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Krajewski E, Lee J, Viswanathan N, Olmstead A, Simmons Z. The Effects of Interactive Context on Acoustic Characteristics of Speech in People With Dysarthria: A Preliminary Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1952-1964. [PMID: 38809826 DOI: 10.1044/2024_ajslp-23-00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The current study compared temporal and spectral acoustic contrast between vowel segments produced by speakers with dysarthria across three speech tasks-interactive, solo habitual, and solo clear. METHOD Nine speakers with dysarthria secondary to amyotrophic lateral sclerosis participated in the study. Each speaker was paired with a typical interlocutor over videoconferencing software. The speakers produced the vowels /i, ɪ, ɛ, æ/ in /h/-vowel-/d/ words. For the solo tasks, speakers read the stimuli aloud in both their habitual and clear speaking styles. For the interactive task, speakers produced a target stimulus for their interlocutor to select among the four possibilities. We measured the duration difference between long and short vowels, as well as the F1/F2 Euclidean distance between adjacent vowels, and also determined how well the vowels could be classified based on their acoustic characteristics. RESULTS Temporal contrast between long and short vowels was higher in the interactive task than in both solo tasks. Spectral distance between adjacent vowel pairs was also higher for some pairs in the interactive task than the habitual speech task. Finally, vowel classification accuracy was highest in the interactive task. CONCLUSIONS Overall, we found evidence that individuals with dysarthria produced vowels with greater acoustic contrast in structured interactions than they did in solo tasks. Furthermore, the speech adjustments they made to the vowel segments differed from those observed in solo speech.
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Affiliation(s)
- Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Navin Viswanathan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Anne Olmstead
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Zachary Simmons
- Departments of Neurology and Humanities, The Pennsylvania State University College of Medicine, Hershey
- Penn State Hershey ALS Clinic and Research Center
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Stenson K, Fecteau TE, O'Callaghan L, Bryden P, Mellor J, Wright J, Earl L, Thomas O, Iqbal H, Barlow S, Parvanta S. Health-related quality of life across disease stages in patients with amyotrophic lateral sclerosis: results from a real-world survey. J Neurol 2024; 271:2390-2404. [PMID: 38200398 PMCID: PMC11055770 DOI: 10.1007/s00415-023-12141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is characterized by a rapid disease course, with disease severity being associated with declining health-related quality of life (HRQoL) in persons living with ALS (pALS). The main objective of this study was to assess the impact of disease progression on HRQoL across King's, Milano-Torino Staging (MiToS), and physician-judgement clinical staging. Additionally, we evaluated the impact of the disease on the HRQoL of care partners (cALS). METHODS Data were sourced from the Adelphi ALS Disease Specific Programme (DSP)™, a cross-sectional survey of neurologists, pALS and cALS presenting in a real-world clinical setting between July 2020 and March 2021 in Europe and the United States. RESULTS Neurologists (n = 142) provided data for 880 pALS. There were significant negative correlations between all three clinical staging systems and EuroQol (European Quality of Life) Five Dimension Five Level Scale (EQ-5D-5L) utility scores and visual analogue scale (VAS) ratings. Although not all differences were significant, 5-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5) scores showed a stepwise increase in HRQoL impairment at each stage of the disease regardless of the staging system. At later stages, high levels of fatigue and substantial activity impairment were reported. As pALS disease states progressed, cALS also experienced a decline in HRQoL and increased burden. CONCLUSIONS Across outcomes, pALS and cALS generally reported worse outcomes at later stages of the disease, highlighting an unmet need in this population for strategies to maximise QoL despite disease progression. Recognition and treatment of symptoms such as pain and fatigue may lead to improved outcomes for pALS and cALS.
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Affiliation(s)
| | | | - L O'Callaghan
- Biogen, Cambridge, MA, USA
- Sage Therapeutics, Boston, MA, USA
| | | | - J Mellor
- Adelphi Real World, Bollington, UK
| | - J Wright
- Adelphi Real World, Bollington, UK
| | - L Earl
- Adelphi Real World, Bollington, UK
| | - O Thomas
- Adelphi Real World, Bollington, UK
| | - H Iqbal
- Adelphi Real World, Bollington, UK
| | - S Barlow
- Adelphi Real World, Bollington, UK
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Washington KT, Mechling CA, Pitzer KA, Maiser S, Mehta AK. Identifying the Unmet Needs of People Living With Amyotrophic Lateral Sclerosis: A National Survey to Inform Interdisciplinary Palliative Care. Am J Hosp Palliat Care 2024:10499091241248653. [PMID: 38657132 DOI: 10.1177/10499091241248653] [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: 04/26/2024] Open
Abstract
Introduction/Aims: This national survey builds on previous qualitative research examining potential palliative care needs among people living with ALS (pALS) by quantifying and investigating relationships among pALS' stage of illness progression; physical, emotional, social, spiritual, and intimacy-related concerns; advance care planning behaviors; perceptions of feeling heard and understood by healthcare providers; and overall quality of life. Methods: Researchers partnered with national organizations to recruit pALS to participate in a one-time survey comprising items from validated instruments (eg, the ALS Specific Quality of Life Instrument-Revised) and researcher-generated measures. Data were analyzed using logistic and linear regression. Results: Among pALS (n = 112), many respondents indicated they had discussed their wishes for end-of-life care with family or friends, shared their wishes with providers, and documented their wishes in writing (79.5%, 49.1%, and 63.4%, respectively). Mean (M) quality of life scores were moderate (M ≈ 6 of 10). Illness stage was associated with documentation of end-of-life care wishes but not with having discussed these wishes with others or with overall quality of life. Reported emotional intimacy received was comparable to that desired (difference = .01 of 10); however, a greater desire for physical intimacy relative to that received was indicated (difference = 1.75 of 10). Discussion: Interdisciplinary palliative care teams may enhance ALS care by promoting advance care planning behaviors (particularly discussing one's wishes with healthcare providers), providing interventions to improve quality of life, and supporting pALS in navigating challenges related to physical intimacy.
