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Abstract
Increased family demands during the postpartum period together with having to cope with symptoms and curtailed everyday functioning associated with multiple sclerosis (MS) suggest the need for additional support for mothers with MS throughout the first postpartum year. This study investigated factors (MS duration, MS relapse, symptoms, social support) that affect functional performance of 172 mothers with MS during the second 6-month postpartum period. Data were analyzed with descriptive statistics and path analysis. Findings indicated a good fit of the path models to the data at 9 and 12 months. Significant effects at both 9 and 12 months included positive relationships between duration of MS and symptoms and between social support and functional performance. Significant negative relationships were observed between symptoms and both social support and functional performance. Social support mediated the relationship between symptoms and functional performance. Findings suggest the importance of continued social support throughout the first postpartum year.
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Tülek Z, Polat C, Kürtüncü M, Eraksoy M. Validity and Reliability of the Turkish Version of the Multiple Sclerosis-Related Symptom Checklist. ACTA ACUST UNITED AC 2016; 54:328-333. [PMID: 29321706 DOI: 10.5152/npa.2016.16976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/28/2016] [Indexed: 12/13/2022]
Abstract
Introduction Multiple sclerosis (MS) is a disease that causes different symptoms in each attack and has an individual-specific course. Detailed questioning and recording of MS symptoms is important for developing a management plan for individual-specific symptoms. The present study was planned to evaluate the validity and reliability of the Turkish version of "Multiple Sclerosis-Related Symptom Checklist" (MS-RS), which has been developed for patients to personally follow-up the symptoms they experience. Methods The study was conducted in the outpatient MS clinic of the Istanbul University Istanbul Faculty of Medicine between January and October 2013 and included a sample group of 148 patients who were aged >18 years, could easily communicate, had a definite diagnosis of MS, and had no other medical problems besides MS. The data were collected using patient information forms, including sociodemographic and MS-RS forms. To assess the linguistic validity, the Likert-type scale with 26 items was first applied to a group of 30 patients. Confirmatory factor analysis was used to test the construct validity. Furthermore, the correlation of the scale with the Expanded Disability Status Scale (EDSS), Hospital Anxiety and Depression Scale (HADS), Mini-Mental Status Evaluation (MMSE) scale, and Multiple Sclerosis Quality of Life Scale-54 (MSQL-54) was evaluated. Results The scale comprised five factors with factor loading values between 0.39 and 0.86. The item-total correlation coefficients revealed values of 0.27-0.88. The Cronbach's alpha reliability coefficient for the whole scale was determined to be 0.89 and for the subscales to be 0.60-0.85. The test-retest analysis revealed no difference between the scale and its subscales in terms of invariance with time (p>0.05). Moreover, MS-RS was significantly correlated with EDSS, HADS, MMSE, and MSQL-54. Conclusion The Turkish version of MS-RS is a valid and reliable scale that can be used in the Turkish population.
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Affiliation(s)
- Zeliha Tülek
- İstanbul University Florence Nightingale Faculty of Nursing, İstanbul, Turkey
| | - Cansu Polat
- İstanbul University Florence Nightingale Faculty of Nursing, İstanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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3
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Finlayson M, Impey MW, Nicolle C, Edwards J. Self-Care, Productivity and Leisure Limitations of People with Multiple Sclerosis in Manitoba. The Canadian Journal of Occupational Therapy 2016. [DOI: 10.1177/000841749806500508] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As part of the activities of the Social Action Committee of the Multiple Sclerosis Society (Manitoba Division), a large mail-out survey was conducted in the spring of 1995. The purpose of the survey was to gather demographic, health, social and financial information from members who have multiple sclerosis to support various government lobbying efforts and to plan individual and family services. The response rate for the 720 surveys sent was 65%. This paper presents descriptive analysis exploring the occupational performance limitations experienced by the survey respondents based on the Model of Occupational Performance (CAOT, 1991). The prevalence of limitation was found to vary by specific occupation, by type of multiple sclerosis, by area of occupational performance, but not by fatigue status. The study findings have assessment and intervention implications for occupational therapists who work with people with multiple sclerosis in both institutional and community settings.
