1
|
Pitkänen LJ, Niskanen J, Malmivaara A, Torkki P. Measuring outcomes of rehabilitation among the elderly-a feasibility study. FRONTIERS IN HEALTH SERVICES 2023; 3:1187713. [PMID: 37786486 PMCID: PMC10541954 DOI: 10.3389/frhs.2023.1187713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
A feasible system for measuring patient outcomes of rehabilitation is required for assessing the real-world cost-effectiveness of rehabilitation. This study aims to assess the feasibility of measuring outcomes of rehabilitation among elderly individuals with early-stage Alzheimer's. We used the principles of Design Science to construct a set of metrics consisting of standardized PROM (Patient-Reported Outcome Measure) questionnaires, clinician-reported measures, and observational measures of functioning. We used standardized questionnaires whenever possible to ensure the validity and reliability of the questionnaires. The set of metrics was piloted on 16 individuals living at home with regular home care services. After the pilot, we further refined the set of metrics based on relevance, sensitivity to change, and applicability. We found that measurement was feasible and we propose the final set of metrics as a minimum set, which could be further improved upon by addition of metrics relevant to each subgroup of elderly individuals. We also found that using self-reported questionnaires in this population is not without difficulties. We therefore suggest that the role of informal caregivers be considered, and that accessibility of outcome questionnaires be improved.
Collapse
Affiliation(s)
- Laura J. Pitkänen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jyri Niskanen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Malmivaara
- Unit for Performance Assessment of the Health and Social Service System, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Belveal K, Gunkel-Lam S, Hajare A, Lambropoulos A, Rogers S, Hilton C, Armstead A. The effectiveness of nontraditional or home-based programing on ADL performance of individuals living with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 71:104576. [PMID: 36842310 DOI: 10.1016/j.msard.2023.104576] [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: 12/08/2022] [Revised: 01/20/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To examine evidence-based nontraditional and home-based interventions and their efficacy for use in individuals with MS to improve performance in their daily activities. MATERIALS AND METHODS A search of five databases including PubMed, CINAHL, Cochrane Library, OT Seeker, and Ovid Medline produced 924 research articles. Thirty-two articles were selected for full-text review, of which 15 were included in this systematic review. INCLUSION CRITERIA Articles were level 2B or higher evidence, had a minimum of 19 participants with MS, addressed ADLs or body functions supporting ADL performance, and were published since 2010. EXCLUSION CRITERIA Articles not written in English and not identified as nontraditional or home-based programming. RESULTS The review uncovered strong evidence for the use of the nontraditional interventions of vestibular rehabilitation, self-management, yoga, musical production, and ELEVIDA to improve ADL performance in individuals with MS. Strong evidence supported the use of home-based programs that included cognitive behavioral therapy, cooling suits, manual dexterity, strengthening, vestibular rehabilitation, and physical activity. CONCLUSIONS High levels of evidence support the use of nontraditional or home-based interventions to improve ADL performance in clients with MS. Innovation and technology continue to expand the occupational therapist's toolbox of interventions.
Collapse
Affiliation(s)
- Kimberlyn Belveal
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Stephanie Gunkel-Lam
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Amanda Hajare
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Alexandra Lambropoulos
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Shelby Rogers
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Claudia Hilton
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States
| | - Amber Armstead
- The University of Texas Medical Branch at Galveston, 301 University Blvd. # 3.908, Galveston, TX 77555-1142, United States.
| |
Collapse
|
3
|
Wills OC, Probst YC. Understanding lifestyle self-management regimens that improve the life quality of people living with multiple sclerosis: a systematic review and meta-analysis. Health Qual Life Outcomes 2022; 20:153. [PMID: 36434609 PMCID: PMC9700996 DOI: 10.1186/s12955-022-02046-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lifestyle self-management as an intervention for people living with multiple sclerosis (plwMS) is an emerging area of research. Previous reviews have highlighted a need to systematically identify effective self-management regimens that influence the health and well-being of plwMS using a common metric of success. OBJECTIVES To examine the effectiveness of lifestyle self-management strategies and interventions aimed at improving the quality of life (QOL), and/or disability of plwMS. The review also aimed to narratively explore common elements of self-management interventions that were effective at improving the outcomes of interest. METHODS A systematic search was performed using five scientific databases. The review process followed the Cochrane Handbook for Systematic Reviews of Interventions and was registered with PROSPERO (Ref: CRD42021235982). RESULTS A total of 57 studies including 5830 individuals diagnosed with MS, met the inclusion criteria. Self-management interventions included physical activity, fatigue, dietary, stress/coping, emotional, symptom and medical management, and lifestyle and wellbeing programs. Self-reported QOL improved in 35 of 47 studies. Dietary intervention had no statistically significant overall effect on reducing MS disability, (P = 0.18). Heterogeneity limited the ability to pool the effects from a large number of eligible studies of the same design. CONCLUSION Multicomponent self-management interventions, multimodal delivery methods, and cognitive behavioural theory principles were common elements of self-management interventions that improved the QOL of plwMS. However, these results should be interpreted with caution and care should be taken in its clinical application. This review has the potential to inform future management practices for plwMS and has revealed a significant gap in the literature, warranting high-quality, large-scale experimental, and observational studies that address lifestyle management.
Collapse
Affiliation(s)
- Olivia C. Wills
- grid.1007.60000 0004 0486 528XSchool of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Yasmine C. Probst
- grid.1007.60000 0004 0486 528XSchool of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| |
Collapse
|
4
|
Dauwan M, Begemann MJH, Slot MIE, Lee EHM, Scheltens P, Sommer IEC. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. J Neurol 2021; 268:1222-1246. [PMID: 31414194 PMCID: PMC7990819 DOI: 10.1007/s00415-019-09493-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/20/2023]
Abstract
We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies ( = k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.
Collapse
Affiliation(s)
- Meenakshi Dauwan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, VU University Medical Center Amsterdam, Neuroscience Campus, Postbus 7057, 1007 MB Amsterdam, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Margot I. E. Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Edwin H. M. Lee
- Department of Psychiatry, 2/F, New Clinical Building, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
5
|
Milne SC, Corben LA, Roberts M, Szmulewicz D, Burns J, Grobler AC, Williams S, Chua J, Liang C, Lamont PJ, Grootendorst AC, Massey L, Sue C, Dalziel K, LaGrappe D, Willis L, Freijah A, Gerken P, Delatycki MB. Rehabilitation for ataxia study: protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ Open 2020; 10:e040230. [PMID: 33334834 PMCID: PMC7747606 DOI: 10.1136/bmjopen-2020-040230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emerging evidence indicates that rehabilitation can improve ataxia, mobility and independence in everyday activities in individuals with hereditary cerebellar ataxia. However, with the rarity of the genetic ataxias and known recruitment challenges in rehabilitation trials, most studies have been underpowered, non-randomised or non-controlled. This study will be the first, appropriately powered randomised controlled trial to examine the efficacy of an outpatient and home-based rehabilitation programme on improving motor function for individuals with hereditary cerebellar ataxia. METHODS AND ANALYSIS This randomised, single-blind, parallel group trial will compare a 30-week rehabilitation programme to standard care in individuals with hereditary cerebellar ataxia. Eighty individuals with a hereditary cerebellar ataxia, aged 15 years and above, will be recruited. The rehabilitation programme will include 6 weeks of outpatient land and aquatic physiotherapy followed immediately by a 24- week home exercise programme supported with fortnightly physiotherapy sessions. Participants in the standard care group will be asked to continue their usual physical activity. The primary outcome will be the motor domain of the Functional Independence Measure. Secondary outcomes will measure the motor impairment related to ataxia, balance, quality of life and cost-effectiveness. Outcomes will be administered at baseline, 7 weeks, 18 weeks and 30 weeks by a physiotherapist blinded to group allocation. A repeated measures mixed-effects linear regression model will be used to analyse the effect of the treatment group for each of the dependent continuous variables. The primary efficacy analysis will follow the intention-to-treat principle. ETHICS AND DISSEMINATION The study has been approved by the Monash Health Human Research Ethics Committee (HREC/18/MonH/418) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (2019/3503). Results will be published in peer-reviewed journals, presented at national and/or international conferences and disseminated to Australian ataxia support groups. TRIAL REGISTRATION NUMBER ACTRN12618000908235.