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Affiliation(s)
- Karla T Washington
- Division of Palliative Medicine, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Charlton A Mechling
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kyle A Pitzer
- Division of Palliative Medicine, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Samuel Maiser
- Department of Neurology and Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Neurology and Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ambereen K Mehta
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Shah NM, Steier J, Hart N, Kaltsakas G. Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure. Thorax 2024; 79:281-288. [PMID: 37979970 DOI: 10.1136/thorax-2023-220035] [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: 05/28/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
Chronic respiratory disease can exacerbate the normal physiological changes in ventilation observed in healthy individuals during sleep, leading to sleep-disordered breathing, nocturnal hypoventilation, sleep disruption and chronic respiratory failure. Therefore, patients with obesity, slowly and rapidly progressive neuromuscular disease and chronic obstructive airways disease report poor sleep quality. Non-invasive ventilation (NIV) is a complex intervention used to treat sleep-disordered breathing and nocturnal hypoventilation with overnight physiological studies demonstrating improvement in sleep-disordered breathing and nocturnal hypoventilation, and clinical trials demonstrating improved outcomes for patients. However, the impact on subjective and objective sleep quality is dependent on the tools used to measure sleep quality and the patient population. As home NIV becomes more commonly used, there is a need to conduct studies focused on sleep quality, and the relationship between sleep quality and health-related quality of life, in all patient groups, in order to allow the clinician to provide clear patient-centred information.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Joerg Steier
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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5
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Hamad AA, Amer BE, Abbas NB, Alnajjar AZ, Meshref M. Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis. Neurol Sci 2024; 45:485-493. [PMID: 37837507 PMCID: PMC10791750 DOI: 10.1007/s10072-023-07119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). METHODS Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. RESULTS Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. CONCLUSION Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.
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Affiliation(s)
| | | | | | - Asmaa Zakria Alnajjar
- Faculty of Medicine, Al-Azhar University, Gaza, Palestine
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
| | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Hardy CJD, Taylor‐Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for semantic and non-fluent/agrammatic variants of primary progressive aphasia. Alzheimers Dement 2024; 20:195-210. [PMID: 37548125 PMCID: PMC10917001 DOI: 10.1002/alz.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Here we set out to create a symptom-led staging system for the canonical semantic and non-fluent/agrammatic variants of primary progressive aphasia (PPA), which present unique diagnostic and management challenges not well captured by functional scales developed for Alzheimer's disease and other dementias. METHODS An international PPA caregiver cohort was surveyed on symptom development under six provisional clinical stages and feedback was analyzed using a mixed-methods sequential explanatory design. RESULTS Both PPA syndromes were characterized by initial communication dysfunction and non-verbal behavioral changes, with increasing syndromic convergence and functional dependency at later stages. Milestone symptoms were distilled to create a prototypical progression and severity scale of functional impairment: the PPA Progression Planning Aid ("PPA-Squared"). DISCUSSION This work introduces a symptom-led staging scheme and functional scale for semantic and non-fluent/agrammatic variants of PPA. Our findings have implications for diagnostic and care pathway guidelines, trial design, and personalized prognosis and treatment for PPA. HIGHLIGHTS We introduce new symptom-led perspectives on primary progressive aphasia (PPA). The focus is on non-fluent/agrammatic (nfvPPA) and semantic (svPPA) variants. Foregrounding of early and non-verbal features of PPA and clinical trajectories is featured. We introduce a symptom-led staging scheme for PPA. We propose a prototype for a functional impairment scale, the PPA Progression Planning Aid.