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Moore F, Wolfson C, Alexandrov L, Lapierre Y. Do General and Multiple Sclerosis-Specific Quality of Life Instruments Differ? Can J Neurol Sci 2014; 31:64-71. [PMID: 15038473 DOI: 10.1017/s0317167100002857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background:Quality of life instruments provide information that traditional outcome measures used in studies of multiple sclerosis do not. It is unclear if longer, disease-specific instruments provide more useful information than shorter, more general instruments, or whether patients prefer one type to another.Methods:We conducted a cross-sectional study of quality of life in a multiple sclerosis clinic population using a mailed questionnaire that combined three different quality of life instruments; the SF-36, the Multiple Sclerosis Quality of Life Instrument-54, and the EuroQol EQ-5D. We assessed the feasability of using each instrument and patient preference for each, calculated correlation coefficients for the summary scores of each instrument and other measures of disease severity, and calculated odds ratios from proportional odds models comparing each instrument with the Expanded Disability Status Scale.Results:We did not find substantial differences between the three instruments. All were well-received by patients, and over 75% felt that the combination of the three instruments best assessed their quality of life. For each instrument there was substantial variability between patients with similar quality of life scores in terms of their disability (as assessed by the Expanded Disability Status Scale and their own perception of their disease severity and quality of life (on simple 1-10 scales).Conclusion:Quality of life instruments are easy to use and well-received by patients, regardless of their length. There do not appear to be clinically important differences between general and disease-specific instruments. Each instrument appears to measure something other than a patient’s disability or perception of their own disease severity or quality of life.
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Affiliation(s)
- Fraser Moore
- Department of Neurology, Jewish General Hospital, Montreal, QC, Canada
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Schwartz CE, Kozora E, Zeng Q. Towards patient collaboration in cognitive assessment: Specificity, sensitivity, and incremental validity of self-report. Ann Behav Med 2013; 18:177-84. [PMID: 24203770 DOI: 10.1007/bf02883395] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The present work addressed the specificity and sensitivity of patient-reported cognitive ability using both cross-sectional and longitudinal data, and the incremental validity of patient self-report in addition to knowledge gained through neuropsychological tests. We examined a sample of individuals with multiple sclerosis (N=130) as a model of chronic illness where neuropsychological deficits are relatively common. Results revealed that 64% of the sample reported noticing some problems with memory or confusion. Very high levels of reported problems were not consistent with objective testing, whereas moderate levels of noticing problems were congruent with test results. This pattern suggests a curvilinear relationship between self-reported and objective assessment. The moderate reporters seem to be attending to subtle increases in deficits over time. Results also supported the incremental validity of combining subjective and objective indices, but only when the high reporters were excluded. We conclude that patients can provide important complementary data which may promote preventive care.
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Affiliation(s)
- C E Schwartz
- Frontier Science & Technology Research Foundation, Inc., Department of Psychiatry Deaconess Hospital, Harvard Medical School, Boston, USA
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6
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Beiske AG, Baumstarck K, Nilsen RM, Simeoni MC. Validation of the multiple sclerosis international quality of life (MusiQoL) questionnaire in Norwegian patients. Acta Neurol Scand 2012; 125:171-9. [PMID: 21470195 DOI: 10.1111/j.1600-0404.2011.01518.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the validity and reliability of the multidimensional, self-administered Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire, previously validated in a large international sample, in Norwegian patients. PATIENTS AND METHODS Patients with different types and severities of multiple sclerosis (MS) were recruited from a single MS centre in Norway. All patients completed the MusiQoL and Short Form-36 (SF-36) QoL questionnaires at baseline and a mean of 21 (SD 7) days later. A neurologist collected sociodemographic, MS history and outcome data. Construct validity, internal consistency, reproducibility and external consistency were tested. RESULTS One hundred and four patients were evaluated. Construct validity was confirmed in terms of satisfactory item internal consistency correlations in eight of nine MusiQoL dimensions (Spearman's correlation: 0.34-0.79) and scaling success of item discriminant validity (75.0-100%). All dimensions of the MusiQoL questionnaire exhibited satisfactory internal consistency (Cronbach's alpha: 0.44-0.87) and reproducibility (intraclass correlation coefficients: 0.36-0.86). External validity testing showed that the global MusiQoL score correlated significantly with all but one individual SF-36 dimension score (Spearman's correlation: 0.29-0.56). CONCLUSIONS These results demonstrate that the Norwegian-language version of the MusiQoL questionnaire is a valid and reliable instrument for assessing health-related QoL in Norwegian patients with MS.
