Objectively assessed physiological, physical, and cognitive function along with patient-reported outcomes during the first 2 years of Alemtuzumab treatment in multiple sclerosis: a prospective observational study

INTRODUCTION

In persons with multiple sclerosis (pwMS), little evidence exist on the effects of Alemtuzumab on physiological, physical, and cognitive function along with patient-reported outcomes, despite these domains are being rated as highly important. Therefore, our purpose was to perform a prospective observational study to examine these outlined outcomes during the first two years of Alemtuzumab treatment in pwMS.

METHODS

In n = 17 relapsing-remitting pwMS, physiological function [body composition; bone mineral content; muscle strength; aerobic capacity], physical function [6-min walk test (6MWT, primary outcome); timed 25 ft walk test (T25FWT); six spot step test (SSST); 9-step stair ascend (9SSA); timed up and go test (TUG); 5 × sit to stand test (5STS)], cognitive function [selective reminding test (SRT); symbol digit modalities test (SDMT)], and patient-reported outcomes [multiple sclerosis impact scale-29 (MSIS29); 12-item multiple sclerosis walking scale (MSWS12); modified fatigue impact scale (MFIS); hospital anxiety and depression scale (HADS)] were assessed prior to Alemtuzumab treatment initiation as well as 3, 6, 12, and 24 months into the treatment.

RESULTS

Improvements were observed at 24-month follow-up in T25FWT (+ 8%), SSST (+ 10%), SDMT (+ 5.2 points, 53% improved more than the clinical cut-off score) and SRT, whereas the primary outcome 6MWT, and all other remaining outcomes, remained stable throughout the Alemtuzumab treatment period.

CONCLUSION

The present findings suggest that Alemtuzumab treatment in relapsing-remitting pwMS can improve certain domains of physical function (short distance walking) and cognitive function (processing speed, memory), and furthermore stabilize physiological and physical function along with patient-reported outcomes.

TRIAL REGISTRATION

Registered at clinicaltrials.gov: NCT03806387.

Can Proxy Ratings Supplement Patient Report to Assess Functional Domains Among Hospitalized Patients?

OBJECTIVE

To (1) characterize the agreement between patient and proxy responses on a multidimensional computerized adaptive testing (MCAT) measure of function, and to (2) determine whether patient, proxy, or MCAT score characteristics identify when a proxy report can be used as a substitute for patient report in clinical decision making.

DESIGN

A psychometric study of the Functional Assessment in Acute Care MCAT (FAMCAT) and its three scales (Applied Cognition, Daily Activity, and Basic Mobility).

SETTING

An Upper Midwestern quaternary academic medical center PARTICIPANTS: A total of 300 pairs of patients [average age 60.9 years (range 19 to 89)] hospitalized on general medical services or readmitted to surgical services for postoperative complications and their proxies [average age 60.5 years (range 20-88].

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

There were three outcomes:. 1) Agreement between patient and proxy scores on the FAMCAT domains, as well as age and gender, analyzed with univariate and multivariate analysis of variance (MANOVA); 2) Associations of patient-proxy relationship and FAMCAT score characteristics with patient-proxy score agreement; and 3) Presence of psychometrically significant intra-dyad differences in FAMCAT scores.

RESULTS

The results of the MANOVA and follow-up ANOVAs indicated that there were no statistically significant differences in FAMCAT scale scores between patient and proxy estimates for either the Daily Activity or Basic Mobility scales. There were significant differences for the Applied Cognition scale (p < .005) between mean patient and proxy scores, with proxies rating patients as functioning at a higher level (mean = 0.42) than patients did themselves (mean = 0.00). However, psychometrically significant intra-dyadic Applied Cognition score differences occurred in only 14% of dyads, compared to 25% in the other two scales. Gender and age were associated with patient-proxy agreement, but the patterns were not sufficiently consistent to permit generalizations regarding the likely validity of a proxy's scores.

CONCLUSIONS

Patient and proxy FAMCAT Daily Activity and Basic Mobility scores did not differ significantly, and proxy reporting offers a credible surrogate for patient report on these domains. Low rates of psychometrically significant intra-dyadic score differences suggest that proxy report may serve as a low resolution screen for functional deficits in all FAMCAT domains. Approximately half the proxies provided multi-domain profile ratings on the three scales that did not differ significantly from these of the associated patients, but more research is needed to identify situations in which proxy profiles could be used in place of those provided by patients.

Testing of Journal Writing for Symptom Concordance in Adults with Multiple Sclerosis

Background

Adults with multiple sclerosis (MS) experience many complex symptoms. However, research is lacking on the best method to record their symptom experience. The primary goal of this study was to test the feasibility of journal writing to capture the description of core symptoms experienced by adults with MS. A secondary goal was to collect self-report symptom data to assess concordance between the journal entries and MS-Related Symptom Checklist (MS-RS) scores.

Methods

A preselected group of participants (n = 5) from the total sample of 16 participants with MS were asked to complete the revised MS-RS and Web-based journal writing for 20 minutes per day for 4 consecutive days over a 4-week period. Feasibility was evaluated by journal completion rates.

Results

Most participants found journal writing acceptable as a method for writing about symptoms. Participants were able to write about symptoms that formed clusters: unpredictable physical alterations and unpredictable sensory and emotional changes. Likewise, participants reported frequent fatigue, difficulty sleeping, heat intolerance, and difficulty concentrating/cognitive problems from the revised MS-RS. Disconcordance between revised MS-RS data and journal entries included lack of disclosure of difficulty sleeping and "pins and needles" in the journals.