Collapse
Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Physiotherapy Department, Monash Health, Cheltenham, Victoria, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa Roberts
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Physiotherapy Department, Monash Health, Cheltenham, Victoria, Australia
| | - David Szmulewicz
- Balance Disorders & Ataxia Service, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Cerebellar Ataxia Clinic, Alfred Health, Caulfield, Victoria, Australia
- Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - J Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health & Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Anneke C Grobler
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shannon Williams
- Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jillian Chua
- Physiotherapy Department, Ryde Hospital, Eastwood, New South Wales, Australia
| | - Christina Liang
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia
| | - Phillipa J Lamont
- Neurogenetic Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Libby Massey
- MJD Foundation, Darwin, Northern Territory, Australia
| | - Carolyn Sue
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia
| | - Kim Dalziel
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | | | - Liz Willis
- MJD Foundation, Darwin, Northern Territory, Australia
| | - Aleka Freijah
- Rehabilitation Services, Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
| | - Paul Gerken
- Rehabilitation Services, Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
de Toledo JHDS, Fraga-Silva TFDC, Borim PA, de Oliveira LRC, Oliveira EDS, Périco LL, Hiruma-Lima CA, de Souza AAL, de Oliveira CAF, Padilha PDM, Pinatto-Botelho MF, dos Santos AA, Sartori A, Zorzella-Pezavento SFG. Organic Selenium Reaches the Central Nervous System and Downmodulates Local Inflammation: A Complementary Therapy for Multiple Sclerosis? Front Immunol 2020; 11:571844. [PMID: 33193354 PMCID: PMC7664308 DOI: 10.3389/fimmu.2020.571844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/08/2020] [Indexed: 01/18/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system (CNS). The persistent inflammation is being mainly attributed to local oxidative stress and inflammasome activation implicated in the ensuing demyelination and axonal damage. Since new control measures remain necessary, we evaluated the preventive and therapeutic potential of a beta-selenium-lactic acid derivative (LAD-βSe), which is a source of organic selenium under development, to control experimental autoimmune encephalomyelitis (EAE) that is an animal model for MS. Two EAE murine models: C57BL/6 and SJL/J immunized with myelin oligodendrocyte glycoprotein and proteolipid protein, respectively, and a model of neurodegeneration induced by LPS in male C57BL/6 mice were used. The preventive potential of LAD-βSe was initially tested in C57BL/6 mice, the chronic MS model, by three different protocols that were started 14 days before or 1 or 7 days after EAE induction and were extended until the acute disease phase. These three procedures were denominated preventive therapy -14 days, 1 day, and 7 days, respectively. LAD-βSe administration significantly controlled clinical EAE development without triggering overt hepatic and renal dysfunction. In addition of a tolerogenic profile in dendritic cells from the mesenteric lymph nodes, LAD-βSe also downregulated cell amount, activation status of macrophages and microglia, NLRP3 (NOD-like receptors) inflammasome activation and other pro-inflammatory parameters in the CNS. The high Se levels found in the CNS suggested that the product crossed the blood-brain barrier having a possible local effect. The hypothesis that LAD-βSe was acting locally was then confirmed by using the LPS-induced neurodegeneration model that also displayed Se accumulation and downmodulation of pro-inflammatory parameters in the CNS. Remarkably, therapy with LAD-βSe soon after the first remitting episode in SJL/J mice, also significantly downmodulated local inflammation and clinical disease severity. This study indicates that LAD-βSe, and possibly other derivatives containing Se, are able to reach the CNS and have the potential to be used as preventive and therapeutic measures in distinct clinical forms of MS.
Collapse
Affiliation(s)
| | | | - Patrícia Aparecida Borim
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Evelyn da Silva Oliveira
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Larissa Lucena Périco
- Department of Structural and Functional Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, Brazil
| | - Clélia Akiko Hiruma-Lima
- Department of Structural and Functional Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, Brazil
| | - Adriana Aparecida Lopes de Souza
- Veterinary Clinical Laboratory, School of Veterinary Medicine and Animal Science (FMVZ), São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Pedro de Magalhães Padilha
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Marcos Felipe Pinatto-Botelho
- LabSSeTe Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Alcindo Aparecido dos Santos
- LabSSeTe Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Alexandrina Sartori
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | | |
Collapse
|
7
|
Gunn H, Andrade J, Paul L, Miller L, Creanor S, Stevens K, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman J. A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31217069 DOI: 10.3310/hta23270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. OBJECTIVE This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. DESIGN Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. SETTING Four sites across the UK. PARTICIPANTS Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. INTERVENTIONS Intervention - manualised 13-week education and exercise programme (BRiMS) plus usual care. Comparator - usual care alone. MAIN OUTCOME MEASURES Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the BRiMS programme (via process evaluation) and economic data. RESULTS A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0-6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 -7.7 [95% confidence interval (CI) -17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI -7.8 to 9) and MSIS-29vs2 psychological -0.4 (95% CI -9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0-93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking BRiMS. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of BRiMS were highlighted. CONCLUSIONS The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries. FUTURE WORK Further development of BRiMS is required to address logistical issues and enhance user-satisfaction and adherence. Following this, a definitive trial to assess the clinical effectiveness and cost-effectiveness of the BRiMS intervention is warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN13587999. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 27. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Hilary Gunn
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Jackie Andrade
- School of Psychology, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda Miller
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Irvine, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.,Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Kara Stevens
- Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Colin Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, Exeter, UK
| | - Paul Ewings
- National Institute for Health Research (NIHR) Research Design Service (South West), Musgrove Park Hospital, Taunton, UK
| | - Andrew Barton
- National Institute for Health Research (NIHR) Research Design Service, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Margie Berrow
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | | | - John Zajicek
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Jennifer Freeman
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| |
Collapse
|
8
|
das Nair R, de Groot V, Freeman J. Beyond current research practice: Methodological considerations in MS rehabilitation research (is designing the perfect rehabilitation trial the Holy Grail or a Gordian knot?). Mult Scler 2020; 25:1337-1347. [PMID: 31469355 DOI: 10.1177/1352458519858271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). The number of randomised controlled trials (RCTs) for rehabilitation interventions in MS has increased over the last two decades. The design, conduct and reporting quality of some of these trials could be improved. There are, however, some specific challenges that researchers face in conducting RCTs of rehabilitation interventions, which are often 'complex interventions'. This paper explores some of the challenges of undertaking robust clinical trials in rehabilitation. We focus on issues related to (1) participant selection and sample size, (2) interventions - the 'dose', content, active ingredients, targeting, fidelity of delivery and treatment adherence, (3) control groups and (4) outcomes - choosing the right type, number, timing of outcomes, and the importance of defining a primary outcome and clinically important difference between groups. We believe that by following internationally accepted RCT guidelines, by developing a critical mass of MS rehabilitation 'trialists' through international collaboration and by continuing to critique, challenge, and develop RCT designs, we can exploit the potential of RCTs to answer important questions related to the effectiveness of rehabilitation interventions.
