1
|
van Egmond E, van der Hiele K, de Rooij M, van Gorp D, Jongen P, van der Klink J, Reneman M, Beenakker E, van Eijk J, Frequin S, de Gans K, Hoitsma E, Gerlach O, Mostert J, Verhagen W, Visser L, Middelkoop H. Longitudinal determinants of employment status in people with relapsing-remitting multiple sclerosis. IBRO Neurosci Rep 2024; 16:518-526. [PMID: 38660124 PMCID: PMC11040135 DOI: 10.1016/j.ibneur.2024.04.002] [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: 02/25/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose To investigate longitudinal relationships between employment status and disease-related, (neuro)psychological, and work-related factors in people with multiple sclerosis (MS). Methods 170 employed people with MS underwent yearly neurological and neuropsychological examinations to assess MS-related disability and cognitive functioning. Additionally, they completed yearly questionnaires assessing depression, anxiety, fatigue, cognitive complaints, workplace support and coping. Multilevel models for change were fitted to examine progression of these factors over three years, and to assess possible relationships with change in employment status. Results People with a deteriorated employment status after three years reported more depression (p=0.009), a higher impact of fatigue (p<0.001), more cognitive complaints (p<0.001) and less workplace support (p=0.001) at baseline than people with a stable employment status. There were no differences in progression over time of the examined variables between people with a stable or deteriorated employment status. Conclusion More depression, a higher impact of fatigue, more cognitive complaints and less workplace support are predictive of a deteriorated employment status after three years in individuals with MS. How these factors progress over time is not different between those with a stable or deteriorated employment. MS-related disability, anxiety, objective cognition and coping were not related to a deterioration in employment status.
Collapse
Affiliation(s)
- E.E.A. van Egmond
- Leiden University, Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands
- Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
- National Multiple Sclerosis Foundation, Rotterdam, the Netherlands
- University of Humanistic Studies, Utrecht, the Netherlands
| | - K. van der Hiele
- Leiden University, Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands
| | - M.J. de Rooij
- Leiden University, Methodology and Statistics Department, Institute of Psychology, Leiden, the Netherlands
| | - D.A.M. van Gorp
- Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
| | - P.J. Jongen
- MS4 Research Institute, Ubbergseweg 34, Nijmegen 6522 KJ, the Netherlands
- Department of Community & Occupational Medicine, University of Groningen, University Medical Centre Groningen, PO Box 30001, Groningen 9700 RB, the Netherlands
| | - J.J.L. van der Klink
- Tilburg School of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, Tilburg University, PO Box 90153, Tilburg 5000 LE, the Netherlands
- Optentia, North West University of South Africa, PO Box 1174, Vanderbijlspark, South Africa
| | - M.F. Reneman
- Department of Rehabilitation Medicine, Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, PO Box 30.002, Haren 9750 RA, the Netherlands
| | - E.A.C. Beenakker
- Department of Neurology, Medical Centre Leeuwarden, PO Box 888, Leeuwarden 8901 BR, the Netherlands
| | - J.J.J. van Eijk
- Department of Neurology, Jeroen Bosch Hospital,, PO Box 90153, ‘s-Hertogenbosch 2000 ME, the Netherlands
| | - S.T.F.M. Frequin
- Department of Neurology, St. Antonius Hospital, PO Box 2500, Nieuwegein 3430 EM, the Netherlands
| | - K. de Gans
- Department of Neurology, Groene Hart Hospital, PO Box 1098, Gouda 2800 BB, the Netherlands
| | - E. Hoitsma
- Department of Neurology, Alrijne Hospital, PO Box 4220, Leiderdorp, the Netherlands
| | - O.H.H. Gerlach
- Department of Neurology, Zuyderland Medical Centre, PO Box 5500, Sittard-Geleen 6130 MB, the Netherlands
- Department of Neurology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, the Netherlands
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, the Netherlands
| | - J.P. Mostert
- Department of Neurology, Rijnstate Hospital, PO Box 9555, Arnhem 6800 TA, the Netherlands
| | - W.I.M. Verhagen
- Department of Neurology, Canisius-Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, the Netherlands
| | - L.H. Visser
- Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
- University of Humanistic Studies, Utrecht, the Netherlands
| | - H.A.M. Middelkoop
- Leiden University, Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands