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Affiliation(s)
- Chris J. D. Hardy
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Cathleen Taylor‐Rubin
- Uniting War Memorial HospitalSydneyAustralia
- Faculty of MedicineHealth and Human SciencesMacquarie UniversitySydneyAustralia
| | - Beatrice Taylor
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Emma Harding
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | - Jessica Jiang
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Division of NeurologyDepartment of Internal MedicineKing Chulalongkorn Memorial HospitalBangkokThailand
- Cognitive Clinical and Computational Neuroscience Research UnitFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Suzie Barker
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Emilie Brotherhood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Claire Waddington
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Olivia Wood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nikki Zimmermann
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Paul M. Camic
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Joshua Stott
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- ADAPT LabResearch Department of ClinicalEducational and Health PsychologyUCLLondonUK
| | | | - Neil P. Oxtoby
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Jonathan D. Rohrer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Anna Volkmer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Psychology and Language Sciences (PALS)UCLLondonUK
| | | | - Jason D. Warren
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
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7
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Gutz SE, Maffei MF, Green JR. Feedback From Automatic Speech Recognition to Elicit Clear Speech in Healthy Speakers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2940-2959. [PMID: 37824377 PMCID: PMC10721250 DOI: 10.1044/2023_ajslp-23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/10/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study assessed the effectiveness of feedback generated by automatic speech recognition (ASR) for eliciting clear speech from young, healthy individuals. As a preliminary step toward exploring a novel method for eliciting clear speech in patients with dysarthria, we investigated the effects of ASR feedback in healthy controls. If successful, ASR feedback has the potential to facilitate independent, at-home clear speech practice. METHOD Twenty-three healthy control speakers (ages 23-40 years) read sentences aloud in three speaking modes: Habitual, Clear (over-enunciated), and in response to ASR feedback (ASR). In the ASR condition, we used Mozilla DeepSpeech to transcribe speech samples and provide participants with a value indicating the accuracy of the ASR's transcription. For speakers who achieved sufficiently high ASR accuracy, noise was added to their speech at a participant-specific signal-to-noise ratio to ensure that each participant had to over-enunciate to achieve high ASR accuracy. RESULTS Compared to habitual speech, speech produced in the ASR and Clear conditions was clearer, as rated by speech-language pathologists, and more intelligible, per speech-language pathologist transcriptions. Speech in the Clear and ASR conditions aligned on several acoustic measures, particularly those associated with increased vowel distinctiveness and decreased speaking rate. However, ASR accuracy, intelligibility, and clarity were each correlated with different speech features, which may have implications for how people change their speech for ASR feedback. CONCLUSIONS ASR successfully elicited outcomes similar to clear speech in healthy speakers. Future work should investigate its efficacy in eliciting clear speech in people with dysarthria.
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Affiliation(s)
- Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
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Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
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Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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9
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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.
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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
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Kvam KA, Benatar M, Brownlee A, Caller T, Das RR, Green P, Kolodziejczak S, Russo J, Sanders D, Sethi N, Stavros K, Stierwalt J, Giles Walters N, Bennett A, Wessels SR, Brooks BR. Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology. Neurology 2023; 101:223-232. [PMID: 37524529 PMCID: PMC10401684 DOI: 10.1212/wnl.0000000000207166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/24/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Kathryn A Kvam
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Michael Benatar
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Alisa Brownlee
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Tracie Caller
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Rohit R Das
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Phil Green
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Sherry Kolodziejczak
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - John Russo
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Danica Sanders
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nadia Sethi
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Kara Stavros
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Julie Stierwalt
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nancy Giles Walters
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Amy Bennett
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Scott R Wessels
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Benjamin Rix Brooks
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
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11
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Hardy CJD, Taylor-Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for primary progressive aphasia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23286972. [PMID: 36993460 PMCID: PMC10055437 DOI: 10.1101/2023.03.13.23286972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The primary progressive aphasias (PPA) present complex and diverse challenges of diagnosis, management and prognosis. A clinically-informed, syndromic staging system for PPA would take a substantial step toward meeting these challenges. This study addressed this need using detailed, multi-domain mixed-methods symptom surveys of people with lived experience in a large international PPA cohort. We administered structured online surveys to caregivers of patients with a canonical PPA syndromic variant (nonfluent/agrammatic (nvPPA), semantic (svPPA) or logopenic (lvPPA)). In an 'exploratory' survey, a putative list and ordering of verbal communication and nonverbal functioning (nonverbal thinking, conduct and wellbeing, physical) symptoms was administered to 118 caregiver members of the UK national PPA Support Group. Based on feedback, we expanded the symptom list and created six provisional clinical stages for each PPA subtype. In a 'consolidation' survey, these stages were presented to 110 caregiver members of UK and Australian PPA Support Groups, and refined based on quantitative and qualitative feedback. Symptoms were retained if rated as 'present' by a majority (at least 50%) of respondents representing that PPA syndrome, and assigned to a consolidated stage based on majority consensus; the confidence of assignment was estimated for each symptom as the proportion of respondents in agreement with the final staging for that symptom. Qualitative responses were analysed using framework analysis. For each PPA syndrome, six stages ranging from 1 ('Very mild') to 6 ('Profound') were identified; earliest stages were distinguished by syndromic hallmark symptoms of communication dysfunction, with increasing trans-syndromic convergence and dependency for basic activities of daily living at later stages. Spelling errors, hearing changes and nonverbal behavioural features were reported at early stages in all syndromes. As the illness evolved, swallowing and mobility problems were reported earlier in nfvPPA than other syndromes, while difficulty recognising familiar people and household items characterised svPPA and visuospatial symptoms were more prominent in lvPPA. Overall confidence of symptom staging was higher for svPPA than other syndromes. Across syndromes, functional milestones were identified as key deficits that predict the sequence of major daily life impacts and associated management needs. Qualitatively, we identified five major themes encompassing 15 subthemes capturing respondents' experiences of PPA and suggestions for staging implementation. This work introduces a prototypical, symptom-led staging scheme for canonical PPA syndromes: the PPA Progression Planning Aid (PPA 2 ). Our findings have implications for diagnostic and care pathway guidelines, trial design and personalised prognosis and treatment for people living with these diseases.
