1
|
Dwyer CP, Oglesby MH, Joyce R, Hynes SM. A Cognitive Occupation-Based programme for people with MS: acceptability, feasibility, and experiences of people with multiple sclerosis. Disabil Rehabil 2024; 46:3026-3036. [PMID: 37493191 DOI: 10.1080/09638288.2023.2239147] [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: 03/04/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE COB-MS is an eight-session, Cognitive Occupation-Based programme for people with both MS and cognitive difficulty - designed to enhance cognition and daily functioning, through a combination of goal-setting, cognitive strategy engagement, group activities, home-practice activities and one-on-one sessions. This research aims to investigate the acceptability of COB-MS from the perspective of people living with MS, as well as the occupational therapists who facilitated the programme. MATERIALS AND METHODS Two content analyses were conducted on interview data from (n = 11) COB-MS participants and (n = 8) COB-MS facilitators. Thematic analysis was also conducted on the participant interview data. RESULTS Through a, primary, content analysis, participants reported that the COB-MS provided both a positive experience and quality resources. Qualitative improvement and utilisation of their learning beyond completion of the intervention were also identified. Four themes were identified via, secondary, thematic analysis: (1) Group interaction within COB-MS was vital; (2) Online COB-MS had positive and negative effects on participation; (3) COB-MS as a provider of clarity; and (4) Using learned strategies after the completion of COB-MS. Recommendations for future administration are provided. CONCLUSIONS Findings suggest COB-MS acceptability, as well as appropriateness and feasibility, indicative of progression to a definitive trial in future research. TRIAL REGISTRATION ISRCTN: ISRCTN11462710. Registered on 9 September 2019.
Collapse
Affiliation(s)
- Christopher P Dwyer
- School of Social Science, Technological University of the Shannon, Athlone, Ireland
| | - Megan H Oglesby
- Discipline of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
| | - Robert Joyce
- Discipline of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
| | - Sinéad M Hynes
- Discipline of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
| |
Collapse
|
2
|
Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
Collapse
Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
3
|
Davies A, Rogers JM, Baker K, Li L, Llerena J, das Nair R, Wong D. Combined Cognitive and Psychological Interventions Improve Meaningful Outcomes after Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09625-z. [PMID: 37955821 DOI: 10.1007/s11065-023-09625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Interventions addressing cognitive and emotional difficulties after acquired brain injury (ABI) often focus on specific impairments in cognition or mood. These interventions can be effective at addressing their specific target, but do not routinely translate to improved activity and participation outcomes. Approaches that combine cognitive and psychological rehabilitation are increasingly popular; however, to date, there have been no systematic evaluations of their efficacy. We conducted a systematic review of five databases, searching for randomised controlled trials of adults with diagnoses of non-progressive ABI at least 1-month post injury, in receipt of interventions that combined cognitive and psychological components compared to any control. Screening and data extraction were evaluated by two independent reviewers using a standardised protocol. Effect sizes were calculated using Hedge's g and estimated using a random-effects model. Risk of bias was assessed using the PEDro-P rating system, and quality of evidence evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) approach. Thirteen studies were included in the meta-analysis (n = 684). There was an overall small-to-medium effect (g = 0.42) for combined interventions compared with controls, with gains maintained at 6-month follow-up. Improvements were observed at the level of impairment, activity, participation and quality of life. GRADE ratings and analyses investigating sensitivity, heterogeneity and publication bias indicated that these effects were robust. No a priori variables moderated these effects. Overall, this review provides strong evidence that combined cognitive and psychological interventions create meaningful change in the lives of people with ABI.