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Affiliation(s)
- A G Beiske
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
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Snook EM, Motl RW. Physical activity behaviors in individuals with multiple sclerosis: roles of overall and specific symptoms, and self-efficacy. J Pain Symptom Manage 2008; 36:46-53. [PMID: 18362058 DOI: 10.1016/j.jpainsymman.2007.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 09/14/2007] [Accepted: 09/18/2007] [Indexed: 11/22/2022]
Abstract
Multiple sclerosis (MS) is associated with a large reduction in physical activity behavior, and emerging evidence indicates that this reduction might be correlated with symptoms and self-efficacy. The present study examined the nature of the associations among MS-related symptoms, exercise self-efficacy, and physical activity behavior in 80 individuals with a definite diagnosis of MS. Participants completed a measure of MS-related symptoms and self-efficacy and then wore an accelerometer for seven days. Both the frequency of overall symptoms and the frequency of motor symptoms had significant moderate inverse relationships with physical activity behavior (r=-0.47, P<0.0001 and r=-0.49, P<0.0001, respectively). Additionally, exercise self-efficacy was significantly and moderately correlated with physical activity (r=0.39, P<0.0001) and had significant and moderate inverse relationships with overall symptom frequency (r=-0.40, P<0.0001) and motor symptom frequency (r=-0.30, P=0.008). Path analysis demonstrated that both overall symptoms and motor symptoms had direct effects on physical activity as well as indirect effects on physical activity by way of self-efficacy. Such results suggest that the management and monitoring of MS-related symptoms may play an important role in encouraging physical activity adoption and maintenance in individuals with MS.
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Affiliation(s)
- Erin M Snook
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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8
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Abstract
Researchers increasingly use self-reported health status assessments, but these require validation. Performance Scales (PS) is a self-report measure for multiple sclerosis (MS)-associated disability, assessing mobility, bowel/bladder, fatigue, sensory, vision, cognition, spasticity and hand function. The criterion validity of the total PS score was established using the Expanded Disability Status Scale (EDSS), but the construct and criterion validity of the individual subscales have not been established. We assessed the criterion and construct validity of the PS subscales. Forty-four patients with MS completed PS, and these criterion measurements: neurological examination (EDSS), the Multiple Sclerosis Functional Composite (MSFC), contrast acuity testing, and the Multiple Sclerosis Quality of Life Inventory. We assessed criterion and construct validity with Spearman rank correlations between PS subscales and the other measurements. PS correlated with the MSFC (r=-0.58, P<0.0001). The mobility, hand, vision, fatigue and bladder subscales correlated with their criterion measures (r=0.59-0.77, P<0.0001). The sensory subscale correlated weakly with the sensory functional system score (r=0.39, P=0.01 ), and the cognitive subscale did not correlate with the PASAT (r=-0.17, P=0.26). This study supports the criterion and construct validity of PS overall, and its mobility, hand, vision, fatigue, and bladder subscales. Further assessment of the cognitive, sensory and spasticity subscales is needed.