Conclusions

Preliminary findings from this study provide the personal perspectives of core symptoms experienced by adults with MS. These results provide preliminary evidence of the feasibility of journal writing, along with self-report survey, to describe symptoms in adults with MS.

β-endorphin and opioid growth factor as biomarkers of physical ability in multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is an autoimmune-mediated degenerative disorder with increased peripheral inflammation disrupting the blood brain barrier. With increasing MS-related healthcare costs, the requirement to validate minimally invasive biomarkers has become imperative.

METHODS

Relapsing-remitting MS patients on disease modifying therapies were consented at the Penn State Health MS Clinic to provide blood samples for analyses of serum cytokines and endogenous opioid peptides, as well as to complete the MSQOL-54 survey.

RESULTS

Serum OGF levels in MS patients on glatiramer acetate (mean = 326 pg/ml), dimethyl fumarate (mean = 193.3 pg/ml) and natalizumab (mean = 393.4 pg/ml) were significantly elevated (p < 0.01) compared to healthy controls (mean = 98.46 pg/ml). Individuals with elevated OGF levels also had increased levels of TNFα (r = 0.78) and IL-17A (r = 0.81). Only patients treated with glatiramer acetate had significant (p < 0.01) elevations in serum β-endorphin levels. Analyses of MS-QoL 54 data showed no significant differences in physical or mental composite scores between treatment groups. However, serum levels of β-endorphin had a direct correlation with physical health composite score (r = 0.70) in all treatments. Serum vitamin D levels had an indirect relationship with 25-foot walk test times (r = 0.47).

CONCLUSION

Both regression and cohort data suggest that serum levels of OGF, β-endorphin, and vitamin D are potential biomarkers for physical disease status in MS.

Differences between patient- and proxy-reported HRQoL using the Wound-QoL

The purpose of this study was to examine the patient- and proxy-report agreement on the Wound-quality of life (QoL) questionnaire to assess health-related QoL in patients with chronic wounds. Patients and their proxies (in this case, relatives) were recruited via different nursing services in Germany and asked to complete the Wound-QoL. Intraclass correlation coefficients were calculated for each Wound-QoL scale and the total score, and weighted Cohen's Kappa coefficients for individual items. Proxies tended to report lower health-related QoL in the Wound-QoL than their relatives with chronic wounds. Agreement between the two perspectives was moderate on single-item level and excellent on scale level. Proxy-reports can be helpful, if patients are unable to provide information, although caution remains when interpreting the results. However, the patient's own perspective remains preferable.

Examining the Relationship Between Family Caregivers' Emotional States and Ability to Empathize with Patients with Multiple Sclerosis: A Pilot Study

BACKGROUND

Multiple sclerosis (MS) is the most common nontraumatic cause of disability affecting young adults in Canada. Caregivers of patients with MS are highly psychologically burdened. Empathy and helping behaviors are hallmarks of quality care, but when they are challenged, suboptimal patient care can result. We aimed to evaluate the prevalence of negative emotional states among primary caregivers of people with MS; the association between the caregiver's empathy-related behavior and the physical and cognitive impairment of the person with MS; and the association between the caregiver's emotional status and his or her empathy-related behaviors.

METHODS

We conducted a descriptive, cross-sectional pilot study with family caregivers of noninstitutionalized individuals living with MS. We used univariate linear regression models for each potential predictor. The Kruskal-Wallis test was conducted to compare differences in caregiver empathic responses depending on Profile of Mood States subscale scores.

RESULTS

Thirty percent of caregivers had elevated or very elevated mood scores, and such elevated scores were associated with greater functional impact of MS on the person with MS. Patient severity of cognitive impairment was not associated with caregiver mood scores. Caregiver mood state was not associated with empathy-related behaviors. Empathy-related behaviors were less frequent when levels of anger and hostility were higher, but this association did not reach statistical significance.

CONCLUSIONS

Given the elevated levels of fatigue, depression, and anger observed among caregivers in this study, clinicians need to be aware of the potential impact of caregiving and to assess the needs of caregivers.

Investigating the minimal important difference in ambulation in multiple sclerosis: a disconnect between performance-based and patient-reported outcomes?

OBJECTIVE

We sought to estimate the MID on two patient-reported outcome (PRO) measures that are frequently used in multiple sclerosis (MS) clinical research: the MS Walking Scale and the MS Impact Scale-29. We anchored the Minimally Important Differences with an objective measure of ambulation, the accelerometer.

METHODS

This secondary analysis used longitudinal data from an observational study of symptoms and physical activity in 269 people with Relapsing-Remitting Multiple Sclerosis. Participants completed a battery of PRO questionnaires, and then wore an accelerometer for seven days at each data collection time point every six months for 2.5 years. Statistical analysis first defined Change Groups on the basis of the performance-based accelerometer scores, anchored to 0.5 standard deviation change; then change was defined on the basis of published and linked MIDs for the PROs.

RESULTS

The performance-based (accelerometer) and PRO-based change distributions were stable over time. Raw scores among the accelerometer and PRO measures were associated with large effect sizes, and PRO change scores were associated with each other but not with accelerometer change scores.

CONCLUSIONS

These findings contradict a central assumption that may underlie clinical research studies: that a cross-sectional correlation implies that change in PROs will correspond with change in behavior/performance. Possible explanations related to accuracy of the performance-based measure, as well as response shift effects on the PROs are discussed.