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Islamoska S, Forman CR, Panicker JN, Flachenecker P, Phé V, Brichetto G, Blok B, Barken KB. The impact of bladder problems on well-being in multiple sclerosis - A cross-sectional study. Mult Scler Relat Disord 2024; 87:105661. [PMID: 38728957 DOI: 10.1016/j.msard.2024.105661] [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: 10/10/2023] [Revised: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) frequently suffer from bladder problems that are not identified and managed optimally, reducing quality of life and increasing risk of health consequences. OBJECTIVE This study aimed to investigate associations between bladder problems and well-being of pwMS. METHODS The study included 1872 pwMS from France, Germany, Italy, and the UK self-reporting on demographics, MS status, bladder problems and management, and well-being. Logistic regression analyses were performed to investigate associations with self-reported well-being. RESULTS Population mean age was 51 years and 79 % were women. Among pwMS, 55 % reported bladder problems indicating overactive bladder (OAB), and 40 % reported self-experienced urinary retention. Self-management of bladder problems was reported by 32 %, 33 % were yet to have problem resolution, and 45 % reported a wish to receive bladder management help. Additionally, 35 % of pwMS reported that bladder problem onset preceded awareness of a link to MS. OAB, problem self-management, and urinary complications were significantly associated with lower well-being. CONCLUSION Bladder problems affect pwMS across disease subtypes and many attempt self-management. Consequently, pwMS with bladder problems are more likely to experience lower well-being, suggesting an unmet need. Raising awareness of the link between bladder problems and well-being could benefit pwMS living with bladder problems.
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Affiliation(s)
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK; UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Véronique Phé
- Sorbonne University, Tenon Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Bertil Blok
- Department of Urology, Section of Neuro-Urology, Erasmus Medical Center, Rotterdam, the Netherlands
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Flachenecker P, Blok B, Brichetto G, Panicker JN, Phé V, Barken KB. MS bladder check tool: Development and validation of a patient awareness tool to facilitate timely management of lower urinary tract dysfunction due to multiple sclerosis. Mult Scler Relat Disord 2024; 82:105353. [PMID: 38194894 DOI: 10.1016/j.msard.2023.105353] [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: 11/14/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Lower urinary tract dysfunction impacts quality of life of people with MS; often, symptoms are 'lived with' or deprioritised by healthcare providers (HCPs). Consequently, patients must be given the skills they need to become confident in managing their illness and enhance their involvement in the process. OBJECTIVE To develop and validate a self-assessment tool to help people with MS become more aware of their bladder symptoms and prompt contact with their HCP to facilitate timely management and specialist referral, if required. METHODS The 'MS bladder check tool' was developed by a multidisciplinary panel of specialist advisors. Consensus meetings and pilot testing were conducted to design and evolve the tool into a series of nine questions, using population-appropriate language, and covering all aspects of bladder dysfunction in MS. The tool was then validated by an international, multidisciplinary team of experts. RESULTS Validity was rated 'excellent' for all questions indicating that the MS bladder check tool is an appropriate method of highlighting bladder problems in people with MS. CONCLUSION The MS bladder check tool is simple, easy-to-use, and empowers patients to take charge of their urinary tract health, aiming to improve the management of MS and, ultimately, patient quality of life.
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Affiliation(s)
| | - Bertil Blok
- Department of Urology, Section of Neuro-Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust; UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Véronique Phé
- Sorbonne University, Tenon Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris, France
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Artola M, Hernando A, Vidal O, Vidal N, Cuenca E, Horno R, Robles MÁ, Oriol C, Peralta S, Solana MAJ, Rubio M, Montero C, Lleixà M, Zabay C, Martin M, Leon I, Molinos C, Matamoros M, Mercadé L, Fornali O, Montero L, Saiz A, Solà-Valls N. The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis. J Clin Nurs 2022. [PMID: 35799407 DOI: 10.1111/jocn.16421] [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: 11/11/2021] [Revised: 04/14/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). OBJECTIVES To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. DESIGN Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. METHODS Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. RESULTS Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0-8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). CONCLUSIONS Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. PATIENT CONTRIBUTION Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.