- Leiden University Medical Centre, Department of Neurology & Neuropsychology, Leiden, the Netherlands
| |
Collapse
|
2
|
Van Hijfte L, Cambron M, Capron B, Dachy B, Decoo D, Dive D, Dubois B, Sankari SE, London F, Perrotta G, Popescu V, Van Pesch V, Van Wijmeersch B, Willekens B, Laureys G. Multiple Sclerosis Multidisciplinary Care: A National Survey and Lessons for the Global Community. Mult Scler Relat Disord 2024; 85:105540. [PMID: 38489948 DOI: 10.1016/j.msard.2024.105540] [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: 03/29/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Access to, standardization and reimbursement of multidisciplinary care for people with MS (PwMS) is lacking in many countries. Therefore, this study aims to describe the current multidisciplinary care for people with MS (PwMS) in Belgium and identify benefits, needs and future perspectives METHODS: A survey for PwMS questioned various aspects of MS and viewpoints on care. For MS nurses (MSN) and neurologists, employment, education, job-content, care organization and perspectives were inquired. Descriptive and univariate statistics were performed RESULTS: The PwMS survey comprised 916 respondents with a mean age of 46±12.7 years and 75,4 % of the respondents being female. The majority of the participants had relapsing remitting MS (60.8 %) and the mean patient determined disease steps (PDDS) was 2.0 (IQR=3). 65.3 % and 60.4 % of the PwMS reported having access to a multidisciplinary team (MDT) or MSN. Access to an MSN was associated with more frequent disease modifying treatment (p=.015), spasticity (p=.042) and gait treatment (p=.035), but also more physiotherapy (p=.004), driver's license adjustment (p<.001) and a higher employment rate (p=.004). MDT access was associated with more frequent symptomatic bladder treatment (p=.047), higher physiotherapy rate (p<.001), higher work- (p=.002), insurance- (p<.001) and home support measures (p=.019). PwMS without an available MDT more often indicated that MS care needs improvement (p<.001). MSN's (n = 22) were mainly funded through various budgets, including hospital and neurology practice budgets. Finally, 69 % and 75 % neurologists (n = 62) working without an MSN or MDT stated a need of such support and 61 % agreed that MDT's should be organized at hospital-network level CONCLUSION: MDT and MSN availability may enhance medical and socio-economic support for PwMS. Guidelines, alignment and reimbursement are needed.
Collapse
Affiliation(s)
- Liesbeth Van Hijfte
- Ghent University Hospital, 4Brain Research Unit, Department of Neurology, Gent, Belgium.
| | - Melissa Cambron
- Sint-Jan Bruges Hospital, Department of Neurology, Brugge, Belgium
| | - Brigitte Capron
- CHU de Charleroi, Department of Neurology, Lodelinsart, Belgium
| | - Bernard Dachy
- Hôpital Brugmann, Université Libre de Bruxelles, Department of Neurology, Brussels, Belgium
| | - Danny Decoo
- AZ Alma, Department of Neurology, Eeklo, Belgium
| | | | - Bénédicte Dubois
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Souraya El Sankari
- Cliniques Universitaires Saint-Luc, UCLouvain, Department of Neurology, Brussels, Belgium
| | - Frederic London
- CHU UCL Namur, Université catholique de Louvain, Department of Neurology, Yvoir, Belgium
| | - Gaetano Perrotta
- Hôpital Erasme, Université Libre de Bruxelles, Department of Neurology, Brussels, Belgium
| | - Veronica Popescu
- University MS Centre (UMSC), Hasselt-Pelt, Belgium; Noorderhart Hospitals, Revalidation and MS, Pelt, Belgium
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, UCLouvain, Department of Neurology, Brussels, Belgium
| | - Bart Van Wijmeersch
- University MS Centre (UMSC), Hasselt-Pelt, Belgium; Noorderhart Hospitals, Revalidation and MS, Pelt, Belgium
| | - Barbara Willekens
- Antwerp University Hospital, Department of Neurology and UNiCA (University Neuroimmunology Center Antwerp), Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Translational Neurosciences Research Group, Wilrijk, Belgium
| | - Guy Laureys
- Ghent University Hospital, 4Brain Research Unit, Department of Neurology, Gent, Belgium
| |
Collapse
|
3
|
Nouh RA, Kamal A, Oyewole O, Abbas WA, Abib B, Omar A, Mansour ST, Abdelnaser A. Unveiling the Potential of Cannabinoids in Multiple Sclerosis and the Dawn of Nano-Cannabinoid Medicine. Pharmaceutics 2024; 16:241. [PMID: 38399295 PMCID: PMC10891830 DOI: 10.3390/pharmaceutics16020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 02/25/2024] Open
Abstract