Collapse
Affiliation(s)
- Alexandra Davies
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Katharine Baker
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Lily Li
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Joshua Llerena
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Roshan das Nair
- School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Health Research, SINTEF Digital, Dept. of Health Research, Torgaarden, P.O. Box 4760, Trondheim, NO-7465, Norway
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
| |
Collapse
|
4
|
Margoni M, Preziosa P, Rocca MA, Filippi M. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Transl Psychiatry 2023; 13:264. [PMID: 37468462 PMCID: PMC10356956 DOI: 10.1038/s41398-023-02555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Neuropsychiatric abnormalities may be broadly divided in two categories: disorders of mood, affect, and behavior and abnormalities affecting cognition. Among these conditions, clinical depression, anxiety and neurocognitive disorders are the most common in multiple sclerosis (MS), with a substantial impact on patients' quality of life and adherence to treatments. Such manifestations may occur from the earliest phases of the disease but become more frequent in MS patients with a progressive disease course and more severe clinical disability. Although the pathogenesis of these neuropsychiatric manifestations has not been fully defined yet, brain structural and functional abnormalities, consistently observed with magnetic resonance imaging (MRI), together with genetic and immunologic factors, have been suggested to be key players. Even though the detrimental clinical impact of such manifestations in MS patients is a matter of crucial importance, at present, they are often overlooked in the clinical setting. Moreover, the efficacy of pharmacologic and non-pharmacologic approaches for their amelioration has been poorly investigated, with the majority of studies showing marginal or no beneficial effect of different therapeutic approaches, possibly due to the presence of multiple and heterogeneous underlying pathological mechanisms and intrinsic methodological limitations. A better evaluation of these manifestations in the clinical setting and improvements in the understanding of their pathophysiology may offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. This review provides an updated overview regarding the pathophysiology of the most common neuropsychiatric symptoms in MS, the clinical and MRI characteristics that have been associated with mood disorders (i.e., depression and anxiety) and cognitive impairment, and the treatment approaches currently available or under investigation.
Collapse
Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
5
|
Paolucci T, de Sire A, Agostini F, Bernetti A, Salomè A, Altieri M, Di Piero V, Ammendolia A, Mangone M, Paoloni M. Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial. Front Neurol 2022; 13:1095180. [PMID: 36619928 PMCID: PMC9812570 DOI: 10.3389/fneur.2022.1095180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The aim of this randomized controlled trial was to evaluate the effect of an embodied rehabilitative protocol, in improving interoceptive awareness respect balance and motor performance in patients with mild multiple sclerosis (pwMS). Methods In this study patients with relapsing-remitting multiple sclerosis were enrolled. The rehabilitative treatment group (TG) participated in an embodied physiotherapy program consisting of 8 one-hour sessions in groups of 4 patients at a time, 1 per week and 2 one-hour sessions of neuro-cognitive exercise in single session during the rehabilitation program. All pwMS underwent a clinical assessment to measure the interoception sense for the Multidimensional Assessment of Interoceptive Awareness scale, balance for the Tinetti Mobility test and stabilometry, quality of life for the Short Form Health Survey-12 and body image perception for Trunk Appearance Perception Scale and Body Image Scale. All previous scales and tests were performed at baseline (T0), at the end of treatment (T1) and after 2 months of follow up (T2). Results Sixty patients were enrolled and randomized into two groups: TG (n = 30), aged 43.0 ± 10.2 years, and a control/waiting list (WLG) group (n = 30), aged 40.7 ± 10.4 years. Statistically significant improvements in interoceptive awareness, body image perception, balance and quality of life were reported in TG versus WLG (p < 0.05). Discussion This study suggests that enhancing interoceptive awareness could improve postural balance. Future studies with a larger sample of patients will be needed to better quantify the effects of an embodied rehabilitation.
Collapse
Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences (DSMOB), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University, Chieti-Pescara, Chieti, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy,*Correspondence: Alessandro de Sire ✉
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy,Department of Neurological and Rehabilitation Science, IRCCS San Raffaele, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Angela Salomè
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Marta Altieri
- Multiple Sclerosis Center, Sapienza University, Rome, Italy
| | | | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| |
Collapse
|
6
|
Kirsty CW, Mary H, Sumner J. Identify the report as a systematic review. Nutr Health 2022; 28:527-542. [PMID: 35254171 DOI: 10.1177/02601060221080240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: To examine the relationship of vitamin B12 and folate concentrations to cognitive function, fatigue measures, physical function, quality of life (patient-centred outcomes) and homocysteine plasma concentrations (intermediate marker of cobalamin and folate deficiency) for patients with Multiple Sclerosis (MS). Methods: Systematic searches for eligible articles of MEDLINE, CINAHL, EMBASE, Scopus, Web of Science and OpenGray databases were conducted from 1983 in March 2021. Heterogeneity, Weighted Mean Difference (WMD) and Confidence Intervals (CI) calculated using Random Effects Model. Results: Sixteen studies were included involving; 616 MS patients and 655 healthy controls. 14 of these had acceptable or better quality but there was high heterogeneity. No difference was found between MS, healthy controls for folate and cobalamin concentrations; WMD 0.00ug/L (95% CI: -0.01, 0.01) and WMD 7.01pmol/L (95% CI: -25.54, 39.55) respectively. MS group showed mild-to-moderate disability WMD was 2.78 (95% CI: 2.00, 3.56). MS may be associated with elevated plasma homocysteine concentrations on average 2.47µmol/L more than healthy controls. Discussion: Physical ability of MS group was worse than healthy controls, but there was no difference in folate and cobalamin concentrations. This suggests folate and cobalamin are not influential factors in worsening physical function. There may be an association between worse cognitive function, and increased homocysteine concentrations. Results were inconclusive due to high heterogeneity and limited number of studies. A core outcome set would enable easier synthesis of future results.