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Affiliation(s)
- R A Marrie
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
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9
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Ozakbas S, Akdede BB, Kösehasanogullari G, Aksan O, Idiman E. Difference between generic and multiple sclerosis-specific quality of life instruments regarding the assessment of treatment efficacy. J Neurol Sci 2007; 256:30-4. [PMID: 17379247 DOI: 10.1016/j.jns.2007.01.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 11/13/2006] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is a chronic and stressful disease, which significantly affects the quality of life (QoL) of patients. QoL instruments provide information which traditional outcome measures of MS do not. It is unclear if the longer disease-specific instruments provide more useful information than the shorter. We aimed to investigate whether there was any difference between general QoL instrument and MS-specific one on the basis of detecting the efficacy of pulse therapy. 112 clinically definite MS patients were included in the study. Patients enrolled in the study were in relapse period treated by 1 g/day methyl-prednisolone for 5 days. World Health Organization Quality of Life Brief Form, Turkish Version (WHOQoL-BREF-TR) was given as a generic measure and Multiple Sclerosis Quality of Life-54 (MSQoL-54) as an MS-specific measure to assess the QoL. The same scales were administered 1 month after the therapy. MSQoL-54 was correlated with the EDSS in the pre-treatment period but WHOQoL-BREF was not. On day 30, there was a significant increase in both WHOQoL-BREF and MSQoL-54 scores. Increase was more prominent in MSQoL-54. There was a weak correlation between WHOQoL-BREF and MSQoL-54 (r=0.17). Correlation between changes in WHOQoL-BREF and MSQoL-54 scores was even weaker (r=0.11). Correlation between WHOQoL-BREF and EDSS was weaker (r=0.13), and correlation between MSQoL-54 and EDSS was still moderate (r=0.46) when compared with day 0. We concluded that although it takes a longer time to administer, MSQoL-54, as a MS-specific QoL instrument, is favorable and reliable for detecting the QoL not only in the remission but also in the relapse period of MS. Our results also indicated that MS-specific measure of QoL might be used for detecting the treatment effects in relapse period of patients with MS.
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Affiliation(s)
- S Ozakbas
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Balcova 35340, Izmir, Turkey.
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10
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Griffiths SY, Yamamoto A, Boudreau VG, Ross LK, Kozora E, Thornton AE. Memory interference in multiple sclerosis. J Int Neuropsychol Soc 2005; 11:737-46. [PMID: 16248909 DOI: 10.1017/s135561770505085x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 06/01/2005] [Accepted: 06/06/2005] [Indexed: 11/07/2022]
Abstract
To explore verbal memory impairments associated with multiple sclerosis (MS), we compared proactive and retroactive interference effects on the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of 83 community-residing individuals with MS and 80 healthy participants. Individuals with MS demonstrated normal accumulation of proactive interference (PI), but attenuated release from PI relative to healthy individuals. Furthermore, accumulation of retroactive interference (RI) at short-delay free recall (SDFR) was intensified for those with MS as compared to healthy participants. Interestingly, accumulation of RI predicted long-term memory (LTM) only for participants with MS. These findings suggest that individuals with MS may experience particular difficulty when required to use semantic properties of information flexibly to facilitate verbal LTM.
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Affiliation(s)
- Stephanie Y Griffiths
- Human Neuropsychology Laboratory, Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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11
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Gulick EE, Kim S. Postpartum Emotional Distress in Mothers With Multiple Sclerosis. J Obstet Gynecol Neonatal Nurs 2004; 33:729-38. [PMID: 15561661 DOI: 10.1177/0884217504270666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the impact of multiple sclerosis (MS)-related symptoms and both received social support and perceived deficits in social support on emotional distress in mothers with MS at 1, 3, and 6 months postpartum. DESIGN Longitudinal correlation descriptive study. SETTING Community-residing women in North America. PARTICIPANTS Convenience sample of 174 postpartum mothers with MS. METHOD Mothers completed the MS-Related Symptom Scale and Postpartum Support Questionnaire at 1, 3, and 6 months postpartum. Bivariate correlations and hierarchical regression analyses determined relationships between the dependent variable, emotional distress, and independent variables: participant characteristics, MS-related symptoms, and social support. RESULTS The authors found moderately strong positive correlations between MS-related symptoms and emotional distress at each assessment. Significant negative correlations existed between received social support and emotional distress at 1 month but not at 3 and 6 months. Significant positive correlations existed between MS-related symptoms and social support deficits at each assessment. Explained variance in emotional distress across the three assessments ranged between 2% and 4% for participant characteristics, 49% and 60% for MS-related symptoms, 2% and 7% for social support, and 57% and 66% for total variance. CONCLUSION MS-related symptoms created considerable emotional distress in mothers that was minimally alleviated by the support given them. In fact, many needed more support than they received.
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Affiliation(s)
- Elsie E Gulick
- Rutgers, the State University of New Jersey, College of Nursing, 180 University Avenue, Newark, NJ 07102, USA.
