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Dennison L, Brown M, Kirby S, Galea I. Do people with multiple sclerosis want to know their prognosis? A UK nationwide study. PLoS One 2018; 13:e0193407. [PMID: 29489869 PMCID: PMC5831099 DOI: 10.1371/journal.pone.0193407] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Multiple sclerosis (MS) has a varied and uncertain trajectory. The recent development of analytical processing tools that draw on large longitudinal patient databases facilitates personalised long-term prognosis estimates. This has the potential to improve both shared treatment decision-making and psychological adjustment. However, there is limited research on how people with MS feel about prognosis communication and forecasting. This study investigated the prognosis communication experiences and preferences of people with MS and explored whether clinical, demographic and psychological factors are associated with prognosis information preferences. Methods 3175 UK MS Register members (59% of those with active accounts) completed an online survey containing 17 questions about prognosis communication experiences, attitudes and preferences. Participants also completed validated questionnaires measuring coping strategies, tendencies to seek out (‘monitor’) or avoid (‘blunt’) information in threatening situations, and MS risk perceptions and reported their clinical and sociodemographic characteristics. Data already held on the MS Register about participants’ quality of life, anxiety and depression symptoms and MS impact were obtained and linked to the survey data. Results 53.1% of participants had never discussed long-term prognosis with healthcare professionals. 54.2% lacked clarity about their long-term prognosis. 76% had strong preferences for receiving long-term prognosis information. 92.8% were interested in using tools that generate personalised predictions. Most participants considered prognostication useful for decision-making. Participants were more receptive to receiving prognosis information at later time-points, versus at diagnosis. A comprehensive set of sociodemographic, clinical and psychological variables predicted only 7.9% variance in prognosis information preferences. Conclusions People with MS have an appetite for individualised long-term prognosis forecasting and their need for information is frequently unmet. Clinical studies deploying and evaluating interventions to support prognostication in MS are now needed. This study indicates suitable contexts and patient preferences for initial trials of long-term prognosis tools in clinical settings.
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Affiliation(s)
- Laura Dennison
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Martina Brown
- Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sarah Kirby
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Mulligan H, Wilkinson A, Barclay A, Whiting H, Heynike C, Snowdon J. Evaluation of a Fatigue Self-Management Program for People with Multiple Sclerosis. Int J MS Care 2016; 18:116-21. [PMID: 27252598 DOI: 10.7224/1537-2073.2015-019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The program "Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis" (MFML) was created in New Zealand because of the lack of a fatigue management program for people with MS in that country. This program aims to empower individuals with MS to manage their own symptoms of fatigue. The objective of this study was to evaluate the MFML fatigue self-management program. METHODS Self-report questionnaires were used to measure impact of fatigue (5-item Modified Fatigue Impact Scale), self-efficacy (MS Self-efficacy Scale), and quality of life (12-item Short Form Health Status Survey [SF-12]) 1 month before (T1), at commencement of (T2) (to investigate the stability of questionnaire scores before the intervention), and at the end of (T3) the 6-week group-based program. Increased self-efficacy and quality of life scores and a decrease in reported impact of fatigue were the anticipated primary outcomes, with participants acting as their own controls. RESULTS Twenty-five women (aged 37-63 years) participated. Stability of scores for all the questionnaires was evidenced between T1 and T2. After the intervention (T3), scores showed a significant improvement in self-efficacy and impact of fatigue, with large effect sizes, but no change in either the physical or mental component summary of the SF-12. CONCLUSIONS Despite the small sample size, this study showed an organized approach to the management of fatigue for people living with MS, and its outcomes demonstrated benefits for participants.
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Affiliation(s)
- Hilda Mulligan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
| | - Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
| | - Amelia Barclay
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
| | - Hayley Whiting
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
| | - Christelle Heynike
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
| | - Jessie Snowdon
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (HM, AW); School of Physiotherapy, University of Otago, Dunedin, New Zealand (AB, HW, CH); and Multiple Sclerosis and Parkinson's Society Canterbury Inc, Christchurch, New Zealand (JS)
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Jones KH, Jones PA, Middleton RM, Ford DV, Tuite-Dalton K, Lockhart-Jones H, Peng J, Lyons RA, John A, Noble JG. Physical disability, anxiety and depression in people with MS: an internet-based survey via the UK MS Register. PLoS One 2014; 9:e104604. [PMID: 25153835 PMCID: PMC4143231 DOI: 10.1371/journal.pone.0104604] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/11/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION People with Multiple Sclerosis are known to have a relatively high prevalence of both anxiety and depression. Studies of the relationship between physical disability and mental health in people with MS have reported mixed results, showing the need for further work. METHODS Between May 2011 and April 2012, 4516 people completed the MSIS-29 (v.1) and HADS scales via the dedicated internet site of the UK MS Register within a 7 day time window. These responses were linked with basic demographic and descriptive data and analysed in SPSS (v.20). RESULTS The proportions of people experiencing anxiety or depression increased with physical disability such that 38.0% of respondents with low, and 66.7% with high disability reported at least mild anxiety, and 17.1% of people with low, and 71.7% with high disability experienced at least mild depression. The multiple regression model explained 18.4% of the variance in anxiety with MSIS-29-PHYS score being the strongest predictor of anxiety. The model for depression explained 37.8% of the variance with MSIS-29-PHYS score being the strongest predictor. Some of the other variables included showed negative associations with anxiety and depression, indicating that the influence of physical disability on mental wellbeing could be underestimated. CONCLUSIONS This study indicates that there is a positive relationship between physical disability and anxiety and depression, that physical disability impacts on anxiety and depression to differing extents, and that the effects vary with gender, age, disease course and disease duration. We have shown that physical disability is a predictor of anxiety and depression, and that other factors may mask the extent of this effect. Whether the causes of anxiety and depression are reactive, organic or a combination, it is essential that mental wellbeing is given due attention in caring for people with MS so that all their health needs can be met.
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Affiliation(s)
- Kerina H. Jones
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Philip A. Jones
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | | | - David V. Ford
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | | | | | - Jeffrey Peng
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Ronan A. Lyons
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Ann John
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - J. Gareth Noble
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
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