Collapse
Affiliation(s)
- Cummins-Williams Kirsty
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
| | - Hickson Mary
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
| | - Jonathan Sumner
- 62641University of Plymouth Faculty of Health and Human Sciences Ringgold standard institution, Peninsula Allied Health Centre Derriford Road, Plymouth PL4 8AA, UK of Great Britain and Northern Ireland
| |
Collapse
|
7
|
Small R, Wilson PH, Wong D, Rogers JM. Who, what, when, where, why, and how: a systematic review of the quality of post-stroke cognitive rehabilitation protocols. Ann Phys Rehabil Med 2021; 65:101623. [PMID: 34933125 DOI: 10.1016/j.rehab.2021.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND . Rehabilitation research findings are not routinely incorporated into clinical practice. A key barrier is the quality of reporting in the original study, including who provided the intervention, what it entailed, when and where it occurred, how patient outcomes were monitored, and why the intervention was efficacious. OBJECTIVES . To facilitate clinical implementation of post-stroke cognitive rehabilitation research, we undertook a review to examine the quality of intervention reporting in this literature. METHODS . Four databases were systematically searched, identifying 27 randomised controlled trials of post-stroke cognitive rehabilitation. The quality of intervention protocol descriptions in each study was independently rated by 2 of the authors using the 12-item Template for Intervention Description and Replication (TIDieR) checklist. RESULTS .Why, when, and where items were reported in more than 70% of interventions, what materials and procedures used was described in 50% to 70%, how items were described in approximately half of the interventions, and who provided interventions was reported in 22% of studies. No study addressed all 12 TIDieR items. "Active ingredients" that may further characterise an intervention and the potential mechanisms of action included restorative training, massed practice, feedback, and tailoring demands (present in approximately 50% of studies). CONCLUSIONS . Descriptions of intervention protocols are variable and frequently insufficient, thereby restricting the ability to understand, replicate, and implement evidence-based cognitive rehabilitation. Use of reporting checklists to address this barrier to research translation is a readily achievable and effective means to advance post-stroke care.
Collapse
Affiliation(s)
- Rebecca Small
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Peter H Wilson
- Centre for Disability and Development Research, Australian Catholic University, Australia
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, Australia
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; neuroCare Group, Sydney, Australia.
| |
Collapse
|
8
|
Harenberg S, St. Onge J, Robinson J, Eguakun O, Feinstein A, Dorsch K, Kakar RS, Abdulhakim R, Rehman Z, Shawush M, Pillay V. Effectiveness of Three-Dimensional Multiple-Object Tracking in Patients with Multiple Sclerosis: A Pilot Trial. Int J MS Care 2021; 23:143-149. [PMID: 34483752 PMCID: PMC8405148 DOI: 10.7224/1537-2073.2020-007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Computerized cognitive training remains an attractive supplemental modality to enhance rehabilitation in multiple sclerosis (MS). The objective of the present study was to assess the usability of three-dimensional multiple-object tracking (3D-MOT) in patients with MS. METHODS In this pilot study, 16 patients with relapsing-remitting MS and nine age-matched controls participated in four 30-minute training sessions of 3D-MOT. Computerized neuropsychological tests, including driving readiness (ie, Useful Field of View) and cognitive function (ie, Stroop Color and Word Test, Paced Visual Serial Addition Test, Symbol Digit Modalities Test) were conducted at baseline and at the conclusion of training. RESULTS Although scoring lower in 3D-MOT, the MS group improved their 3D-MOT scores in similar magnitude as the control group. The 3D-MOT training led to significant improvements in driving readiness in the MS group. Taken together, 3D-MOT training showed similar effectiveness in patients with MS as in age-matched controls. CONCLUSIONS Training with 3D-MOT may be an accessible and remotely administrable supplement to cognitive rehabilitation protocols for patients with MS.