Collapse
Affiliation(s)
- Roshan das Nair
- Clinical Psychology and Neuropsychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Vincent de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Freeman
- Physiotherapy and Rehabilitation, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| |
Collapse
|
9
|
Turner-Stokes L, Harding R, Yu P, Dzingina M, Gao W. Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England. Mult Scler J Exp Transl Clin 2020; 6:2055217320912789. [PMID: 32206333 PMCID: PMC7079310 DOI: 10.1177/2055217320912789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Rehabilitation is effective for multiple sclerosis, but is it value for
money? Objectives To evaluate functional outcomes, care needs and cost-efficiency of specialist
inpatient rehabilitation for adults with multiple sclerosis (MS). Methods A multicentre cohort study of prospectively collected clinical data from the
UK Rehabilitation Outcomes Collaborative national clinical database. Data
included all adults with MS (n = 1007) admitted for
specialist inpatient (Level 1 or 2) rehabilitation in England,
2010–2018. Outcome measures Dependency/care needs: Northwick Park Dependency Scale/Care Needs Assessment,
Functional independence: UK Functional Assessment Measure (UK FIM+FAM).
Cost-efficiency. Patients were analysed in three dependency groups
(High/Medium/Low). Results All groups showed significant reduction in dependency between admission and
discharge on all measures (paired t-tests:
p < 0.001). Mean reduction in care costs/week was
greatest in the most dependent patients: High: £519 (95% CI: 447–597),
Medium: £148 (76–217), Low: £36 (12–83). Despite longer stays, time taken to
offset the cost of rehabilitation was shortest in the most dependent
patients: High: 12.9 (12.0–14.1) months; Medium: 29.3 (21.3–51.8); Low: 76.8
(0–36.1). Item-level changes corresponded with clinical experience. Conclusions Specialist rehabilitation provided good value for money in patients with MS,
yielding improved outcomes and substantial savings in ongoing care costs,
especially in high-dependency patients.
Collapse
Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Peihan Yu
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Mendwas Dzingina
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW This article discusses the prevalence, identification, and management of multiple sclerosis (MS)-related symptoms and associated comorbidities, including complications that can present at all stages of the disease course. RECENT FINDINGS The impact of comorbidities on the outcome of MS is increasingly recognized. This presents an opportunity to impact the course and outcome of MS by identifying and treating associated comorbidities that may be more amenable to treatment than the underlying inflammatory and neurodegenerative disease. The identification of MS-related symptoms and comorbidities is facilitated by brief screening tools, ideally completed by the patient and automatically entered into the patient record, with therapeutic suggestions for the provider. The development of free, open-source screening tools that can be integrated with electronic health records provides opportunities to identify and treat MS-related symptoms and comorbidities at an early stage. SUMMARY Identification and management of MS-related symptoms and comorbidities can lead to improved outcomes, improved quality of life, and reduced disease activity. The use of brief patient-reported screening tools at or before the point of care can facilitate identification of symptoms and comorbidities that may be amenable to intervention.
Collapse
|
11
|
Broscheid KC, Dettmers C, Vieten M. Is the Limit-Cycle-Attractor an (almost) invariable characteristic in human walking? Gait Posture 2018; 63:242-247. [PMID: 29778064 DOI: 10.1016/j.gaitpost.2018.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Common methods of gait analyses measure step length/width, gait velocity and gait variability to name just a few. Those parameters tend to be changing with fitness and skill of the subjects. But, do stable subject characteristic parameters in walking exist? Does the Limit-Cycle-Attractor qualify as such a parameter?. RESEARCH QUESTION The attractor method is a new approach focusing on the dynamics of human motion. It classifies the fundamental walking pattern by calculating the Limit-Cycle-Attractor and its variability from acceleration data of the feet. Our hypothesis is that the fundamental walking pattern in healthy controls and in people with Multiple Sclerosis (pwMS) is stable, but can be altered through acute interventions or rehabilitation. METHODS For this purpose, two investigations were conducted involving 113 subjects. The short-term stability was tested pre and post a 15 min passive/active MOTOmed (ergometer) session as well as up to 20 min afterwards. The long-term stability was tested over five weeks of rehabilitation once a week in pwMS. The main parameter of interest describes the velocity normalized average difference between two attractors (δM), which is an indicator for the change in movement pattern. RESULTS The Friedman's two-way ANOVA by ranks did not reveal any significant difference in δM. However, the conventional walking tests (6 min.10 m) improved significantly (p < 0.05) during rehabilitation. Contrary to our original hypothesis, the fundamental walking pattern was highly stable against controlled motor-assisted movement initiation via MOTOmed and rehabilitation treatment. Movement characteristics appeared to be independent of the improved fitness as indicated by the enhanced walking speed and distance. SIGNIFICANCE The individual Limit-Cycle-Attractor is extremely robust and might indeed qualify as an (almost) invariable characteristic in human walking. This opens up the possibility to encode the individual walking characteristics. Conditions as Parkinson, Multiple Sclerosis etc., might display disease specific distinctions via the Limit-Cycle-Attractor.
Collapse
Affiliation(s)
| | - Christian Dettmers
- Lurija Institute, Kliniken Schmieder Allensbach, Germany; Kliniken Schmieder Konstanz, Germany
| | | |
Collapse
|
12
|
Henze T, Feneberg W, Flachenecker P, Seidel D, Albrecht H, Starck M, Meuth SG. [New aspects of symptomatic MS treatment: Part 6 - cognitive dysfunction and rehabilitation]. DER NERVENARZT 2018; 89:453-459. [PMID: 29079868 DOI: 10.1007/s00115-017-0443-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The symptomatic treatment of multiple sclerosis (MS) is nowadays of similar importance as immunotherapy within a comprehensive treatment concept of this chronic disease. It makes a considerable contribution to the reduction of disabilities in activities of daily living as well as social and occupational life. Moreover, symptomatic treatment is of great importance for amelioration of the quality of life. Since our last survey of symptomatic MS treatment in 2004 and publication of the guidelines of the German Neurological Society and the Clinical Competence Network Multiple Sclerosis ("Klinisches Kompetenznetz Multiple Sklerose", KKN-MS) in 2014 several developments within the topics of mobility, bladder and sexual function, vision, fatigue, cognition and rehabilitation have taken place. These new findings together with further aspects of disease measurement methods and overall treatment strategies of the respective symptoms, as well as treatment goals are introduced in several individual contributions. In this article the symptoms of cognitive disorders and the growing impact of rehabilitation are discussed.