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Affiliation(s)
- Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Cathleen Taylor-Rubin
- Uniting War Memorial Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Beatrice Taylor
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Keir XX Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Josh Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- ADAPTlab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Anna Volkmer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Psychology and Language Sciences (PALS), UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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12
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Tülek Z, Özakgül A, Alankaya N, Dik A, Kaya A, Ünalan PC, Özaydin AN, İdrisoğlu HA. Care burden and related factors among informal caregivers of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:125-132. [PMID: 35652417 DOI: 10.1080/21678421.2022.2079993] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) affects the life of the family caregiver as well as the patient. This study aimed to determine the care burden and related factors among family caregivers of Turkish ALS patients. Methods: This descriptive study was conducted with 108 ALS patients and their informal caregivers through face-to-face interviews at home. The data were collected using the ALS Functional Rating Scale, Zarit Burden Interview, European Quality of Life-Five Dimensions Questionnaire, Multidimensional Scale of Perceived Social Support, and the Hospital Anxiety and Depression Scale. Results: The mean age of the caregivers was 48.1 ± 13.4 years; the vast majority were female, and they were either spouses or children of the patients. While 49.1% reported moderate or severe burden, the quality of life was moderate (mean 70.4 ± 22.8). The caregiver burden was related to sex and the functional state of the patient, as well as caregiver factors such as the relation to the patient, sex, health status, time spent for care, and living in the same house with a limited environment. Walking ability, percutaneous endoscopic gastrostomy, tracheostomy, and communication problems were not associated with the burden. Furthermore, burden was associated with the caregiver's quality of life, social support, anxiety, and depression. Conclusions: The present study draws attention to the fact that the care burden in family caregivers of ALS patients is high and their quality of life is impaired. Our findings reveal that not only ALS patients but also caregivers need to be supported with an organized and planned system.
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Affiliation(s)
- Zeliha Tülek
- Department of Medical Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aylin Özakgül
- Department of Fundamentals of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naile Alankaya
- Department of Nursing, Faculty of Health Sciences, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Aynur Dik
- National Association for Home Care, Istanbul, Turkey
| | - Alper Kaya
- National ALS-MND Association, Izmir Chapter, Turkey
| | - Pemra C Ünalan
- Department of Family Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ayşe Nilüfer Özaydin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey, and
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13
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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14
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Hashimoto M, Manabe Y, Yamaguchi T, Toya S, Ikeda M. Treatment needs of dementia with Lewy bodies according to patients, caregivers, and physicians: a cross-sectional, observational, questionnaire-based study in Japan. Alzheimers Res Ther 2022; 14:188. [PMID: 36522749 PMCID: PMC9751509 DOI: 10.1186/s13195-022-01130-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Understanding the treatment needs of patients with dementia with Lewy bodies (DLB) is essential to develop treatment strategies. We examined the treatment needs of patients with DLB and their caregivers and the extent to which the attending physicians understand these treatment needs. METHODS This was a cross-sectional, observational study conducted using questionnaires for patients, caregivers, and physicians. The study participants included patients, their caregivers, and their attending physicians who were experts in DLB. Fifty-two symptoms that are frequent and clinically important in DLB were pre-selected and classified into seven symptom domains. Treatment needs of patients and caregivers were defined as "symptom that causes them most distress," and the frequency of each answer was tabulated. To assess the physician's understanding of the treatment needs of patients and caregivers, patient-physician and caregiver-physician concordance rates for each answer regarding treatment needs were calculated according to symptom domains. RESULTS In total, 263 pairs of patients-caregivers and 38 physicians were surveyed. The mean age of patients was 79.3 years, and their mean total score on the Mini-Mental State Examination was 20.9. Thirty-five and 38 symptoms were selected as symptoms causing patients and caregivers most distress, respectively. Memory impairment was most frequently selected for the treatment needs of patients, followed by constipation and bradykinesia. Memory impairment was also most frequently selected by caregivers, followed by visual hallucinations. For the symptom domain that causes patients or caregivers most distress, only about half of the patient-physician pairs (46.9%) and caregiver-physician pairs (50.8%) were matched. Logistic regression analysis identified that concordance rates for treatment needs between patient-physician and caregiver-physician were lower when autonomic dysfunction and sleep-related disorders were selected as the symptom domains that cause most distress. CONCLUSION There was considerable variability in the treatment needs of patients with DLB and their caregivers. Attending physicians had difficulty understanding the top treatment needs of their patients and caregivers, despite their expertise in DLB, because of various clinical manifestations. Attending physicians should pay more attention to autonomic dysfunction and sleep-related disorders in the treatment of DLB. TRIAL REGISTRATION UMIN Clinical Trials Registry, UMIN000041844. Registered on 23 September 2020.