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12
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Abstract
BACKGROUND Emotional distress is higher in persons with multiple sclerosis (MS) than in other chronic illnesses. Not known is whether personal attributes of the person with MS and/or the presence of social support will function as mediating and/or moderating variables between emotional distress and adaptation to the illness. OBJECTIVES Determine if personal attributes and social support function as mediating and/or moderating variables between emotional distress and ADL functioning in persons with MS. METHODS Secondary analyses of data obtained from 686 persons with MS through self-report measures of emotional distress, personal attributes, social support, and ADL functioning was conducted. Separate mediation and moderation models were tested using stepwise and hierarchical multiple regression. Demographic variables of education, age, and length of MS illness, were controlled in all analyses. RESULTS Personal attributes and social support functioned as mediator variables between emotional distress and ADL functioning. Additionally, personal attributes and not social support functioned as a moderator. Significant main effects were shown for social support and emotional distress in the moderator model. CONCLUSION Personal attributes and social support mediated the effects of emotional distress by decreasing its impact on ADL functioning. Personal attributes, as a moderator variable, demonstrated that higher levels were associated with low levels of emotional stress and moderate or lower levels of personal attributes were associated with increased emotional distress suggesting that personal attributes may intervene between emotional distress and ADL functioning by attenuating or preventing a stress appraisal response.
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Affiliation(s)
- E E Gulick
- College of Nursing, Rutgers, The State University of New Jersey, Newark 07102, USA
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13
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Abstract
Although 75% of elective surgery is performed on an outpatient basis, no measures of patients' at-home postoperative recovery were found in the literature. The postdischarge surgical recovery (PSR) scale was designed to serve as a dependent variable capable of measuring variations in perceived recovery in patients dismissed within 24 hours of their surgical procedure. Five concepts: health status; activity; fatigue; work ability; and expectations, derived from an ethnographic analysis, are represented in the 15-item 10-point semantic differential scale. The PSR scale exhibited strong internal consistency in two samples (alpha=.88-.91). The concurrent validity coefficient between the PSR scale and the previously tested Wolfer-Davis Recovery Inventory (1970) was .76 (n = 163; p< or =.001). Construct validity was supported by the relationship (r=.72, p< or =.001) between patients' reported percentage of recovery (0-100%) and PSR scores. Construct val idity was also supported by correlations between the PSR scale and in-home assessment by a master clinical nurse specialist (r=.77, p=.003, n=12) and by trained in-home observers (r=.71, p< or =.001, n=59). Clinicians or researchers interested in the extent of perceived at-home Postoperative recovery may now search for symptom patterns and changes over time in a variety of ambulatory surgery patients using the PSR scale.
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Affiliation(s)
- S V Kleinbeck
- Family Care Research, University of Kansas School of Nursing, Kansas City 66160-7503, USA
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14
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Lane N. Medical constraints on the quantum mind. J R Soc Med 2000; 93:571-5. [PMID: 11198687 PMCID: PMC1298147 DOI: 10.1177/014107680009301105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- N Lane
- University Department of Surgery, Royal Free and University College Medical School, Pond Street, London NW3 2QG, UK.
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15
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Abstract
BACKGROUND Symptom control in chronic illness is not merely a matter of medical management as the patient and family must rely on their own judgment, wisdom, and ingenuity for controlling symptoms. The absence in the literature regarding the effects of multiple sclerosis (MS) as perceived by afflicted people and their family members led to the 10-year longitudinal study. OBJECTIVES To study patient self-report data to determine whether particular interventions may be needed to enhance the individual's comfort and functional levels. METHODS The chronic illness trajectory of three groups of people with MS (< or =5 years of diagnosis, n=49; >5 to 10 years, n=36; and >10 years, n=68) was examined over a 10-year period. Serial self-assessments of the subjects' prevalence of MS-related symptoms (motor, brain stem, sensory, elimination, mental/emotional) and level of activities of daily living (ADL) functioning (fine and gross motor activities, sensory/communication, socializing/recreation, intimacy) were obtained annually. Profiles illustrating the subject's symptom and ADL pattern were also returned annually to each subject. RESULTS Using 10-year average scores, study findings indicated no group differences relative to symptoms but showed significant group differences in all ADL functions. Separate group within-year (1, 3, 5, 7, 10) comparisons reflected significant increases in motor, brain stem, and elimination symptoms together with a decline in all ADL functions for specific groups. CONCLUSIONS Medical data suggest, on average, a continuous downward trajectory beginning in the first years of illness or at approximately 36 to 37 years of age. In contrast, in this research, patient self-reports of fine and gross motor ADL, a correlate of neurologically based disability evaluations, reflect that relatively major decline begins after 5 years post-diagnosis and after age 40 for subjects recruited primarily from nonclinical sites.