Multiple sclerosis is the predominant autoimmune disorder affecting the central nervous system in adolescents and adults. Specific treatments are categorized as disease-modifying, whereas others are symptomatic treatments to alleviate painful symptoms. Currently, no singular conventional therapy is universally effective for all patients across all stages of the illness. Nevertheless, cannabinoids exhibit significant promise in their capacity for neuroprotection, anti-inflammation, and immunosuppression. This review will examine the traditional treatment for multiple sclerosis, the increasing interest in using cannabis as a treatment method, its role in protecting the nervous system and regulating the immune system, commercially available therapeutic cannabinoids, and the emerging use of cannabis in nanomedicine. In conclusion, cannabinoids exhibit potential as a disease-modifying treatment rather than merely symptomatic relief. However, further research is necessary to unveil their role and establish the safety and advancements in nano-cannabinoid medicine, offering the potential for reduced toxicity and fewer adverse effects, thereby maximizing the benefits of cannabinoids.
Collapse
Affiliation(s)
- Roua A. Nouh
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Ahmed Kamal
- Biochemistry Department, Faculty of Science, Suez University, P.O. Box 43221, Suez 43533, Egypt;
| | - Oluwaseyi Oyewole
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Walaa A. Abbas
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Bishoy Abib
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (B.A.); (S.T.M.)
| | - Abdelrouf Omar
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Somaia T. Mansour
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (B.A.); (S.T.M.)
| | - Anwar Abdelnaser
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt
| |
Collapse
|
4
|
Zarghami A, Fuh-Ngwa V, Claflin SB, van der Mei I, Ponsonby AL, Broadley S, Simpson-Yap S, Taylor BV. Changes in employment status over time in multiple sclerosis following a first episode of central nervous system demyelination, a Markov multistate model study. Eur J Neurol 2024; 31:e16016. [PMID: 37525323 DOI: 10.1111/ene.16016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND PURPOSE Understanding predictors of changes in employment status among people living with multiple sclerosis (MS) can assist health care providers to develop appropriate work retention/rehabilitation programs. We aimed to model longitudinal transitions of employment status in MS and estimate the probabilities of retaining employment status or losing or gaining employment over time in individuals with a first clinical diagnosis of central nervous system demyelination (FCD). METHODS This prospective cohort study comprised adults (aged 18-59 years) diagnosed with FCD (n = 237) who were followed for more than 11 years. At each review, participants were assigned to one of three states: unemployed, part-time, or full-time employed. A Markov multistate model was used to examine the rate of state-to-state transitions. RESULTS At the time of FCD, participants with full-time employment had an 89% chance of being in the same state over a 1-year period, but this decreased to 42% over the 10-year follow-up period. For unemployed participants, there was a 92% likelihood of remaining unemployed after 1 year, but this probability decreased to 53% over 10 years. Females, those who progressed to clinically definite MS, those with a higher relapse count, and those with a greater level of disability were at increased risk of transitioning to a deteriorated employment state. In addition, those who experienced clinically significant fatigue over the follow-up period were less likely to gain employment after being unemployed. CONCLUSIONS In our FCD cohort, we found a considerable rate of employment transition during the early years post-diagnosis. Over more than a decade of follow-up post-FCD, we found that females and individuals with a greater disability and a higher relapse count are at higher risk of losing employment.
Collapse
Affiliation(s)
- Amin Zarghami
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon Broadley
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
5
|
Ponzio M, Podda J, Pignattelli E, Verri A, Persechino B, Vitturi BK, Bandiera P, Manacorda T, Inglese M, Durando P, Battaglia MA. Work Difficulties in People with Multiple Sclerosis. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10149-9. [PMID: 37921967 DOI: 10.1007/s10926-023-10149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features. METHODS A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties. RESULTS The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work. CONCLUSION Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.