Collapse
Affiliation(s)
- T Henze
- Praxisgemeinschaft für Neurologie, Psychiatrie, Psychotherapie, Günzstr. 1, 93059, Regensburg, Deutschland.
| | - W Feneberg
- Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - P Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof, Bad Wildbad, Deutschland
| | | | - H Albrecht
- Praxis für Neurologie, München, Deutschland
| | - M Starck
- Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - S G Meuth
- Department für Neurologie und Institut für Translationale Neurologie, Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| |
Collapse
|
13
|
Al-Sharman A, Khalil H, Nazzal M, Al-Sheyab N, Alghwiri A, El-Salem K, AlDughmi M. Living with multiple sclerosis: A Jordanian perspective. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [DOI: 10.1002/pri.1709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Mohammad Nazzal
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Nihaya Al-Sheyab
- Faculty of Nursing, Department of Maternal and Child Nursing-Faculty member; Jordan University of Science and Technology; Irbid Jordan
| | - Alia Alghwiri
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
| | - Khalid El-Salem
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Mais AlDughmi
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
| |
Collapse
|
14
|
A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life. PLoS One 2017; 12:e0185931. [PMID: 29020113 PMCID: PMC5636105 DOI: 10.1371/journal.pone.0185931] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). PURPOSE To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. METHOD A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). RESULTS The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. CONCLUSION Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.
Collapse
|
15
|
Boesen F, Nørgaard M, Trénel P, Rasmussen PV, Petersen T, Løvendahl B, Sørensen J. Longer term effectiveness of inpatient multidisciplinary rehabilitation on health-related quality of life in MS patients: a pragmatic randomized controlled trial - The Danish MS Hospitals Rehabilitation Study. Mult Scler 2017; 24:340-349. [PMID: 28984159 PMCID: PMC5846853 DOI: 10.1177/1352458517735188] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: There is insufficient evidence to support the effectiveness of multidisciplinary rehabilitation on the health-related quality of life (HRQoL) of MS patients. Objectives: To evaluate the longer term effectiveness of inpatient multidisciplinary rehabilitation on the HRQoL of MS patients. Methods: The study was a two-hospital, pragmatic, randomized controlled trial with a 6-month follow-up. Patients aged 18–65 years with MS and Expanded Disability Status Scale scores ≤7.5 were randomly assigned (1:1) to 4 weeks of inpatient multidisciplinary rehabilitation (20 days of scheduled rehabilitation) or 6 months on a wait list. The outcome measures were Functional Assessment in Multiple Sclerosis (FAMS), Multiple Sclerosis Impact Scale-29 (MSIS-29), EQ-5D-5L and 15D. Results: We randomized 213 patients to the wait-list control group and 214 patients to the treatment group. Trends in favour of the treatment group were observed across all measures. However, the difference was significant in only two of the six measures. The treatment effect was −2.7 (95% CI: −5.6 to (−0.1)), p = 0.046) for the MSIS-29 Psychological and 0.017 (95% CI: 0.005–0.030, p = 0.008) for the 15D. FAMS, which we used to calculate the sample size, was not significant. Conclusion: The results indicated that inpatient multidisciplinary rehabilitation is effective in improving the HRQoL of MS patients after 6 months.
Collapse
Affiliation(s)
| | | | | | | | - Thor Petersen
- Department of Neurology, Aarhus University hospital, Aarhus, Denmark
| | | | - Jan Sørensen
- Centre of Health Economics Research (COHERE), Department of Public Health, University of Southern Denmark, Odense, Denmark/Healthcare Outcome Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
16
|
Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews. Arch Phys Med Rehabil 2017; 98:353-367. [DOI: 10.1016/j.apmr.2016.04.016] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/22/2016] [Indexed: 01/08/2023]
|
17
|
Nechemia Y, Moreh E, Weingarden H, Bloch A, Givon U, Vaknin-Dembinsky A, Schwartz I, Meiner Z, Zeilig G. Effectiveness of multi-disciplinary rehabilitation for patients with Neuromyelitis Optica. J Spinal Cord Med 2016; 39:311-6. [PMID: 26446695 PMCID: PMC5073758 DOI: 10.1179/2045772315y.0000000060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Neuromyelitis optica (NMO), previously considered a subtype of multiple sclerosis (MS), is now known to be a unique disorder associated with autoantibodies against aquaporin-4. The rehabilitation protocols for MS have been applied to NMO, without specific measures of efficacy. PURPOSE The evaluation of the effectiveness of an MS type inpatient rehabilitation program for patients with NMO. PATIENT AND METHODS Retrospective chart reviews of 15 inpatients with NMO and 32 inpatients with MS. Clinical severity was assessed by the Expanded Disability Status Scale (EDSS), functional assessments were scored using the Functional Independence Measure (FIM), the Montebello Rehabilitation Factor Score (MRFS), and the Functional Ambulation Category (FAC). There was a higher percentage of women in the NMO group (87% vs 56% P = 0.003). The MS group had significantly more cognitive and communication deficits (P = 0.003 and P = 0.00001). No significant differences were found in admission FIM, EDSS and FAC scores. RESULTS Both groups benefitted, however at discharge, the NMO group showed greater improvement in FIM scores (NMO admission 79 ± 24, discharge 98 ± 21; MS admission 80 ± 28, discharge 89 ± 28); and lower EDSS score (NMO from 7.2 ± 1.4 to 6.3 ± 1.4; MS from 7.4 ± 1.4 to 7 ± 1.5). CONCLUSIONS Inpatient multidisciplinary rehabilitation programs available for the patients with MS may be successfully implemented for patients with NMO.
Collapse
Affiliation(s)
- Yael Nechemia
- Department of Neurological Rehabilitation, the Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Elior Moreh
- Hadassah Hebrew University Medical Center, Jerusalem
| | - Harold Weingarden
- Department of Neurological Rehabilitation, the Chaim Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Israel
| | - Ayala Bloch
- Department of Neurological Rehabilitation, the Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Sackler School of Medicine, Tel Aviv University, Israel,Multiple Sclerosis Center, the Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Zeev Meiner
- Hadassah Hebrew University Medical Center, Jerusalem
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, the Chaim Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Israel,Correspondence to: Gabi Zeilig, Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
| |
Collapse
|
18
|
Nedeljkovic U, Dackovic J, Tepavcevic DK, Basuroski ID, Mesaros S, Pekmezovic T, Drulovic J. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial. Arch Med Sci 2016; 12:380-9. [PMID: 27186184 PMCID: PMC4848347 DOI: 10.5114/aoms.2015.47289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone. MATERIAL AND METHODS This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later. RESULTS The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score. CONCLUSIONS Our findings suggest that MDR improves MS relapse outcome.
Collapse
Affiliation(s)
- Una Nedeljkovic
- Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Dackovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Irena Dujmovic Basuroski
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
19
|
Pappalardo A, D’Amico E, Leone C, Messina S, Chisari C, Rampello L, Torre L, Patti F. Inpatient versus outpatient rehabilitation for multiple sclerosis patients: effects on disability and quality of life. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40893-016-0005-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
20
|
Haselkorn JK, Hughes C, Rae-Grant A, Henson LJ, Bever CT, Lo AC, Brown TR, Kraft GH, Getchius T, Gronseth G, Armstrong MJ, Narayanaswami P. Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016; 85:1896-903. [PMID: 26598432 DOI: 10.1212/wnl.0000000000002146] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation treatments in multiple sclerosis (MS). METHODS We systematically searched the literature (1970-2013) and classified articles using 2004 American Academy of Neurology criteria. RESULTS This systematic review highlights the paucity of well-designed studies, which are needed to evaluate the available MS rehabilitative therapies. Weekly home/outpatient physical therapy (8 weeks) probably is effective for improving balance, disability, and gait (MS type unspecified, participants able to walk ≥5 meters) but probably is ineffective for improving upper extremity dexterity (1 Class I). Inpatient exercises (3 weeks) followed by home exercises (15 weeks) possibly are effective for improving disability (relapsing-remitting MS [RRMS], primary progressive MS [PPMS], secondary progressive MS [SPMS], Expanded Disability Status Scale [EDSS] 3.0-6.5) (1 Class II). Six weeks' worth of comprehensive multidisciplinary outpatient rehabilitation possibly is effective for improving disability/function (PPMS, SPMS, EDSS 4.0-8.0) (1 Class II). Motor and sensory balance training or motor balance training (3 weeks) possibly is effective for improving static and dynamic balance, and motor balance training (3 weeks) possibly is effective for improving static balance (RRMS, SPMS, PPMS) (1 Class II). Breathing-enhanced upper extremity exercises (6 weeks) possibly are effective for improving timed gait and forced expiratory volume in 1 second (RRMS, SPMS, PPMS, mean EDSS 4.5); this change is of unclear clinical significance. This technique possibly is ineffective for improving disability (1 Class II). Inspiratory muscle training (10 weeks) possibly improves maximal inspiratory pressure (RRMS, SPMS, PPMS, EDSS 2-6.5) (1 Class II).