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Affiliation(s)
- E E Gulick
- College of Nursing, Rutgers, The State University of New Jersey, USA
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16
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Alexander RW, Bradley LA, Alarcón GS, Triana-Alexander M, Aaron LA, Alberts KR, Martin MY, Stewart KE. Sexual and physical abuse in women with fibromyalgia: association with outpatient health care utilization and pain medication usage. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1998; 11:102-15. [PMID: 9668733 DOI: 10.1002/art.1790110206] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the relationship between sexual and/or physical abuse and health care usage in patients with fibromyalgia (FM) and identify variables that may influence this relationship. METHODS We assessed history of sexual/physical abuse, health care utilization, and medication usage, as well as related variables in 75 women with FM using standardized questionnaires, structured interviews, and laboratory pain perception tasks. RESULTS Fifty-seven percent of FM patients reported a history of sexual/physical abuse. Compared to non-abused patients, abused patients reported significantly greater utilization of outpatient health care services for problems other than FM and greater use of medications for pain (P < or = 0.025). Consistent with our expectations, abused patients also were characterized by significantly greater pain, fatigue, functional disability, and stress, as well as by a tendency to label dolorimeter stimuli as painful regardless of their intensities (P < or = 0.05). Additional analyses suggested that the high frequency of sexual/physical abuse in our patients was associated primarily with seeking health care for chronic pain rather than the FM syndrome itself or genetic factors. CONCLUSION There is an association in FM patients between sexual/physical abuse and increased use of outpatient health care services and medications for pain. This association may be influenced by clinical symptoms, functional disability, psychiatric disorders, stress, and abnormal pain perception. The relationships among these variables should be further tested in prospective, population-based studies.
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Affiliation(s)
- R W Alexander
- Department of Psychology (Medical Psychology Program), University of Alabama at Birmingham 35294, USA
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17
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Di Fabio RP, Soderberg J, Choi T, Hansen CR, Schapiro RT. Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. Arch Phys Med Rehabil 1998; 79:141-6. [PMID: 9473994 DOI: 10.1016/s0003-9993(98)90290-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the influence of an extended outpatient rehabilitation program on symptom frequency, fatigue, and functional status for persons with multiple sclerosis (MS). DESIGN Nonequivalent pretest/posttest control-group design, with posttest 1 year after initial assessment. Multiple regression analysis and analysis of covariance were used to control for symptom severity at the initial assessment and comorbid factors including depression, cognitive function, and social interaction. Effect sizes (ES) provided a descriptive measure of the change in outcomes. SETTING Outpatient multidisciplinary rehabilitation clinic. PATIENTS Forty-six patients with definite chronic progressive MS; 20 received treatment and 26 were in a nontreatment comparison group ("waiting list"). INTERVENTION Rehabilitation services for 5 hours, 1 day per week, over 1 year. MAIN OUTCOME MEASURES The MS-Related Symptom Checklist composite score, fatigue frequency, and selected items from the Rehabilitation Institute of Chicago Functional Assessment Scale. RESULTS Receiving treatment was a significant predictor of reduced symptom frequency (partial r2 = .26) at the 1-year follow-up. The ES adjusted for baseline values indicated substantial reductions in symptom frequency for the treatment group (EStreatment = .27 vs ESwaitlist = -.32). Fatigue was significantly reduced at the time of follow-up for the treatment group compared with the waiting list group (EStreatment = .46 vs ESwaitlist = -.20). There were no statistically significant differences among groups regarding functional status, but there appeared to be less loss of functional status in the treatment group compared with the waiting list group (EStreatment = -.07 vs ESwaitlist = -.70). CONCLUSIONS An extended outpatient rehabilitation program for persons with definite progressive MS appears to effectively reduce fatigue and the severity of other symptoms associated with MS.