Collapse
Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
- Department of Research, Italian Multiple Sclerosis Foundation, via Operai 40, 16149, Genoa, Italy.
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Elena Pignattelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| |
Collapse
|
6
|
Nouh RA, Kamal A, Abdelnaser A. Cannabinoids and Multiple Sclerosis: A Critical Analysis of Therapeutic Potentials and Safety Concerns. Pharmaceutics 2023; 15:pharmaceutics15041151. [PMID: 37111637 PMCID: PMC10146800 DOI: 10.3390/pharmaceutics15041151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
Multiple sclerosis (MS) is a complicated condition in which the immune system attacks myelinated axons in the central nervous system (CNS), destroying both myelin and axons to varying degrees. Several environmental, genetic, and epigenetic factors influence the risk of developing the disease and how well it responds to treatment. Cannabinoids have recently sparked renewed interest in their therapeutic applications, with growing evidence for their role in symptom control in MS. Cannabinoids exert their roles through the endogenous cannabinoid (ECB) system, with some reports shedding light on the molecular biology of this system and lending credence to some anecdotal medical claims. The double nature of cannabinoids, which cause both positive and negative effects, comes from their actions on the same receptor. Several mechanisms have been adopted to evade this effect. However, there are still numerous limitations to using cannabinoids to treat MS patients. In this review, we will explore and discuss the molecular effect of cannabinoids on the ECB system, the various factors that affect the response to cannabinoids in the body, including the role of gene polymorphism and its relation to dosage, assessing the positive over the adverse effects of cannabinoids in MS, and finally, exploring the possible functional mechanism of cannabinoids in MS and the current and future progress of cannabinoid therapeutics.
Collapse
Affiliation(s)
- Roua A. Nouh
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Ahmed Kamal
- Biochemistry Department, Faculty of Science, Suez University, P.O. Box 43518, Suez 43533, Egypt
| | - Anwar Abdelnaser
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt
| |
Collapse
|
7
|
Zarghami A, van der Mei I, Hussain MA, Claflin SB, Bessing B, Simpson-Yap S, Ponsonby AL, Lechner-Scott J, Broadley S, Blizzard L, Taylor BV. Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination. Mult Scler 2022; 28:1793-1807. [PMID: 35549477 DOI: 10.1177/13524585221089900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes. OBJECTIVE We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD). METHODS Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression. RESULTS Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41). CONCLUSION These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.
Collapse
Affiliation(s)
- Amin Zarghami
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mohammad Akhtar Hussain
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Central Coast Public Health Unit, Central Coast Local Health District, New South Wales Health, Gosford, NSW, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Barnabas Bessing
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia/Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Jeanette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia/Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Simon Broadley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | |
Collapse
|
8
|
Lex H, Price P, Clark L. Qualitative study identifies life shifts and stress coping strategies in people with multiple sclerosis. Sci Rep 2022; 12:6536. [PMID: 35444194 PMCID: PMC9021186 DOI: 10.1038/s41598-022-10267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is an auto-immune disease in which the body’s immune system attacks the central nervous system. The demyelination of the nerve fibers can lead to physical, emotional, and cognitive impairments. We wanted to learn about challenges of living with the illness and how people deal with stress. 128 individuals with MS from Austria and the US participated in the qualitative interviews. We interviewed participants and coded their answers using inductive grounded theory. We asked three open-ended questions to inquire about life since being diagnosed with MS as well as about dealing with stress. Life shifts since diagnosis involved ‘experiencing limitations’ and could be categorized in ‘emotional changes’, ‘changes with work’, ‘changes in social interaction’, ‘physical changes’, ‘changes in the medical context’. For dealing with stress active (strategies and activities) and passive coping strategies (avoid/ignore) were employed. General stress reactions were expressed in areas of emotional, physical and /or lifestyle. We recommend developing interventions in three core areas for the MS population: (1) dealing with life changes and significant experiences with MS, (2) focusing on the areas where life shifts took place, (3) focusing on active coping with stress and discussing consequences of passive coping strategies.