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Affiliation(s)
- Mamoru Hashimoto
- grid.136593.b0000 0004 0373 3971Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan ,grid.258622.90000 0004 1936 9967Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yuta Manabe
- grid.462431.60000 0001 2156 468XDepartment of Dementia and Geriatric Medicine, Division of Clinical Science, Kanagawa Dental University School of Dentistry, Yokosuka, Japan
| | - Takuhiro Yamaguchi
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Toya
- Medical Affairs, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Manabu Ikeda
- grid.136593.b0000 0004 0373 3971Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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15
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Lian L, Zheng M, He R, Lin J, Chen W, Pei Z, Yao X. Analysing the influencing factors on caregivers' burden among amyotrophic lateral sclerosis patients in China: a cross-sectional study based on data mining. BMJ Open 2022; 12:e066402. [PMID: 36130747 PMCID: PMC9494583 DOI: 10.1136/bmjopen-2022-066402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES There is significant burden on caregivers of patients with amyotrophic lateral sclerosis (ALS). However, only a few studies have focused on caregivers, and traditional research methods have obvious shortcomings in dealing with multiple influencing factors. This study was designed to explore influencing factors on caregiver burden among ALS patients and their caregivers from a new perspective. DESIGN Cross-sectional study. SETTING The data were collected at an affiliated hospital in Guangzhou, Guangdong, China. PARTICIPANTS Fifty-seven pairs of patients with ALS and their caregivers were investigated by standardised questionnaires. MAIN OUTCOME MEASURES This study primarily assessed the influencing factor of caregiver burden including age, gender, education level, economic status, anxiety, depression, social support, fatigue, sleep quality and stage of disease through data mining. Statistical analysis was performed using SPSS 24.0, and least absolute shrinkage and selection operator (LASSO) regression model was established by Python 3.8.1 to minimise the effect of multicollinearity. RESULTS According to LASSO regression model, we found 10 variables had weights. Among them, Milano-Torinos (MITOS) stage (0-1) had the highest weight (-12.235), followed by younger age group (-3.198), lower-educated group (2.136), fatigue (1.687) and social support (-0.455). Variables including sleep quality, anxiety, depression and sex (male) had moderate weights in this model. Economic status (common), economic status (better), household (city), household (village), educational level (high), sex (female), age (older) and MITOS stage (2-4) had a weight of zero. CONCLUSIONS Our study demonstrates that the severity of ALS patients is the most influencing factor in caregiver burden. Caregivers of ALS patients may suffer less from caregiver burden when the patients are less severe, and the caregivers are younger. Low educational status could increase caregiver burden. Caregiver burden is positively correlated with the degree of fatigue and negatively correlated with social support. Hopefully, more attention should be paid to caregivers of ALS, and effective interventions can be developed to relieve this burden.
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Affiliation(s)
- Ling Lian
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Minying Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ruojie He
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Jianing Lin
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Weineng Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Xiaoli Yao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
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16
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Poppe C, Verwey M, Wangmo T. "Walking a tightrope": A grounded theory approach to informal caregiving for amyotrophic lateral sclerosis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1935-e1947. [PMID: 34719073 PMCID: PMC9545073 DOI: 10.1111/hsc.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
Informal caregivers, mainly family members and friends, provide supportive and palliative care for people with amyotrophic lateral sclerosis (ALS) during their terminal disease course. Informal caregiving for people with ALS continues towards palliative care and end-of-life care with the progression of the disease. In this study, we provide a theoretical understanding of informal caregiving in ALS utilising 23 semi-structured interviews conducted with informal caregivers of people with ALS (pwALS) in Switzerland. Due to the expected death of the care recipient, our grounded theory approach outlines informal caregivers' caregiving work as an effort to secure a balance amongst different caregiving activities, which feed into the final stage of providing palliative care. Overall, our theoretical understanding of ALS informal caregiving work encompasses the core category 'holding the balance' and four secondary categories: 'Organising support', 'being present', 'managing everyday life' and 'keeping up with ALS'. The core category of holding the balance underlines the significance of ensuring care and normalcy even as disease progresses and until the end of life. For the informal caregivers, this balancing act is the key element of care provision to pwALS and therefore guides decisions surrounding caregiving. On this understanding, those caregivers that succeed in holding the balance can provide care at home until death. The balance is heavily influenced by contextual factors of caregiving, for example relating to personal characteristics of the caregiver, or activities of caregiving where the goal is to ensure the quality of life of the pwALS. As there is a heterogeneity of speed and subtype of progression of ALS, our work accounts for multiple caregiving trajectories.
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Affiliation(s)
| | - Martine Verwey
- Patient Association ALS Patients ConnectedBilthovenThe Netherlands
| | - Tenzin Wangmo
- Institute for Biomedical EthicsUniversity of BaselBaselSwitzerland
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17
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Fernandes IAM, Menezes ROA, Rego G. EMPATIA: A Guide for Communicating the Diagnosis of Neuromuscular Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9792. [PMID: 36011430 PMCID: PMC9407777 DOI: 10.3390/ijerph19169792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Neuromuscular diseases comprise a heterogeneous group of genetic syndromes that lead to progressive muscle weakness, resulting in functional limitation. There is a gap in the literature regarding the communication of the diagnosis of such diseases, compromising the autonomy of patients and families, besides causing stress on the assistant physician. OBJECTIVES Developing a guide to reduce communication barriers in the diagnosis of neuromuscular diseases. METHODOLOGY Systematic review, after searching the descriptors ("Muscular Diseases" OR "Neuromuscular Diseases") AND ("Truth Disclosure" OR "Bad news communication" OR "Breaking bad News") in the Pubmed, Bireme, and Scopus websites, and these results were analyzed through narrative textual synthesis. RESULTS 16 articles were submitted to the final analysis, giving rise to seven steps to support the communication process. These are Empathy, Message, Prognosis, Reception, Time, Individualization, and Autonomy. DISCUSSION AND CONCLUSION The empathic transmission of the message and the prognosis must accommodate the feelings of the interlocutors with different information needs. In this way, communication planning optimizes the time and individualizes each context, respecting the autonomy of those involved. EMPATIA reflects the bioethical and interdisciplinary analysis of the literature and comes to fill the gap related to the communication of bad news in neuromuscular diseases.