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Affiliation(s)
- R P Di Fabio
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, USA
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18
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Reilly CA, Holzemer WL, Henry SB, Slaughter RE, Portillo CJ. A comparison of patient and nurse ratings of human immunodeficiency virus-related signs and symptoms. Nurs Res 1997; 46:318-23. [PMID: 9422050 DOI: 10.1097/00006199-199711000-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Since management strategies are guided by the assessment of the symptom experience, agreement between patients' and nurses' perceptions of symptoms is central to clinical management. In this study, acquired immune deficiency syndrome patients' perceptions of 41 human immunodeficiency virus-related signs and symptoms were compared in 207 pairs of ratings by patients (n = 207) and nurses (n = 103). Ten symptoms were reported by 50% or more of the patients. Mean patient intensity ratings for all signs and symptoms, with the exception of anxiety, were higher than nurse ratings. Using patients' ratings as the gold standard, chance-corrected estimates of sensitivity, specificity, positive predictive value, and negative predictive value of the nurses' ratings suggested that nurses' ratings poorly predicted patients' symptom experiences.
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Affiliation(s)
- C A Reilly
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA
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19
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Abstract
The purpose of this study was to investigate the extent to which objective (demographic) and subjective (self-reported health and role) domains predicted quality of life among 153 persons with multiple sclerosis (MS). Subjects completed the Life Situation Survey, a measure of quality of life, a demographic from (sex, education, age, MS duration, employment status, marital status), the MS-Related Symptoms Scale (motor, brain stem, sensory, mental/emotions, elimination subscales), and the 15-Item Activities of Daily Living (ADL) Self-Care Scale for MS Persons (fine/gross motor, communicating, recreation/socializing, intimacy subscales). Hierarchical multiple regression was used to enter three blocks of variables (demographic, symptom, and ADL domains), and stepwise was used to enter variables within each block. The final model resulted in two health domains (mental/emotions and sensory symptoms) and two role domains (intimacy and recreation/socializing) that predicted 61% of the variance in quality of life of persons with MS.
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Affiliation(s)
- E E Gulick
- College of Nursing, Rutgers, State University of New Jersey, Newark 07102, USA.
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Vickrey BG, Hays RD, Genovese BJ, Myers LW, Ellison GW. Comparison of a generic to disease-targeted health-related quality-of-life measures for multiple sclerosis. J Clin Epidemiol 1997; 50:557-69. [PMID: 9180648 DOI: 10.1016/s0895-4356(97)00001-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Evaluation of the relative contributions of generic and disease-targeted measures to assessing health-related quality of life (HRQOL) for chronic conditions is needed to help in selection of appropriate measures. We administered a generic HRQOL measure (the Short Form-36 [SF-36]), three disease-targeted supplemental scales to the SF-36, and two disease-targeted HRQOL instruments to 171 adults with multiple sclerosis. Most scales yielded adequate variability, internal consistency reliability, and test-retest reliability. The relationship between each measure and four primary "criterion" variables were assessed: overall symptom severity in the prior year; ambulation status; days unable to work or attend school in the prior month: and a rating of overall quality of life. Results indicate that the disease-targeted scales provided unique information not captured by the generic measure. We conclude that if a generic measure of HRQOL is desirable for a given study of multiple sclerosis, additional information will be gained by supplementing that measure with selected scales.
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Affiliation(s)
- B G Vickrey
- Department of Neurology, University of California, Los Angeles 90095-1769, USA
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21
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Berzon RA, Simeon GP, Simpson RL, Donnelly MA, Tilson HH. Quality of life bibliography and indexes: 1993 update. Qual Life Res 1995; 4:53-74. [PMID: 7711692 DOI: 10.1007/bf00434384] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R A Berzon
- Burroughs Wellcome Co., Research Triangle Park, NC, USA
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