Collapse
|
9
|
de Bruin M, Black N, Javornik N, Viechtbauer W, Eisma MC, Hartman-Boyce J, Williams AJ, West R, Michie S, Johnston M. Underreporting of the active content of behavioural interventions: a systematic review and meta-analysis of randomised trials of smoking cessation interventions. Health Psychol Rev 2021; 15:195-213. [PMID: 31906781 DOI: 10.1080/17437199.2019.1709098] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Despite its importance, underreporting of the active content of experimental and comparator interventions in published literature has not been previously examined for behavioural trials. We assessed completeness and variability in reporting in 142 randomised controlled trials of behavioural interventions for smoking cessation published between 1/1996 and 11/2015. Two coders reliably identified the potential active components of experimental and comparator interventions (activities targeting behaviours key to smoking cessation and qualifying as behaviour change techniques, BCTs) in published, and in unpublished materials obtained from study authors directly. Unpublished materials were obtained for 129/204 (63%) experimental and 93/142 (65%) comparator groups. For those, only 35% (1200/3403) of experimental and 26% (491/1891) of comparator BCTs could be identified in published materials. Reporting quality (#published BCTs/#total BCTs) varied considerably between trials and between groups within trials. Experimental (vs. comparator) interventions were better reported (B(SE) = 0.34 (0.11), p < .001). Unpublished materials were more often obtained for recent studies (B(SE) = 0.093 (0.03), p = .003) published in behavioural (vs. medical) journals (B(SE) = 1.03 (0.41), p = .012). This high variability in underreporting of active content compromises reader's ability to interpret the effects of individual trials, compare and explain intervention effects in evidence syntheses, and estimate the additional benefit of an experimental intervention in other settings.
Collapse
Affiliation(s)
- Marijn de Bruin
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Neza Javornik
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Jamie Hartman-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute of Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A Jess Williams
- Institute of Mental HealthSchool of Psychology, University of Birmingham, Birmingham, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
| |
Collapse
|
10
|
Lincoln NB, Bradshaw LE, Constantinescu CS, Day F, Drummond AE, Fitzsimmons D, Harris S, Montgomery AA, das Nair R. Group cognitive rehabilitation to reduce the psychological impact of multiple sclerosis on quality of life: the CRAMMS RCT. Health Technol Assess 2021; 24:1-182. [PMID: 31934845 DOI: 10.3310/hta24040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with multiple sclerosis have problems with memory and attention. The effectiveness of cognitive rehabilitation has not been established. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of a cognitive rehabilitation programme for people with multiple sclerosis. DESIGN This was a multicentre, randomised controlled trial in which participants were randomised in a ratio of 6 : 5 to receive cognitive rehabilitation plus usual care or usual care alone. Participants were assessed at 6 and 12 months after randomisation. SETTING The trial was set in hospital neurology clinics and community services. PARTICIPANTS Participants were people with multiple sclerosis who had cognitive problems, were aged 18-69 years, could travel to attend group sessions and gave informed consent. INTERVENTION The intervention was a group cognitive rehabilitation programme delivered weekly by an assistant psychologist to between four and six participants for 10 weeks. MAIN OUTCOME MEASURES The primary outcome was the Multiple Sclerosis Impact Scale - Psychological subscale at 12 months. Secondary outcomes included results from the Everyday Memory Questionnaire, the 30-Item General Health Questionnaire, the EuroQol-5 Dimensions, five-level version and a service use questionnaire from participants, and the Everyday Memory Questionnaire - relative version and the Modified Carer Strain Index from a relative or friend of the participant. RESULTS Of the 449 participants randomised, 245 were allocated to cognitive rehabilitation (intervention group) and 204 were allocated to usual care (control group). Of these, 214 in the intervention group and 173 in the control group were included in the primary analysis. There was no clinically important difference in the Multiple Sclerosis Impact Scale - Psychological subscale score between the two groups at the 12-month follow-up (adjusted difference in means -0.6, 95% confidence interval -1.5 to 0.3; p = 0.20). There were no important differences between the groups in relation to cognitive abilities, fatigue, employment, or carer strain at follow-up. However, there were differences, although small, between the groups in the Multiple Sclerosis Impact Scale - Psychological subscale score at 6 months (adjusted difference in means -0.9, 95% confidence interval -1.7 to -0.1; p = 0.03) and in everyday memory on the Everyday Memory Questionnaire as reported by participants at 6 (adjusted difference in means -5.3, 95% confidence interval -8.7 to -1.9) and 12 months (adjusted difference in means -4.4, 95% confidence interval -7.8 to -0.9) and by relatives at 6 (adjusted difference in means -5.4, 95% confidence interval -9.1 to -1.7) and 12 months (adjusted difference in means -5.5, 95% confidence interval -9.6 to -1.5) in favour of the cognitive rehabilitation group. There were also differences in mood on the 30-Item General Health Questionnaire at 6 (adjusted difference in means -3.4, 95% confidence interval -5.9 to -0.8) and 12 months (adjusted difference in means -3.4, 95% confidence interval -6.2 to -0.6) in favour of the cognitive rehabilitation group. A qualitative analysis indicated perceived benefits of the intervention. There was no evidence of a difference in costs (adjusted difference in means -£574.93, 95% confidence interval -£1878.93 to £729.07) or quality-adjusted life-year gain (adjusted difference in means 0.00, 95% confidence interval -0.02 to 0.02). No safety concerns were raised and no deaths were reported. LIMITATIONS The trial included a sample of participants who had relatively severe cognitive problems in daily life. The trial was not powered to perform subgroup analyses. Participants could not be blinded to treatment allocation. CONCLUSIONS This cognitive rehabilitation programme had no long-term benefits on quality of life for people with multiple sclerosis. FUTURE WORK Future research should evaluate the selection of those who may benefit from cognitive rehabilitation. TRIAL REGISTRATION Current Controlled Trials ISRCTN09697576. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 4. See the National Institute for Health Research Journals Library website for further project information.
Collapse
Affiliation(s)
- Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
11
|
Manca R, Mitolo M, Wilkinson ID, Paling D, Sharrack B, Venneri A. A network-based cognitive training induces cognitive improvements and neuroplastic changes in patients with relapsing-remitting multiple sclerosis: an exploratory case-control study. Neural Regen Res 2021; 16:1111-1120. [PMID: 33269758 PMCID: PMC8224115 DOI: 10.4103/1673-5374.300450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life. No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically. This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis. Forty-five patients (36 females and 9 males, mean age 44.62 ± 8.80 years) with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups (sham training and non-active control). The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks. The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load. The non-active control group received no cognitive training. All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks. Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models. At reassessment, the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training: the Buschke Selective Reminding Test and the Semantic Fluency test. The standard training group showed reductions in functional connectivity of the salience network, in the anterior cingulate cortex, associated with improvements on the Buschke Selective Reminding Test. No changes were observed in the sham training group. These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed. The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains. This study was approved by the Regional Ethics Committee of Yorkshire and Humber (approval No. 12/YH/0474) on November 20, 2013.
Collapse
Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Micaela Mitolo
- Department of Neuroscience, University of Sheffield, Sheffield, UK; Istituto di Ricovero e Cura a Carattere Scientifico Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica, Bologna, Italy
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - David Paling
- Department of Neuroscience, University of Sheffield; Academic Department of Neuroscience, Sheffield Teaching Hospital, National Health Service Foundation Trust, Sheffield, UK
| | - Basil Sharrack
- Academic Department of Neuroscience, Sheffield Teaching Hospital, National Health Service Foundation Trust, Sheffield, UK
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| |
Collapse
|
12
|
Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G. Focus on neglected features of cognitive rehabilitation in MS: Setting and mode of the treatment. Mult Scler 2020; 28:1009-1019. [PMID: 33045916 PMCID: PMC9131413 DOI: 10.1177/1352458520966300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cognitive rehabilitation in multiple sclerosis (MS) aims at reducing patients’
cognitive impairments, improving their awareness and ability to take cognitive
difficulties into account in their daily living. However, at this moment, more
high-quality randomized trials are needed to draw conclusion about the
effectiveness of cognitive interventions in MS. Although existing studies
provide clear descriptions of intervention key ingredients (e.g. targeted
cognitive domain as well as treatment frequency and duration) and the practical
details needed to manage these key elements (e.g. restorative approaches,
compensatory strategies, or environmental modifications), other crucial aspects
received less attention in rehabilitation research. The aim of this topical
review is to try to elucidate some critical issues that were only partly
addressed and analyzed by the scientific literature: setting (center-based vs
home-based) and mode (individual vs group) of the cognitive rehabilitation
treatment.