Collapse
|
21
|
Sangelaji B, Smith CM, Paul L, Sampath KK, Treharne GJ, Hale LA. The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil 2015. [DOI: 10.1177/0269215515595274] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. Data resources: MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. Trial selection: Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. Data extraction: Data extraction was conducted by two independent reviewers and the Cochrane Collaboration’s recommended method was used to assess the risk of bias of each included study. Results: A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I2 = 68%) (eight to 12 weeks’ duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. Conclusion: Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis.
Collapse
|
22
|
Amatya B, Galea M, Kesselring J, Khan F. Effectiveness of telerehabilitation interventions in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2015. [DOI: 10.1016/j.msard.2015.06.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
Helland CB, Holmøy T, Gulbrandsen P. Barriers and Facilitators Related to Rehabilitation Stays in Multiple Sclerosis: A Qualitative Study. Int J MS Care 2015; 17:122-9. [PMID: 26052257 DOI: 10.7224/1537-2073.2014-007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have shown the positive effects of multidisciplinary rehabilitation on disability and health-related quality of life in multiple sclerosis (MS). However, many patients do not seek such treatment, even if it is available free of charge. The aim of this study was to identify facilitators and barriers related to use of such treatment options. METHODS Five focus group interviews with 27 MS patients were conducted. Three groups included patients who had been admitted to a multidisciplinary MS rehabilitation institution, and two groups included outpatients of a university hospital who had not applied for specialized rehabilitation. Interviews were audiotaped and transcribed, and were analyzed qualitatively by means of a modified form of systematic text condensation. RESULTS Important factors influencing the use of an MS rehabilitation service were 1) the availability and suitability of initial information about the disease and the service, 2) assumptions and expectations about such a service, and 3) practical barriers in the patient's life. The prospect of having a retreat from work and family was described as a motivational factor. Lack of reorientation after diagnosis, fears and perceptions of being labeled as an MS patient, or having information overload and being confronted with disabled individuals were identified as barriers. CONCLUSIONS Communication skills, including information-giving skills, of neurologists in relation to newly diagnosed MS patients need improvement. Rehabilitation programs for MS patients should include stays of different durations and purposes to fit patients' needs. Health-care authorities should take measures to secure equal access to information about rehabilitation options across institutions and practicing physicians.
Collapse
Affiliation(s)
- Caroline Bruun Helland
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
| | - Trygve Holmøy
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
| | - Pål Gulbrandsen
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
| |
Collapse
|
24
|
Kamm CP, Mattle HP, Müri RM, Heldner MR, Blatter V, Bartlome S, Lüthy J, Imboden D, Pedrazzini G, Bohlhalter S, Hilfiker R, Vanbellingen T. Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial. Mult Scler 2015; 21:1546-56. [DOI: 10.1177/1352458514565959] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/04/2014] [Indexed: 11/15/2022]
Abstract
Background: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life. Objective: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients. Methods: This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test. Results: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements. Conclusion: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.
Collapse
Affiliation(s)
- Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - René M Müri
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Verena Blatter
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Sandrine Bartlome
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Judith Lüthy
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Debora Imboden
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Giovanna Pedrazzini
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Roger Hilfiker
- HES-SO Valais-Wallis, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland
| | - Tim Vanbellingen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland/Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| |
Collapse
|
25
|
Pagnini F, Bosma CM, Phillips D, Langer E. Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurol 2014; 14:222. [PMID: 25433519 PMCID: PMC4253984 DOI: 10.1186/s12883-014-0222-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023] Open
Abstract
Background Multiple Sclerosis is a disease of the central nervous system involving a variety of debilitating physical, sensory, cognitive and emotional symptoms. This literature review evaluated the impact of psychological interventions on the physiological symptoms associated with the illness. Methods A systematic literature search was conducted using Medline, PsycINFO, Scopus, and the Cochrane Library databases, as well as reference lists. Relevant studies were selected and assessed according to a preset protocol. Results The search produced 220 articles, with 22 meeting inclusion criteria for the review. A total of 5,705 subjects with Multiple Sclerosis were analyzed. Results from the included studies indicate a general improvement in both psychological and physiological outcomes following psychological treatment. The most highly influenced physical symptoms include fatigue, sleep disturbances, pain, and physical vitality. Conclusions Findings from the review suggest a positive relationship between psychological interventions and physiological Multiple Sclerosis symptoms. Implications for future research are discussed.
Collapse
Affiliation(s)
- Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy. .,Niguarda Ca' Granda Hospital, Milan, Italy. .,Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Colin M Bosma
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Deborah Phillips
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Ellen Langer
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| |
Collapse
|
26
|
Khan F, Amatya B, Galea M. Management of fatigue in persons with multiple sclerosis. Front Neurol 2014; 5:177. [PMID: 25309504 PMCID: PMC4163985 DOI: 10.3389/fneur.2014.00177] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022] Open
Abstract
Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.
Collapse
Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
27
|
|
28
|
Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroeng Rehabil 2014; 11:79. [PMID: 24885412 PMCID: PMC4017705 DOI: 10.1186/1743-0003-11-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain. METHODS The study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI). RESULTS The DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean. CONCLUSION People with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.
Collapse
Affiliation(s)
- Mitchell E Tyler
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kurt A Kaczmarek
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kathy L Rust
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Alla M Subbotin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kimberly L Skinner
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Yuri P Danilov
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| |
Collapse
|
29
|
Dixon-Ibarra A, Vanderbom K, Dugala A, Driver S. Systematic framework to evaluate the status of physical activity research for persons with multiple sclerosis. Disabil Health J 2014; 7:151-6. [DOI: 10.1016/j.dhjo.2013.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 09/23/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
|
30
|
Yu CH, Mathiowetz V. Systematic Review of Occupational Therapy–Related Interventions for People With Multiple Sclerosis: Part 1. Activity and Participation. Am J Occup Ther 2014; 68:27-32. [DOI: 10.5014/ajot.2014.008672] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This article is the first part of a systematic review of studies on occupational therapy–related intervention for people with multiple sclerosis (MS). The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice for people with multiple sclerosis? This article focuses on occupational therapy interventions aimed at activity and participation, including programs (e.g., inpatient and outpatient rehabilitation) in which an occupational therapy practitioner was one member of the team. Part 2 (Yu & Mathiowetz, 2014) focuses on interventions within the scope of occupational therapy to remediate impairment (e.g., exercise, cognition, emotional regulation).