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Affiliation(s)
- Isabella Araujo Mota Fernandes
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- Lauro Wanderley University Hospital, Federal University of Paraíba, Joao Pessoa 58051-900, Brazil
| | | | - Guilhermina Rego
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
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18
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Ronquest NA, Paret K, Lucas A, Ciepielewska M, Hagan M. Quantifying the Value of Introducing an Oral Drug Delivery Option for Edaravone: A Review of Analyses Evaluating the Economic Impact of Oral versus Intravenous Formulations. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:499-511. [PMID: 35923520 PMCID: PMC9342658 DOI: 10.2147/ceor.s359025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Drug formulation and route of administration can have an impact on not only patients’ quality of life and disease outcomes but also costs of care. It is essential for decision makers to use appropriate economic modeling methods to guide drug coverage policies and to support patients’ decision-making. Purpose To illustrate key cost considerations for decision makers in economic evaluation of innovative oral formulations as alternatives to intravenous medication. Materials and Methods A structured literature review was conducted using the PubMed database to examine methods used for quantifying the economic impact of introducing a new oral pharmaceutical formulation as an alternative to intravenous medication. To illustrate the methods described in this review, a cost-minimization analysis was conducted to quantify the impact of introducing an oral formulation of a medication originally developed as an intravenous treatment for amyotrophic lateral sclerosis. Results We identified 14 published evaluations of oral and intravenous formulations from 10 countries across a variety of disease areas. The identified studies used cost-effectiveness (n=10), cost-minimization (n=2), and cost-calculation (n=2) modeling approaches. All but one (13/14) reported outcomes from payers’ perspective, while societal perspectives were also incorporated in 3 of the reviewed evaluations. One study estimated costs from a public hospital’s perspective. Only a subset of the identified studies accounted for the effects of safety (n=6) or efficacy (n=8) differences on treatment costs when estimating the costs of a formulation choice. Many studies that omitted these aspects did not include rationales for their decisions. Conclusion We found significant design variations in published models that estimated the impact of an additional formulation option on the treatment costs to payers and the society. Models need to be accompanied with clear descriptions on rationales for their time horizons and assumptions on how different formulations may affect healthcare costs from the selected perspectives.
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Affiliation(s)
- Naoko A Ronquest
- Health Economics, RTI Health Solutions, Research Triangle Park, Durham, NC, USA
- Correspondence: Naoko A Ronquest, Health Economics, RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA, Tel +1 919 597 5122, Fax +1 919 541 7222, Email
| | - Kyle Paret
- Health Economics, RTI Health Solutions, Research Triangle Park, Durham, NC, USA
| | - Aaron Lucas
- Health Economics, RTI Health Solutions, Research Triangle Park, Durham, NC, USA
| | - Malgorzata Ciepielewska
- Medical Affairs-HEOR/RWE/Publications, Mitsubishi Tanabe Pharma America, Inc, Jersey City, NJ, USA
| | - Melissa Hagan
- Medical Affairs-HEOR/RWE/Publications, Mitsubishi Tanabe Pharma America, Inc, Jersey City, NJ, USA
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19
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Olesen LK, la Cour K, With H, Handberg C. Reflections of family caregivers and health professionals on the everyday challenges of caring for persons with amyotrophic lateral sclerosis and cognitive impairments: a qualitative study. Palliat Care Soc Pract 2022; 16:26323524221077702. [PMID: 35187490 PMCID: PMC8855464 DOI: 10.1177/26323524221077702] [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: 07/03/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
Aims and objectives: To explore reflections of family caregivers and health professionals
regarding the challenges involved in caring for persons with amyotrophic
lateral sclerosis and cognitive and/or behavioral impairments
(PALS/CIs). Background: Family caregivers of PALS/CIs are highly burdened and at great risk of
psychological sequela. Professionals working with these families can be
negatively affected on their well-being and are at risk of burnout. Design: The design was a qualitative interview study. Methods: One focus group and 10 individual semi-structured interviews were conducted
with seven family caregivers and nine professionals after the death of a
PALS/CIs. The analysis was guided by the interpretive description
methodology and the theory of sense of coherence. This study adheres to the
COREQ guidelines and the ICMJE recommendations. Results: The family caregivers’ challenges regarding coping with everyday needs
related to the sick person were associated with ‘Accepting that nothing else
matters’, ‘Adjusting to new roles while balancing’, and ‘Realizing different
values in relationships’; whereas the professionals’ challenges were related
to ‘Collaboration a balancing act’, ‘Working in a home of sorrow’, and
‘Coordinating threads to tie’. Conclusion: Family caregivers found coping with the complexity of the diseases a
challenge, and their everyday life needed constant adjustment to new roles,
coping with inappropriate behavior, and navigating through the progression
of the diseases of their sick relatives while collaborating with numerous
professionals. The professionals struggled with coordinating and
collaborating with the families and with other colleagues due to the
severeness and complexity of diseases. Relevance to clinical practice: Findings point to the importance of relationships for caregivers and
professionals and a need to provide support through an online palliative
rehabilitation program that encompass coping strategies in relation to the
diseases. Trial registration details: Id no. NCT 04638608.