Collapse
Affiliation(s)
- Heidemarie Lex
- Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, USA.
| | - Pollie Price
- OTR/L, FAOTA, University of Utah College of Occupational and Recreational Therapies, Salt Lake City, USA
| | - Lauren Clark
- FAAN, University of California at Los Angeles College of Nursing, Los Angeles, USA
| |
Collapse
|
9
|
The aerobic capacity – fatigue relationship in persons with Multiple Sclerosis is not reproducible in a pooled analysis of two randomized controlled trials. Mult Scler Relat Disord 2022; 58:103476. [DOI: 10.1016/j.msard.2021.103476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
|
10
|
The evolution of multiple sclerosis in Spain over the last decade from the patient's perspective. Mult Scler Relat Disord 2022; 57:103355. [DOI: 10.1016/j.msard.2021.103355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
|
11
|
Demirtepe-Saygılı D. Multiple sclerosis experiences of couples: Examination of patient and partner perspectives. J Health Psychol 2021; 27:2079-2090. [PMID: 34111986 DOI: 10.1177/13591053211017192] [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: 11/16/2022] Open
Abstract
The study aims to investigate Multiple Sclerosis (MS) experiences of couples. Using a dyadic qualitative method, separate simultaneous interviews were conducted with 20 couples, including one partner with MS. The themes resulting from content analysis were examined in two categories: Convergent (anxiety about future, acceptance of MS and MS as an accelerator of the relationship) and divergent (sexual problems, the experience of MS symptoms, the priority of the problems and untold issues). The findings revealed shared and unique perspectives of partners in the illness process, having the potential to guide the psychosocial interventions for couples living with a chronic illness.
Collapse
|
12
|
Fatigue in Patients with Multiple Sclerosis in Tehran in 1398. IRAN JOURNAL OF NURSING 2020. [DOI: 10.52547/ijn.33.126.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
13
|
Marck CH, Aitken Z, Simpson S, Weiland TJ, Kavanagh A, Jelinek GA. Predictors of Change in Employment Status and Associations with Quality of Life: A Prospective International Study of People with Multiple Sclerosis. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:105-114. [PMID: 31392475 PMCID: PMC7031412 DOI: 10.1007/s10926-019-09850-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose This prospective international study aimed to assess the changes in employment, and predictors thereof, and associated change in mental health quality of life in people with multiple sclerosis (MS). Methods People with MS were recruited online through social media, forums and newsletters to complete an online English-language survey in 2012 and again in 2015, to assess changes in employment and clinical characteristics. Results 1276 people with MS of working age were included of whom 35.9% were employed full time, 25.6% part-time, 3.1% were unemployed and seeking employment, 19.7% were retired due to disability and 15.7% were not in the labour force. Part/full time employment decreased from 61.4 to 57.1% of the sample 2.5 years later, and 25.5% experienced some change in employment status. Lower level of education and higher level of disability at baseline predicted loss of employment at follow-up. 62.0% of the sample indicated that MS impacted on employment over their lifetime, associated with a lower level of education and progressive MS at time of diagnosis. Retiring due to disability was predictive of a decreased mental health related QOL score. Conclusion Employment status was negatively impacted by MS for most participants. We showed for the first time that employment loss was prospectively associated with poorer mental health related quality of life. Employment support including vocational services, reasonable flexibility in the workplace, and legal protection against discrimination should be widely available to assist people with MS, especially for those with progressive onset MS, higher disability and lower levels of education who are at higher risk of employment loss.
Collapse
Affiliation(s)
- Claudia H Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
| | - Zoe Aitken
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Anne Kavanagh
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| |
Collapse
|
14
|
Pust GEA, Dettmers C, Randerath J, Rahn AC, Heesen C, Schmidt R, Gold SM. Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities. Front Psychiatry 2020; 11:811. [PMID: 33005150 PMCID: PMC7485280 DOI: 10.3389/fpsyt.2020.00811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventy-one PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities. Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck's Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS). The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18). The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance. Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations.
