFS, Aracaju, SE, Brazil. .,Health Sciences Graduate Center of Universidade Federal de Sergipe-UFS, São Cristóvão, SE, 49100-000, Brazil.
| |
Collapse
|
23
|
Simpson S, Smith S, Furlong M, Ireland J, Giebel C. Supporting access to activities to enhance well-being and reduce social isolation in people living with motor neurone disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2282-2289. [PMID: 32483867 DOI: 10.1111/hsc.13049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE People living with Motor Neurone Disease (plwMND) have emphasised the importance of psychological support and well-being in helping them manage their condition. Social prescribing is a formal process of referring patients with largely socioeconomic and psychosocial issues to a link worker to co-design a plan to improve their health and well-being. Intervention involves supporting engagement in meaningful activities based within the individual's local community. This pilot project aimed to explore the application of social prescribing with plwMND. METHODS A cohort of plwMND were supported by an occupational therapist and link worker to identify and access community-based activities. Qualitative interviews were completed post-intervention with the plwMND and the link workers. Findings were analysed using thematic analysis. RESULTS A total of nine plwMND took part in this pilot service, and five plwMND and four link workers were interviewed. PlwMND valued participation and wanted to engage in community-based activities. Those with mild symptomatology were able to access activities and reported a positive impact on their well-being. Those with more complex needs, particularly reduced mobility, experienced significant barriers to participation. Barriers included transport, equipment provision, lack of company to support participation and lack of confidence using mobility aids in a community environment. Link workers valued joint working with an occupational therapist. CONCLUSION Social prescribing aims to address the health inequalities of those living with long-term conditions, although currently it likely excludes plwMND. Future work needs to quantitatively evaluate the effects of the service on the well-being of plwMND.
Collapse
Affiliation(s)
- Suzanne Simpson
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Moira Furlong
- NIHR ARC NWC, Liverpool, UK
- MND Association, Liverpool, UK
| | - Janet Ireland
- NIHR ARC NWC, Liverpool, UK
- The Brain Charity, Liverpool, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| |
Collapse
|
24
|
Brizzi KT, Bridges JFP, Yersak J, Balas C, Thakur N, Galvin M, Hardiman O, Heatwole C, Ravits J, Simmons Z, Bruijn L, Chan J, Bedlack R, Berry JD. Understanding the needs of people with ALS: a national survey of patients and caregivers. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:355-363. [DOI: 10.1080/21678421.2020.1760889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kate T. Brizzi
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Chad Heatwole
- Medical Center, University of Rochester, Rochester, NY, USA,
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, CA, USA,
| | | | - Lucie Bruijn
- Translational Medicine, EMEA, AVeXis, London, UK,
| | - James Chan
- Center for Biostatistics, Massachusetts General Hospital, Boston, MA, USA,
| | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
| |
Collapse
|
25
|
Edge R, Mills R, Tennant A, Diggle PJ, Young CA. Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature. J Neurol 2020; 267:607-615. [PMID: 31696295 PMCID: PMC7035222 DOI: 10.1007/s00415-019-09615-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The importance of elucidating the relationships between pain, mood and quality of life (QoL) amongst people with amyotrophic lateral sclerosis/motor neuron disease is evident to clinicians, yet the literature is limited and inconsistent. We explored the relationships between pain, depression, anxiety and QoL to reconcile the previous contrasting findings and inform future research and clinical practice. METHODS Patient-reported outcomes were obtained as part of the Trajectories of Outcomes in Neurological Conditions study. Mood and QoL scales underwent Rasch analysis. Correlation coefficients examined the strength of association between variables of interest. A bivariate regression model was developed to examine the effects of pain, depression and anxiety on joint psychological and physical QoL domains. RESULTS Of 636 people with ALS, 69% reported pain, of these most had mild pain. Seven percent (7%) of participants exceeded published cutoffs for probable depression and 14% had probable anxiety. Pain, depression and anxiety all influence quality of life; depression has a significant effect on both physical and psychological domains of QoL, whereas pain affects physical QoL and anxiety psychological QoL. CONCLUSIONS These results show the importance of expressing quality of life in a conceptually appropriate way, as failing to take account of the multidimensional nature of QoL can result in important nuances being overlooked. Clinicians must be aware that pain, depression and anxiety all worsen QoL across their ranges, and not just when pain is severe or when anxiety or depression reach case level.