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Affiliation(s)
- Montse Artola
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Ana Hernando
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Oscar Vidal
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Núria Vidal
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ester Cuenca
- Hospital Residencia Sant Camil, Sant Pere de Ribes, Barcelona, Spain
| | - Rosalía Horno
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miguel Ángel Robles
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Clara Oriol
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Matilde Rubio
- Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Cristina Montero
- Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Mercè Lleixà
- Hospital de Sant Joan Despí-Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Cinta Zabay
- Centre Neurorehabilitador Mas Sabaté, Fundació Esclerosi Multiple, Reus, Tarragona, Spain
| | - Montse Martin
- Hospital Sant Joan de Déu Althaia de Manresa, Manresa, Barcelona, Spain
| | - Isabel Leon
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Consuelo Molinos
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mandi Matamoros
- Hospital Verge de la Cinta de Tortosa, Tortosa, Tarragona, Spain
| | | | | | | | - Albert Saiz
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Núria Solà-Valls
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain.,Secció de Neurologia, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
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Moghadasi AN. Lack of Attention to the Administration of Fampridine as a Symptomatic Drug in Iranian Multiple Sclerosis Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1513-1514. [PMID: 34568200 PMCID: PMC8426761 DOI: 10.18502/ijph.v50i7.6654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study. Neurol Sci 2020; 41:2781-2792. [PMID: 32281038 DOI: 10.1007/s10072-020-04392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Botulinum toxin (BT) is an effective and safe treatment for spasticity, with limited evidence in multiple sclerosis (MS). We aim to describe the use of BT for the management of MS spasticity in the clinical practice, its combination with other anti-spastic treatments in MS and possible MS clinical correlates. METHODS This is a multicentre cross-sectional observational study including 386 MS patients, receiving BT for spasticity in 19 Italian centres (age 53.6 ± 10.9 years; female 228 (59.1%); disease duration 18.7 ± 9.2 years; baseline Expanded Disability Status Scale (EDSS) 6.5 (2.0-9.0)). RESULTS BT was used for improving mobility (n = 170), functioning in activities of daily living (n = 56), pain (n = 56), posturing-hygiene (n = 63) and daily assistance (n = 41). BT formulations were AbobotulinumtoxinA (n = 138), OnabotulinumtoxinA (n = 133) and IncobotulinumtoxinA (n = 115). After conversion to unified dose units, higher BT dose was associated with higher EDSS (Coeff = 0.591; p < 0.001), higher modified Ashworth scale (Coeff = 0.796; p < 0.001) and non-ambulatory patients (Coeff = 209.382; p = 0.006). Lower BT dose was used in younger patients (Coeff = - 1.746; p = 0.009), with relapsing-remitting MS (Coeff = - 60.371; p = 0.012). BT dose was higher in patients with previous BT injections (Coeff = 5.167; p = 0.001), and with concomitant treatments (Coeff = 43.576; p = 0.022). Three patients (0.7%) reported on post-injection temporary asthenia/weakness (n = 2) and hypophonia (n = 1). CONCLUSION BT was used for spasticity and its consequences from the early stages of MS, without significant adverse effects. MS-specific goals and injection characteristics can be used to refer MS patients to BT treatment, to decide for the strategy of BT injections and to guide the design of future clinical trials and observational studies.
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Cost-Effectiveness Analysis of Cannabinoid Oromucosal Spray Use for the Management of Spasticity in Subjects with Multiple Sclerosis. Clin Drug Investig 2020; 40:319-326. [DOI: 10.1007/s40261-020-00895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Forsmark A, Rosengren L, Ertzgaard P. Inequalities in pharmacologic treatment of spasticity in Sweden - health economic consequences of closing the treatment gap. HEALTH ECONOMICS REVIEW 2020; 10:4. [PMID: 32030530 PMCID: PMC7006187 DOI: 10.1186/s13561-020-0261-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective. Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking. METHODS Botulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness. RESULTS The proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000. The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness. CONCLUSIONS There is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings.
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Affiliation(s)
| | | | - Per Ertzgaard
- Department of Rehabilitation Medicine and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Linköping University Hospital, Linköping, Sweden
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Edwards L, Ellis B, Donnellan C, Osman H, Haboubi N, Jones M, Sunman W, Pinnington L, Phillips MF. Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study. Clin Rehabil 2019; 33:1819-1830. [PMID: 31266351 DOI: 10.1177/0269215519859621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. DESIGN Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. SETTING 22 care homes in Derbyshire and Nottinghamshire. SUBJECTS 60 care home residents with upper motor neuron syndrome-related spasticity. INTERVENTIONS No intervention. When unmet needs around spasticity management were identified, the participant's general practitioner was advised of these in writing. MAIN MEASURES Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. RESULTS Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. CONCLUSION Care home residents in this study had high levels of unmet need for spasticity management.
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Affiliation(s)
- Laura Edwards
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, Derby, UK
| | | | - Clare Donnellan
- Linden Lodge Neuro-Rehabilitation Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hanan Osman
- The Walton Centre NHS Foundation Trust and The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Naseer Haboubi
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Jones
- Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton, Derby, UK
| | - Wayne Sunman
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lorraine Pinnington
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
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Rommer PS, Eichstädt K, Ellenberger D, Flachenecker P, Friede T, Haas J, Kleinschnitz C, Pöhlau D, Rienhoff O, Stahmann A, Zettl UK. Symptomatology and symptomatic treatment in multiple sclerosis: Results from a nationwide MS registry. Mult Scler 2018; 25:1641-1652. [PMID: 30230952 DOI: 10.1177/1352458518799580] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease. Over time, symptoms accumulate leading to increased disability of patients. OBJECTIVE The objective of this article is to analyze the prevalence of symptoms and symptomatic treatment patterns in a nationwide MS registry. METHODS Data sets from 35,755 patients were analyzed. RESULTS More than two-thirds of patients were women with a mean age of 46.1 (±12.8) years. Median Expanded Disability Status Score (EDSS) was 3.0. The most frequently reported symptoms were fatigue, spasticity, and voiding disorders. In patients with short disease duration, fatigue was reported most frequently. Symptomatic treatment was most common for spasticity and depression, whereas fatigue was treated only in a third of affected patients. Almost a fifth of patients with EDSS ⩽ 3.5 and neuropsychological symptoms had retired from work. CONCLUSION Whereas treatment for spasticity and depression is common in our cohort, sexual dysfunction, dysphagia, cognitive dysfunction, and fatigue are treated to a far lesser extent. The need for psychological support, physical, and occupational therapy has to be recognized as neuropsychological symptoms have a great impact on retirement at an early stage. Overall symptomatic treatment rates for the most common symptoms have increased over the last years (p < 0.001).
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Affiliation(s)
- Paulus Stefan Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany/Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - David Ellenberger
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Judith Haas
- MS-Center, Jewish Hospital Berlin, Berlin, Germany
| | | | - Dieter Pöhlau
- Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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Widerström-Noga E, Loeser JD, Jensen TS, Finnerup NB. AAPT Diagnostic Criteria for Central Neuropathic Pain. THE JOURNAL OF PAIN 2017; 18:1417-1426. [DOI: 10.1016/j.jpain.2017.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/21/2023]
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