Collapse
Affiliation(s)
- Gesa E A Pust
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, University of Konstanz, Konstanz, Germany.,ZIST, Penzberg, Germany
| | - Christian Dettmers
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Anne C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Roger Schmidt
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.,Klinik für Psychosomatik und Konsiliarpsychiatrie, Departement Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychosomatic Medicine, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
15
|
Povolo CA, Blair M, Mehta S, Rosehart H, Morrow SA. Predictors of vocational status among persons with multiple sclerosis. Mult Scler Relat Disord 2019; 36:101411. [PMID: 31586801 DOI: 10.1016/j.msard.2019.101411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a common cause of neurological disability in young to middle-aged adults, resulting in physical, psychosocial, and cognitive impairments. Manifestation of these symptoms during crucial work-life years can greatly influence the ability of persons with (PwMS) to retain employment. It is unknown what factors are most important in leading to work disability, and if/how these different factors interact with each other and result in work disability. OBJECTIVE To determine significant predictors of vocational status among PwMS using a structural equation modeling approach. METHODS A retrospective chart review identified PwMS at an academic tertiary care hospital. The following data was collected: demographics and disease characteristics, vocational status, physical disability status (Expanded Disability Status Scale, EDSS), fine motor function (Nine Hole Peg Test, NHPT), generalized fatigue (Fatigue Severity Scale, FSS), mood and anxiety symptoms (Hospital Anxiety and Depression Scale, HADS) and cognitive function (Symbol Digit Modalities Test, SDMT). An exploratory structural equation model (SEM) was developed to examine the predictive utility of clinical and psychosocial variables on vocational status after controlling for demographic and disease characteristics. The fit of the model to the data was examined using the comparative fit index (CFI), normal fit index (NFI), root-mean-squared error of approximation (RMSEA), and standardized root mean residual (SRMR). RESULTS There were 158 PwMS included in the analysis. The final model demonstrated that SDMT (β = 0.16), EDSS (β = -0.33), and HADS-D (β = -0.23) significantly predicted vocational status (ps < 0.05). It explained 37% of the variance and provided a good fit to the data (χ2(11) = 13.01, p > 0.05, SRMR = 0.055, RMSEA = 0.034, NFI = 0.94, CFI = 0.99. CONCLUSIONS Physical disability, depressive symptoms, and reduced information processing affect work-related disability and vocational status among PwMS. Interventions targeting these factors should be prioritized by clinicians.
Collapse
Affiliation(s)
| | - Mervin Blair
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Swati Mehta
- Lawson Health Research Institute, Department of Physical Medicine and Rehabilitation, Western University, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | | | - Sarah A Morrow
- London Health Sciences Center, London, Ontario, Canada; University of Western Ontario, Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
| |
Collapse
|
16
|
In search of distinct MS-related fatigue subtypes: results from a multi-cohort analysis in 1.403 MS patients. J Neurol 2019; 266:1663-1673. [PMID: 31004211 DOI: 10.1007/s00415-019-09311-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 01/07/2023]
Abstract
Fatigue is among the most disabling symptoms in patients with multiple sclerosis (PwMS). The common distinction between cognitive and motor fatigue is typically incorporated in self-rating instruments, such as the Chalder Fatigue Questionnaire (CFQ), the Fatigue Scale for Motor and Cognitive Functions (FSMC) or the Modified Fatigue Impact Scale (MFIS). The present study investigated the factor structure of the CFQ, the FSMC and the MFIS utilizing exploratory (EFA) and confirmatory factor analysis (CFA) as well as exploratory structural equation modeling (ESEM). Data of 1.403 PwMS were analyzed, utilizing four samples. The first sample (N = 605) was assessed online and split into two stratified halves to perform EFA, CFA, and ESEM on the CFQ and FSMC. The second sample (N = 293) was another online sample. It served to calculate CFA and ESEM on the CFQ and FSMC. The third sample was gathered in a clinical setting (N = 196) and analyzed by applying CFA and ESEM to the FSMC. The fourth sample (N = 309) was assessed in a clinical setting and allowed to run a CFA and ESEM on the MFIS. Proposed factor structures of all questionnaires were largely confirmed in EFA. However, none of the calculated CFAs and ESEMs could verify the proposed factor structures of the three measures, even with oblique rotation techniques. The findings might have implications for future research into the pathophysiological basis of MS-related fatigue and could affect the suitability of such measures as outcomes for treatment trials, presumably targeting specific sub-components of fatigue.
Collapse
|
17
|
Roddam H, Rog D, Janssen J, Wilson N, Cross L, Olajide O, Dey P. Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature. Mult Scler Relat Disord 2019; 28:290-304. [DOI: 10.1016/j.msard.2018.12.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/11/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
|