Collapse
Affiliation(s)
- Rhiannon Edge
- Lancaster Medical School, Lancaster University, B38 Furness Building, Bailrigg, Lancaster, UK, LA1 4YW.
| | - Roger Mills
- Walton Centre NHS Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Alan Tennant
- Emeritus Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter J Diggle
- Lancaster Medical School, Lancaster University, B38 Furness Building, Bailrigg, Lancaster, UK, LA1 4YW
| | - Carolyn A Young
- Walton Centre NHS Trust, Lower Lane, Liverpool, L9 7LJ, UK
- University of Liverpool, Liverpool, L69 3BX, UK
| |
Collapse
|
26
|
Ferri A, Lanfranconi F, Corna G, Bonazzi R, Marchese S, Magnoni A, Tremolizzo L. Tailored Exercise Training Counteracts Muscle Disuse and Attenuates Reductions in Physical Function in Individuals With Amyotrophic Lateral Sclerosis. Front Physiol 2019; 10:1537. [PMID: 31920728 PMCID: PMC6939659 DOI: 10.3389/fphys.2019.01537] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by the progressive loss of motor neurons, which leads to a reduction in strength and exercise capacity. Although the concept of “Exercise is Medicine” is accepted for many diseases, the role of exercise in individuals with ALS is still debated. The aim of this study was to propose a tailored exercise training program that was both safe and effective for individuals with ALS, and to evaluate the effects of this combined, moderate-intensity, aerobic and strength training program on aerobic capacities, strength, and physical function. Sixteen individuals with ALS were randomly assigned to either a training (three times a week for 12 weeks; TRAIN, n = 8) or usual care (continued their usual standard of care and served as control; UC, n = 8) group. Peak power, peak oxygen uptake, as well as the gas exchange threshold (GET) during a cardiopulmonary exercise test (CPET) on a cycle ergometer, and the maximal strength (1RM) of the knee extensor muscles, were evaluated before and after 12 weeks. Participants also performed the “Timed Up and Go” (TUG) and the “6-min walking” (6MWT) tests. The ALS Functional Rating Scale revisited (ALSFRS-R), the ALS Severity Scale (ALS-SS), and the McGill quality of life (QoL) questionnaire were also measured. The GET increased from 0.94 ± 0.08 to 1.06 ± 0.10 L min–1 in TRAIN (p = 0.009) and decreased from 0.79 ± 0.17 to 0.72 ± 0.17 L min–1 in UC (p = 0.001). There was a significant difference between groups for changes in TUG (9.1 ± 5.5% improvement in TRAIN and 56.8 ± 18.5% worsening in UC, p = 0.002), ALSFRS-R (4.7 ± 2.6% decrease in TRAIN and 23.0 ± 5.6% decrease in UC, p = 0.007), and for the ALS-SS (2.2 ± 2.1% decrease in TRAIN and 12.4 ± 4.4% decrease in UC, p = 0.04). Even if the 1RM of the knee-extensor muscles showed a tendency to increase in TRAIN (70.1 ± 30.0%, p = 0.07), there was not a statistically significant difference (p = 0.57) with respect to the changes in the UC group (44.9 ± 20.7% increase, p = 0.11). This study showed that a combined moderate-intensity aerobic and strength training program, tailored to the physical capacities of each individual, can improve aerobic fitness and maintain physical function in individuals with ALS.
Collapse
Affiliation(s)
- Alessandra Ferri
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Francesca Lanfranconi
- Foundation Monza and Brianza for the Mother and Her Child, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Corna
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Riccardo Bonazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Andrea Magnoni
- Resting Home "San Pietro," Cooperativa La Meridiana, Monza, Italy
| | - Lucio Tremolizzo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Neurology Unit, San Gerardo Hospital, Monza, Italy
| |
Collapse
|