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Affiliation(s)
- Lene Klem Olesen
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Kongsvang Allé 23, 8000 Aarhus, Denmark
| | - Karen la Cour
- Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Heidi With
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
| | - Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
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20
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Caregivers' View of Socio-Medical Care in the Terminal Phase of Amyotrophic Lateral Sclerosis-How Can We Improve Holistic Care in ALS? J Clin Med 2022; 11:jcm11010254. [PMID: 35011995 PMCID: PMC8745628 DOI: 10.3390/jcm11010254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Multidimensional socio-medical care with an early integration of palliative principles is strongly recommended in amyotrophic lateral sclerosis (ALS), but provided inconsistently. We conducted telephone interviews with 49 former caregivers of deceased ALS patients to examine their experience of care in the terminal phase including caregiver burden. Patients who received specialized palliative care (45% of patients) were more likely to die at home (p = 0.004) and without burdening symptoms (p = 0.021). The majority of caregivers (86%) reported deficits in socio-medical care. Most frequently mentioned were problems receiving medical aids (45%) and a lack of caregiver support (35%). A higher level of deficits experienced by caregivers was associated with negative health outcomes on the side of the caregivers (reported by 57% of them; p = 0.002) and stronger caregiver burden (p = 0.004). To provide good quality of dying to patients and reduce the burden on caregivers, multidimensional—including palliative—care in ALS urgently needs to be strengthened in the healthcare structures.
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21
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Poppe C, Iseli LM, Verwey M, Wangmo T. Bereavement and Support Experiences of Informal Caregivers of Persons with Amyotrophic Lateral Sclerosis: A Qualitative Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:63-79. [PMID: 34605373 DOI: 10.1080/15524256.2021.1976352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Informal caregivers provide the major part of care for persons with amyotrophic lateral sclerosis (ALS), a terminal neurodegenerative disease. Apart from providing care, informal caregivers are themselves in need of support to fulfill the task of daily caregiving and to reduce their burden of caregiving. This need for support does not end with the death of the person cared for. In this study, we explore the themes of bereavement and support experience of informal caregivers of persons with ALS from interviews conducted with bereaved informal caregivers (n = 14) in Switzerland. Three key themes were salient in our data: Reacting to bereavement, finding support, and adjusting to life without the person with ALS. These themes are contrasted with themes from interviews (n = 11) with healthcare professionals (nurses, therapists, physicians) who care for patients and families with ALS. The themes described were offering support and identifying gaps in the support. We discuss support after bereavement for informal caregivers of persons with ALS in the established public health model of bereavement support. Bereavement support needs to be proactive from healthcare professionals; however, it requires the goodness of fit to address those in need and not those who are adequately supported by informal sources of support.
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Affiliation(s)
- Christopher Poppe
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Luzia M Iseli
- University Hospital, University of Basel, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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22
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Hertler C, Hundsberger T. [Palliative Care in Neurology]. PRAXIS 2021; 110:897-901. [PMID: 34814720 DOI: 10.1024/1661-8157/a003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Palliative Care in Neurology Abstract. Neurology as a discipline clearly overlaps with palliative care. Nevertheless, an early integration of palliative care accompanying neurological treatment rarely takes place, and there are still misunderstandings with regard to the timing of the inclusion of palliative care and its role beyond pure end-of-life care and hospice care. A further expansion and use of synergies should become an integral part of both disciplines in the coming years, and training should focus on appropriate training, especially for our young medical colleagues.
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Affiliation(s)
- Caroline Hertler
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitässpital Zürich, Zürich
| | - Thomas Hundsberger
- Klinik für Neurologie und Klinik für medizinische Onkologie und Hämatologie, Kantonsspital St. Gallen, St. Gallen
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23
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Gillespie J, Przybylak-Brouillard A, Watt CL. The Palliative Care Information Needs of Patients with Amyotrophic Lateral Sclerosis and their Informal Caregivers: A Scoping Review. J Pain Symptom Manage 2021; 62:848-862. [PMID: 33757892 DOI: 10.1016/j.jpainsymman.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease, associated with impaired quality of life for patients and caregivers. As treatment is largely supportive, early involvement of palliative care (PC) is recommended as standard of care. Despite this, literature surrounding PC information needs is limited. OBJECTIVES To explore the PC information needs of patients with ALS and their caregivers and identify gaps in the literature. METHODS A scoping review using MEDLINE, EMBASE, CINAHL and PsycINFO databases (2000-2019) was conducted. Articles examining PC information needs as stated by ALS patients and/or current/bereaved caregivers were included. Studies examining other diagnoses and those focused on healthcare workers were excluded. Thematic synthesis was used to summarize and identify prevalent domains and themes in the literature. RESULTS 581 articles underwent primary screening, with thirty-two ultimately included (26 original articles, six reviews). Fourteen examined information needs of both patients and caregivers, 13 caregivers only, 5 patients only. The most common PC information needs were as follows: for patients, disease course/prognosis (n = 10), general disease information (n = 9), decision-making (n = 7) and symptoms (n = 6); for caregivers, services and resources (n = 15), disease course/prognosis (n = 14), general disease information (n = 13) and skills (n = 10). There was substantial variability in information needs, both between patients and caregivers and among members of the same group. CONCLUSION ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.