Collapse
Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| |
Collapse
|
13
|
Developing a clinical pathway to identify and manage cognitive problems in Multiple Sclerosis: Qualitative findings from patients, family members, charity volunteers, clinicians and healthcare commissioners. Mult Scler Relat Disord 2020; 49:102563. [PMID: 33677366 PMCID: PMC7533050 DOI: 10.1016/j.msard.2020.102563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/03/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cognitive problems are a common and debilitating symptom of multiple sclerosis (MS). Screening and treatment for cognitive problems are recommended, however these are not routinely delivered in UK clinics. We collected and synthesised stakeholder perspectives to develop a care pathway for cognitive problems in MS and produce a logic model, illustrating how this pathway might operate. METHODS Forty-nine stakeholders, including people with MS and care providers, participated in semi-structured interviews and focus groups. Participants viewed information that illustrated how the pathway might work and provided feedback. Data, transcribed verbatim and analysed using Framework Analysis, were mapped onto a preliminary logic model and accompanying thematic framework. RESULTS The proposed pathway was perceived as helpful in providing standardised support for a neglected MS symptom. Training packages, online cognitive screening, and triaging decisions were viewed as crucial activities. Shared responsibility, a person-centred approach, and addressing the complexity of cognitive problems were important engagement mechanisms. Allocating time during clinic appointments and within staff workloads were essential resources for implementation. CONCLUSION Our co-constructed MS cognitive screening and management pathway will be evaluated for clinical and cost-effectiveness in a trial. However, in the interim, clinicians can adapt and implement this pathway in their own services and evaluate it locally.
Collapse
|
14
|
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
|
15
|
Lincoln NB, Bradshaw LE, Constantinescu CS, Day F, Drummond AER, Fitzsimmons D, Harris S, Montgomery AA, das Nair R, Morgan M, Scott J, Evans S, McKeown S, Bharadia T, Moore P, Young C, Sharrack B, Isaac C, Griffths D, Fixter V, Hanley L, Evans S, Palmer L, Tyrell T, Gaughan S, Elliot G, Keogh S, Oldknow H, Edwards C, Schofield N, Clarke S, Crossley K, Griffiths H, Knight C, Martin K, Cunliffe A, Pollard C, Wilson J, Trigg E, Vanzan S, Dalton J, Pegnall S, Carpenter H, Cogger H, Harnell R, Klein O, Mhizha-Murira J, Powers K, Squires L, Sprange K, Evans A, Hobbs J, Wakefield N, Barnes B, Crone M, Foster M, Rumsey C, Erven A, Moss-Morris R, Bowen A, O’Connor R, Freeman J, Taylor R, Rose A. Cognitive rehabilitation for attention and memory in people with multiple sclerosis: a randomized controlled trial (CRAMMS). Clin Rehabil 2019; 34:229-241. [DOI: 10.1177/0269215519890378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the clinical and cost-effectiveness of cognitive rehabilitation for attention and memory problems in people with multiple sclerosis. Design: Multicentre, pragmatic, randomized controlled trial. Setting: Community Participants: People with multiple sclerosis aged 18–69 years, who reported cognitive problems in daily life and had cognitive problems on standardized assessment. Interventions: A group cognitive rehabilitation programme delivered in 10 weekly sessions in comparison with usual care. Main measures: The primary outcome was the Multiple Sclerosis Impact Scale Psychological subscale at 12 months after randomization. Secondary outcomes included measures of everyday memory problems, mood, fatigue, cognitive abilities and employment at 6 and 12 months after randomization. Results: In all, 245 participants were allocated to cognitive rehabilitation and 204 to usual care. Mean Multiple Sclerosis Impact Scale Psychological at 12 months was 22.2 (SD = 6.1) for cognitive rehabilitation and 23.4 (SD = 6.0) for usual care group; adjusted difference −0.6, 95% confidence interval (CI) = −1.5 to 0.3, P = 0.20. No differences were observed in cognitive abilities, fatigue or employment. There were small differences in favour of cognitive rehabilitation for the Multiple Sclerosis Impact Scale Psychological at 6 months and everyday memory and mood at 6 and 12 months. There was no evidence of an effect on costs (−£808; 95% CI = −£2248 to £632) or on quality-adjusted life year gain (0.00; 95% CI = −0.01 to 0.02). Conclusion: This rehabilitation programme had no long-term benefits on the impact of multiple sclerosis on quality of life, but there was some evidence of an effect on everyday memory problems and mood.
Collapse
Affiliation(s)
- Nadina B Lincoln
- Division of Rehabilitation and Ageing, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|