Collapse
Affiliation(s)
- Chih-Huang Yu
- Chih-Huang Yu, MSc (OT), OT (Taiwan), is PhD Student, Rehabilitation Science Program, University of Minnesota, MMC 388, 420 Delaware Street SE, Minneapolis, MN 55455;
| | - Virgil Mathiowetz
- Virgil Mathiowetz, PhD, OTR/L, FAOTA, is Associate Professor, Program in Occupational Therapy, University of Minnesota, Minneapolis
| |
Collapse
|
31
|
Outcomes of a Peer Support Program in Multiple Sclerosis in an Australian Community Cohort: A Prospective Study. JOURNAL OF NEURODEGENERATIVE DISEASES 2013; 2013:429171. [PMID: 26316989 PMCID: PMC4437345 DOI: 10.1155/2013/429171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022]
Abstract
Background/Objectives. This pilot study evaluated the impact of a peer support program on improving multiple sclerosis (MS) related psychological functions (depression, anxiety, and stress) and enhancing quality of life. Methodology. Participants (n = 33) were recruited prospectively and received an 8-week group face-to-face peer support program. Assessments were at baseline (T1), 6 weeks after program (T2), and 12 months after program (T3), using validated questionnaires: Depression Anxiety Stress Scale (DASS), McGill Quality of Life (MQOL), and Brief COPE. Results. Participants' mean age was 52; the majority were female (64%) and married (64%). Median time since MS diagnosis was 16 years. At T2, participants reported improved psychological functioning (DASS "depression," "anxiety," and "stress" subscales, z values -2.36, -2.22, and -2.54, moderate effect sizes (r) 0.29, 0.28, and 0.32, resp.) and quality of life (MQOL SIS z score -2.07, r = 0.26) and were less likely to use "self-blame" as a coping mechanism (Brief COPE z score -2.37, r = 0.29). At T3, the positive improvements in stress (DASS stress subscale z score -2.41, r = 0.31) and quality of life were maintained (MQOL SIS, z score -2.30, r = 0.29). There were no adverse effects reported.
Collapse
|
32
|
Khan F, Amatya B, Ytterberg C, Johansson S, Kesselring J. Content comparison of multidimensional, patient-reported outcome measures in multiple sclerosis rehabilitation and the ICF. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Multiple sclerosis (MS) is a complex condition, with long-term physical, cognitive and behavioral disabilities, and lifestyle consequences. Individuals with MS require regular evaluation for persisting disability and psychological sequelae. This should incorporate patients’ perspectives on functioning and health. This review summarizes and compares the content of commonly used multidimensional, patient-reported outcome measures in MS in relation to the International Classification of Functioning, Disability and Health comprehensive MS Core set. The focused domains of these measures, the commonalities and discrepancies, and breadth and depth of coverage in relation to the MS Core set are discussed. Understanding of the content of these instruments is needed for clinicians/researchers to make an informed choice for the selection of the most appropriate instrument to capture the variability inherent in MS for treatment efficacy.
Collapse
Affiliation(s)
- Fary Khan
- Department of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34–54 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Huddinge, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Huddinge, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
| |
Collapse
|
33
|
Liberatore G, Clarelli F, Nuara A, Ungaro D, Gatti R, Rovaris M, Martinelli V, Comola M, Comi G, Rossi P, Martinelli-Boneschi F. Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis. Mult Scler 2013; 20:862-70. [PMID: 24166355 DOI: 10.1177/1352458513508834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/15/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify clinical predictors of effectiveness of a motor rehabilitation treatment in a cohort of multiple sclerosis (MS) patients. MATERIALS AND METHODS We analysed 212 consecutive patients who underwent a short-term (3-7 weeks) intensive (two hours per day, five days per week), individualised, goal-oriented inpatient rehabilitation program. Activity limitation and impairment were measured on admission and discharge of the rehabilitation trial using the motor sub-items of the Functional Independence Measure (mFIM) and the Expanded Disability Status Scale (EDSS) score. Multivariate logistic regression models have been tested to evaluate the role of clinical baseline features on rehabilitation effectiveness. RESULTS According to pre-defined outcome measures, 75.1% of MS patients improved in either activity limitation (≥5 points delta mFIM) or impairment (≥1.0 delta EDSS score if baseline EDSS was ≤5.5, or ≥0.5 if baseline EDSS was >5.5), and 35.4% of MS patients improved in both outcomes. A relapsing-remitting course of disease, a more severe baseline impairment and activity limitation level, a shorter disease duration and a less severe balance dysfunction were predictive of the effectiveness of rehabilitation. DISCUSSION These data confirm that an intensive inpatient rehabilitation program is able to produce a short-term relevant improvement on clinical and functional outcome measures and suggest some clinical features which can be considered as potential predictors of the outcome of rehabilitative intervention.
Collapse
Affiliation(s)
- G Liberatore
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
| | - F Clarelli
- Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
| | - A Nuara
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - D Ungaro
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - R Gatti
- Laboratory of Movement Analysis, San Raffaele Scientific Institute, Italy
| | - M Rovaris
- Neurorehabilitation Unit, Don C. Gnocchi Foundation ONLUS, Italy
| | - V Martinelli
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - M Comola
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - G Comi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - P Rossi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Clinica Hildebrand, Centro Riabilitazione Brissago, Switzerland
| | - F Martinelli-Boneschi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
| |
Collapse
|
34
|
Schäffler N, Schönberg P, Stephan J, Stellmann JP, Gold SM, Heesen C. Comparison of patient-reported outcome measures in multiple sclerosis. Acta Neurol Scand 2013; 128:114-21. [PMID: 23398571 DOI: 10.1111/ane.12083] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-reported outcome measurements (PROMS) have been proposed sensitive outcome parameters in multiple sclerosis (MS). In this study, we assessed a German version of the Multiple Sclerosis Impact Scale (MSIS-29) and a revised version of the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS) in comparison with rater- and physician-based tools. METHODS Consecutive MS patients (n = 117) of the MS outpatient unit were included. In addition to MSIS-29 and HAQUAMS, the following parameters were obtained: Expanded Disability Status Scale (EDSS) and modified Multiple Sclerosis Functional Composite (MSFC) [9-hole peg test (9HPT), 25-foot walk test and symbol digit modalities test]. We investigated validity, internal consistency and test-retest reliability as well as correlation between these measures. RESULTS Internal consistency (Cronbach's α ≤ 0.96) and test-retest coefficients (ICC ≤ 0.87) of both scales were high and satisfied psychometric standards. Convergent and discriminant validity was supported by direction, magnitude and pattern of correlation with other rater-based measures depending on the functional subdomain. Both MSIS-29 and HAQUAMS correlated with EDSS (ρ = 0.55 vs 0.62), but stronger correlation was found between MSIS-29 and HAQUAMS total score (ρ = 0.90). Both scales distinguished between patient groups of varied disease severity and cognitive impairment. CONCLUSION Patient-reported outcome measurements as MSIS-29 and HAQUAMS seem to be valid instruments to detect different impairment levels in comparison with traditional rater-based instruments like EDSS or MSFC.