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Affiliation(s)
- Jacqueline Gillespie
- Division of Palliative Care, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Christine L Watt
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada.
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24
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Sethi A, Everett E, Mehta A, Besbris J, Burke C, Pedowitz E, Kilpatrick M, Foster L, Maiser S. The Role of Specialty Palliative Care for Amyotrophic Lateral Sclerosis. Am J Hosp Palliat Care 2021; 39:865-873. [PMID: 34583569 DOI: 10.1177/10499091211049386] [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: 11/16/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive and incurable neurodegenerative disease resulting in the loss of motor neurons, eventually leading to death. ALS results in complex physical, emotional, and spiritual care needs. Specialty Palliative Care (SPC) is a medical specialty for patients with serious illness that provides an extra layer of support through complicated symptom management, goals of care conversations, and support to patients and families during hard times. Using MEDLINE, APA Psychinfo, and Dynamed databases, we reviewed the literature of SPC in ALS to inform and support an expert opinion perspective on this topic. This manuscript focuses on several key areas of SPC for ALS including insurance and care models, advance care planning, symptom management, quality of life, caregiver support, and end-of-life care. Recommendations to improve specialty palliative care for patients with ALS are reviewed in the discussion section.
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Affiliation(s)
- Anish Sethi
- University of Minnesota College of Biological Sciences, Minneapolis, MN, USA
| | - Elyse Everett
- John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Ambereen Mehta
- Department of Medicine, John Hopkins Medicine, Baltimore, MD, USA
| | - Jessica Besbris
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christa Burke
- Division of Palliative Medicine, John T. Milliken Department of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Elizabeth Pedowitz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Molly Kilpatrick
- Palliative Care and Supportive Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Laura Foster
- Department of Neurology, University of Colorado School of Medicine, Boulder, CO, USA
| | - Sam Maiser
- University of Minnesota College of Biological Sciences, Minneapolis, MN, USA.,Department of Neurology, Hennepin Healthcare, Minneapolis, MN, USA
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25
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Wigand B, Schlichte I, Schreiber S, Heitmann J, Meyer T, Dengler R, Petri S, Haghikia A, Vielhaber S, Vogt S. Characteristics of pain and the burden it causes in patients with amyotrophic lateral sclerosis - a longitudinal study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:284-291. [PMID: 34392762 DOI: 10.1080/21678421.2021.1962354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pain currently plays a subordinate role in the clinical care of patients with ALS. We aim to examine epidemiological and clinical characteristics of pain as well as its impact throughout the disease course. METHODS During a longitudinal follow-up at three time points, 151 ALS patients from three German outpatient clinics completed the Brief Pain Inventory, ALS-Functional Rating Scale-Extension and ALS Depression Inventory. Analysis of variance and covariance with repeated measures were performed. RESULTS Pain was prevalent in 56% of the 151 patients at baseline and in 70% of the remaining 40 patients at the third survey. Of the 28 patients with pain who participated in all three surveys, about two thirds suffered from an average pain intensity corresponding to at least moderate pain on the numerical rating scale (NRS ≥ 4). Patients reported different pain qualities and localized the pain most frequently in the extremities, back and neck. Pain moderately impaired the functions of daily living. Pain intensity, pain quality and pain-related impairment did not significantly change over time. One third of the patients suffered from clinically relevant depressive symptoms. However, there was no conclusive evidence of a link between pain intensity and depressive symptoms. CONCLUSION Pain is frequent and constitutes an additional strain on ALS patients who have to endure a rapidly progressive and severely debilitating disease. This study contributes to better understanding of the characteristics of pain and its impact on ALS patients throughout the disease course and may thus help to more effectively address this symptom.
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Affiliation(s)
- Bernadette Wigand
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Ina Schlichte
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Johanna Heitmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
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26
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Prediction of caregiver quality of life in amyotrophic lateral sclerosis using explainable machine learning. Sci Rep 2021; 11:12237. [PMID: 34112871 PMCID: PMC8192926 DOI: 10.1038/s41598-021-91632-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative, fatal and currently incurable disease. People with ALS need support from informal caregivers due to the motor and cognitive decline caused by the disease. This study aims to identify caregivers whose quality of life (QoL) may be impacted as a result of caring for a person with ALS. In this study, we worked towards the identification of the predictors of a caregiver’s QoL in addition to the development of a model for clinical use to alert clinicians when a caregiver is at risk of experiencing low QoL. The data were collected through the Irish ALS Registry and via interviews on several topics with 90 patient and caregiver pairs at three time-points. The McGill QoL questionnaire was used to assess caregiver QoL—the MQoL Single Item Score measures the overall QoL and was selected as the outcome of interest in this work. The caregiver’s existential QoL and burden, as well as the patient’s depression and employment before the onset of symptoms were the features that had the highest impact in predicting caregiver quality of life. A small subset of features that could be easy to collect was used to develop a second model to use it in a clinical setting. The most predictive features for that model were the weekly caregiving duties, age and health of the caregiver, as well as the patient’s physical functioning and age of onset.
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