Collapse
Affiliation(s)
- N Schäffler
- Department of Neurology, Institute of Neuroimmunology and Clinical MS Research (inims), University Medical Center, Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
35
|
Mayo NE, Bayley M, Duquette P, Lapierre Y, Anderson R, Bartlett S. The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial. BMC Neurol 2013; 13:69. [PMID: 23809312 PMCID: PMC3706216 DOI: 10.1186/1471-2377-13-69] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/30/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the commonly known benefits of exercise and physical activity evidence shows that persons Multiple Sclerosis (MS) are relatively inactive yet physical activity may be even more important in a population facing functional deterioration. No exercise is effective if it is not done and people with MS face unique barriers to exercise engagement which need to be overcome. We have developed and pilot tested a Multiple Sclerosis Tailored Exercise Program (MSTEP) and it is ready to be tested against general guidelines for superiority and ultimately for its impact on MS relevant outcomes. The primary research question is to what extent does an MS Tailored Exercise Program (MSTEP) result in greater improvements in exercise capacity and related outcomes over a one year period in comparison to a program based on general guidelines for exercise among people with MS who are sedentary and wish to engage in exercise as part of MS self-management. METHODS/DESIGN The proposed study is an assessor-blind, parallel-group, randomized controlled trial (RCT). The duration of the intervention will be one year with follow-up to year two. The targeted outcomes are exercise capacity, functional ambulation, strength, and components of quality of life including frequency and intensity of fatigue symptoms, mood, global physical function, health perception, and objective measures of activity level. Logistic regression will be used to test the main hypothesis related to the superiority of the MSTEP program based on a greater proportion of people making a clinically relevant gain in exercise capacity at 1 year and at 2 years, using an intention-to-treat approach. Sample size will be 240 (120 per group). DISCUSSION The MS community is clearly looking for interventions to help alleviate the disabling sequelae of MS and promote health. Exercise is a well-known intervention which has known benefits to all, yet few exercise regularly. For people with MS, the role of exercise in MS management needs to be rigorously assessed to inform people as to how best to use exercise to reduce disability and promote health. TRIAL REGISTRATION Clinical Trials.gov: NCT01611987.
Collapse
Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Mark Bayley
- UHN - Toronto Rehabilitation Institute, University Centre, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Pierre Duquette
- Centre hospitalier de l’Université de Montréal, 1560 Sherbrooke Street E, Montreal, Quebec H2L 4M1, Canada
| | - Yves Lapierre
- Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Ross Anderson
- Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC H2W 1S4, Canada
| | - Susan Bartlett
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| |
Collapse
|
36
|
Milivojević I, Adamec I, Habek M. Utilization of physical rehabilitation among people with multiple sclerosis. Ir J Med Sci 2013; 182:429-32. [DOI: 10.1007/s11845-013-0905-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
|
37
|
A Protocol for Measuring the Direct Psychological Benefit of Neuropsychological Assessment with Feedback in Multiple Sclerosis. BRAIN IMPAIR 2012. [DOI: 10.1017/brimp.2012.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article reports on the design of a two-arm, randomised controlled trial of neuropsychological assessment with feedback as a direct therapeutic intervention to improve psychological wellbeing in multiple sclerosis (MS). MS patients and their caregivers are randomly allocated to one of two groups: neuropsychological assessment with feedback (the intervention), or ‘sham wait-list’ control. The trial investigates: (1) whether the intervention directly benefits patients by leading to improved knowledge of their own specific cognitive strengths and weaknesses, and improved use of adaptive psychological strategies for coping with MS; and (2) whether the intervention directly benefits caregivers by leading to improved knowledge of the patients’ specific cognitive strengths and weaknesses, and to a more positive caregiving outcome. A range of primary and secondary measures is used to evaluate these outcomes. The protocol utilises a wait-list control method which is structured to effectively blind patients and caregivers to their group allocation. Publishing the protocol prior to the results of the trial being available has a number of important methodological benefits, and informs the research community of the work that is under way to allow for collaboration and to reduce duplication of research effort. (This trial has been registered on the ANZCTR; ACTRN12612000161820.)
Collapse
|
38
|
Hale LA, Mulligan HF, Treharne GJ, Smith CM. The feasibility and short-term benefits of Blue Prescription: a novel intervention to enable physical activity for people with multiple sclerosis. Disabil Rehabil 2012; 35:1213-20. [DOI: 10.3109/09638288.2012.723787] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Spooren AIF, Timmermans AAA, Seelen HAM. Motor training programs of arm and hand in patients with MS according to different levels of the ICF: a systematic review. BMC Neurol 2012; 12:49. [PMID: 22747894 PMCID: PMC3527200 DOI: 10.1186/1471-2377-12-49] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The upper extremity plays an important role in daily functioning of patients with Multiple Sclerosis (MS) and strongly influences their quality of life. However, an explicit overview of arm-hand training programs is lacking. The present review aims to investigate the training components and the outcome of motor training programs for arm and hand in MS. METHODS A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro and Cochrane) was performed using the following Mesh terms: Multiple Sclerosis, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies and Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. A descriptive analyses was performed using the PICO principle, including scoring of training components with the calculation of Hedges'g effect sizes. RESULTS Eleven studies were eligible (mean Van Tulder-score = 10.82(SD2.96)). Most studies reported a specific improvement in arm hand performance at the ICF level that was trained at. The mean number of training components was 5.5(SD2.8) and a significant correlation (r = 0.67; p < 0.05) between the number of training components and effect sizes was found. The components 'client-centered' and 'functional movement' were most frequently used, whereas 'distribution based practice', 'feedback' and 'random practice' were never used. The component 'exercise progression' was only used in studies with single ICF body function training, with the exception of 1 study with activity level training. Studies including the component 'client-centred' demonstrated moderate to high effect sizes. CONCLUSION Motor training programs (both at the ICF body function and activity level) have shown to improve arm and hand performance in MS in which the value of the training specificity was emphasized. To optimize upper extremity training in MS the component 'client-centred' and 'exercise progression' may be important. Furthermore, given the importance attributed to the components 'distribution based practice', 'feedback' and 'random practice' in previous research in stroke patients, the use of these components in arm hand training should be explored in future research.
Collapse
Affiliation(s)
- Annemie IF Spooren
- Department of Healthcare, PHL University College Hasselt, Hasselt, Belgium
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRi, Maastricht, The Netherlands
- Guffenslaan 39, 3500, Hasselt, Belgium
| | - Annick AA Timmermans
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRi, Maastricht, The Netherlands
| | - Henk AM Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRi, Maastricht, The Netherlands
| |
Collapse
|
40
|
Validation of the comprehensive ICF core set for multiple sclerosis from the perspective of physical therapists. Phys Ther 2012; 92:799-820. [PMID: 22403092 DOI: 10.2522/ptj.20110056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of people with MS. OBJECTIVES The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physical therapists. DESIGN A 3-round survey based on the Delphi technique was used. METHODS Physical therapists experienced in the management of MS were asked about problems and resources of people with MS as well as environmental aspects treated by physical therapists (eg, use of assistive devices, support). Statements were linked to the ICF and compared with the Comprehensive ICF Core Set for MS. RESULTS Eighty physical therapists from 23 countries mentioned 2,133 issues that covered all of the ICF components. Two hundred thirty-eight ICF categories were linked to the statements. Forty-six categories in the Comprehensive ICF Core Set for MS were confirmed by physical therapists at the same level or a more specific level of classification. Nineteen additional ICF categories were reported by at least 75% of the participants. CONCLUSIONS The results of this study support the content and face validity of the Comprehensive ICF Core Set for MS. Areas of functioning and health that physical therapists believe should be assessed were identified. The findings of this study as well as the results of completed and ongoing validation studies will further elucidate the validity of the Comprehensive ICF Core Set for MS from different perspectives.
Collapse
|
41
|
Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler 2012; 18:1686-704. [PMID: 23235779 DOI: 10.1177/1352458512445201] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective is to estimate the extent to which existing health care interventions designed specifically to target health-related quality of life (HRQL) in persons with multiple sclerosis (MS) achieve this aim. The structured literature search was conducted using multiple electronic databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trial, for the years 1960 to 2011. The methodological quality of selected randomized controlled trials (RCTs) was assessed using the Cochrane Collaboration's recommended domain-based method. Effect size (ES) was used to measure the effect of each intervention on HRQL. The studies were combined using a random-effects model to account for inter-study variation. Heterogeneity was tested for using the I-test and publication bias was assessed using funnel plots and the Egger weighted regression statistic. Thirty-nine RCTs met the criteria, all with acceptable methodological quality. Six major types of interventions were identified through the search. The smallest effect was observed for self-management and complementary and alternative medicine (ES=0.2), followed by medication (ES=0.3) then cognitive training and exercise (ES=0.4), and psychological interventions to improve mood (ES=0.7). The magnitude of positive effect on HRQL varied between the different types of interventions. The extent to which interventions are able to improve HRQL depends on delivering a potent intervention to those persons who have the potential to benefit.
Collapse
Affiliation(s)
- Ayse Kuspinar
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Canada.
| | | | | |
Collapse
|
42
|
Conrad A, Coenen M, SchmalZ H, Kesselring J, Cieza A. Validation of the Comprehensive ICF Core Set for Multiple Sclerosis from the perspective of occupational therapists. Scand J Occup Ther 2012; 19:468-87. [DOI: 10.3109/11038128.2012.665475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
43
|
Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. PSYCHOL HEALTH MED 2012; 17:636-51. [PMID: 22313192 DOI: 10.1080/13548506.2011.652640] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Physical activity is associated with many benefits, but persons with multiple sclerosis (MS) are less physically active than the general population. There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population. This randomized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS. Physically inactive, ambulatory persons with MS (N = 45) were randomly assigned to intervention (n = 22) or control (n = 23) conditions and completed a battery of questionnaires before, after, and three months after a 12-week intervention period. Data analyses were conducted in PASW 18.0. Partial eta squared ([Formula: see text]) effect size indicated that there was a large, statistically significant condition-by-time interaction on physical activity ([Formula: see text]). Cohen's d effect sizes indicated that the intervention group had a large increase in physical activity after the 12-week trial (d = .98) that was sustained over a three-month follow-up (d = .79). The current study supports the efficacy of a behavioral intervention for increasing and sustaining physical activity in a sample of persons with MS.
Collapse
|
44
|
Akkuş Y, Akdemir N. Improving the quality of life for multiple sclerosis patients using the nurse-based home visiting model. Scand J Caring Sci 2011; 26:295-303. [DOI: 10.1111/j.1471-6712.2011.00933.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Khan F, Amatya B, Turner-Stokes L. Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurol Res Int 2011; 2011:740505. [PMID: 22013521 PMCID: PMC3196037 DOI: 10.1155/2011/740505] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a "neuropalliative" approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes.
Collapse
Affiliation(s)
- Fary Khan
- Department of Medicine, Dentistry and Health Sciences at The University of Melbourne, Royal Melbourne Hospital and Western Health, Rehabilitation Service—Royal Melbourne Hospital, Poplar Road, Parkville, Melbourne, VIC 3052, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Melbourne, VIC 3052, Australia
| | - Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| |
Collapse
|
46
|
Ng L, Khan F. Use of the international classification of functioning, disability and health to describe patient-reported disability: A comparison of motor neurone disease, Guillain-Barré syndrome and multiple sclerosis in an Australian cohort. Disabil Rehabil 2011; 34:295-303. [DOI: 10.3109/09638288.2011.606345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
47
|
Burks JS, Bigley GK, Hill HH. Rehabilitation challenges in multiple sclerosis. Ann Indian Acad Neurol 2011; 12:296-306. [PMID: 20182578 PMCID: PMC2824958 DOI: 10.4103/0972-2327.58273] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 10/18/2009] [Accepted: 10/18/2009] [Indexed: 11/04/2022] Open
Abstract
While current immunomodulating drugs aim to reduce multiple sclerosis (MS) exacerbations and slow disease progression, rehabilitation aims to improve and maintain the functional abilities of patients in the face of disease progression. An increasing number of journal articles are describing the value of the many rehabilitation interventions that can be used throughout the course of the disease, from the initial symptoms to the advanced stages. An integrated team of healthcare professionals is necessary to address a myriad of problems to reduce impairments, disabilities, and handicaps. The problems may be related to fatigue, weakness, spasticity, mobility, balance, pain, cognition, mood, relationships, bowel, bladder, sexual function, swallowing, speech, transportation, employment, recreation, and activities of daily living (ADL) such as dressing, eating, bathing, and household chores. The team can help prevent complications and secondary disabilities, while increasing patient safety. Improving neurologically related function, maintaining good relationships, and feeling productive and creative adds enormously to the quality of life of people with MS and their families. Rehabilitation is more than an 'extra' service that is given after medical therapies; it is an integral part of the management of the diverse set of problems encountered throughout the course of the disease. An interdisciplinary team may have many members, including physicians, nurses, physical therapists, occupational therapists, speech and language pathologists, psychotherapists, social workers, recreational therapists, vocational rehabilitation therapists, patients, families, and other caregivers.
Collapse
Affiliation(s)
- Jack S Burks
- Medicine (Neurology), University School of Medicine, Reno, Nevada; and Chief Medical Officer, Multiple Sclerosis Association of America (MSAA), Cherry Hill, New Jersey, USA
| | | | | |
Collapse
|
48
|
|
49
|
Miller L, Paul L, Mattison P, McFadyen A. Evaluation of a home-based physiotherapy programme for those with moderate to severe multiple sclerosis: a randomized controlled pilot study. Clin Rehabil 2011; 25:720-30. [PMID: 21504954 DOI: 10.1177/0269215511398376] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effect of an eight-week home-based physiotherapy programme in reducing physical impairment, disability and psychological distress for people with moderate to severe multiple sclerosis (MS). DESIGN Pilot randomized controlled trial. SETTING Community; subjects' homes. SUBJECTS Thirty people moderately to severely affected by MS (Extended Disability Status Score, EDSS, 6.5-8) were randomized to an intervention or control group. INTERVENTION The intervention group received twice weekly, home-based physiotherapy for eight weeks and the control group received usual care. MAIN MEASURES The following outcome measures were recorded at baseline, post-intervention (Week 8) and at follow-up (Week 16). Primary outcome measure; Multiple Sclerosis Impact Scale (MSIS29) and secondary outcome measures assessed physical impairment, MS symptoms, quality of life, mood, and disability. RESULTS Although the Group * Time interaction failed to reach statistical significance with MSIS29 (p = 0.925), MS - related symptom checklist (MS-RS) (p = 0.627) and for lower limb strength, right knee extension (p = 0.375) and right knee flexion (p = 0.794), there is more evidence of altered levels in the treatment group than in the control group. CONCLUSION A minimum of 58 subjects per group are required to achieve a power of 80% at the 5% level of significance based on the MSIS29. A larger scale study is required.
Collapse
Affiliation(s)
- L Miller
- MS Service, NHS Ayrshire and Arran, School of Health, Glasgow Caledonian University, Irvine, UK.
| | | | | | | |
Collapse
|
50
|
Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia. Zdr Varst 2011. [DOI: 10.2478/v10152-010-0025-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|