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Radakovic R, Radakovic C, Abrahams S, Simmons Z, Carroll A. Quality of life, cognitive and behavioural impairment in people with motor neuron disease: a systematic review. Qual Life Res 2024; 33:1469-1480. [PMID: 38345764 PMCID: PMC11116232 DOI: 10.1007/s11136-024-03611-5] [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] [Accepted: 01/18/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Motor neuron disease (MND) is a neurodegenerative disease, progressively impacting function and self-perceived quality of life (QoL). Up to 50% of people with MND can present with cognitive and behavioural impairment, with an associated increase in caregiver burden or strain. However, there has been no systematic exploration of the relationship between QoL and cognitive or behavioural impairment in MND. The aim was to determine if there is a relationship between QoL and cognitive/behavioural impairment in MND, while also supplementarily looking to determine the types of cognitive/behavioural and QoL measures utilised in these studies. METHODS A systematic search was performed across multiple databases (PsychINFO, Embase, Medline, AMED) for research published up to the date of February 22, 2023. Studies utilising quantitative methods of measuring QoL, cognitive/behavioural functioning/impairment were included. Findings examining relationships between QoL-cognitive/behavioural impairment were extracted and synthesised. RESULTS A total of 488 studies were identified, with 14 studies included in the systematic review. All 14 studies were observational (11 cross-sectional, 3 longitudinal). 13 studies utilised MND non-specific measures, particularly in relation to QoL and cognitive impairment. Of 8 studies measuring behavioural impairment 62.5% (N = 5) found either a lower QoL difference or association. Only 33.3% (N = 4) of 12 studies measuring cognitive impairment found a lower QoL difference or association. CONCLUSIONS This systematic review shows that behavioural impairment may have an impact on QoL in MND. There is variability in types of assessments used to measure QoL and also cognitive/behavioural impairment, most of which are disease-non-specific. Recommendations for future research are to use comprehensive disease-specific, multidomain measures to further elucidate the QoL-cognitive/behavioural impairment relationship.
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Affiliation(s)
- Ratko Radakovic
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK.
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University, Hershey, PA, USA
| | - Amy Carroll
- Norfolk and Norwich University Hospital, Norwich, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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Ciećwierska K, Lulé D, Bielecki M, Helczyk O, Maksymowicz-Śliwińska A, Finsel J, Nieporęcki K, Andersen PM, Ludolph AC, Kuźma-Kozakiewicz M. Quality of life and depression in patients with amyotrophic lateral sclerosis - does the country of origin matter? BMC Palliat Care 2023; 22:72. [PMID: 37312136 DOI: 10.1186/s12904-023-01189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Given the inevitable relentless progressing nature of amyotrophic lateral sclerosis (ALS), it is essential to identify factors influencing patients' wellbeing. The study aimed to prospectively assess factors influencing the quality of life (QoL) and depression in ALS patients compared to healthy controls (HCs) from Poland, Germany and Sweden and their relationship to socio-demographic and clinical factors. METHODS 314 ALS patients (120 from Poland, 140 from Germany, 54 from Sweden) and 311 age-, sex- and education-level-matched HCs underwent standardized interviews for quality of life, depression, functional status and pain. RESULTS Patients from all three countries showed similar levels of functional impairment (ALSFRS-R). Overall, ALS patients assessed their quality of life as lower compared to HCs (p < 0.001 for the anamnestic comparative self-assessment (ACSA), p = 0.002 for the Schedule for the evaluation of the subjective quality of life - SEIQoL- direct weighting (SEIQoL-DW). Also, the German and Swedish patients, but not the Polish, reported higher depression levels than the corresponding HCs (p < 0.001). Analysis of ALS groups revealed that functional impairment was related to a lower quality of life (ACSA) and higher depression levels among German ALS patients. Longer time since diagnosis predicted lower depression and (in male subjects) higher quality of life. CONCLUSIONS ALS patients assess their quality of life and mood lower than healthy individuals within the studied countries. The relationships between clinical and demographic factors are moderated by country of provenance, which bears implications for the design and interpretation of scientific and clinical studies, which should reflect the complexity and heterogeneity of mechanisms determining QoL.
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Affiliation(s)
- Katarzyna Ciećwierska
- Department of Neurology, University Clinical Center of Medical University of Warsaw, Warsaw, Poland
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Maksymilian Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Olga Helczyk
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Julia Finsel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Krzysztof Nieporęcki
- Department of Neurology, University Clinical Center of Medical University of Warsaw, Warsaw, Poland
| | - Peter M Andersen
- Institute of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden
| | | | - Magdalena Kuźma-Kozakiewicz
- Department of Neurology, University Clinical Center of Medical University of Warsaw, Warsaw, Poland.
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
- Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland.
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Zahir F, Hanman A, Yazdani N, La Rosa S, Sleik G, Sullivan B, Mehdipour A, Malouka S, Kuspinar A. Assessing the psychometric properties of quality of life measures in individuals with amyotrophic lateral sclerosis: a systematic review. Qual Life Res 2023:10.1007/s11136-023-03377-2. [PMID: 36881218 DOI: 10.1007/s11136-023-03377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults. There are many patient-reported outcome measures (PROMs) for measuring quality of life (QoL) and health-related QoL (HRQoL) within this population; however, there is limited consensus regarding which are most valid, reliable, responsive, and interpretable. This systematic review assesses the psychometric properties and interpretability of QoL and HRQoL PROMs for individuals with ALS. METHODS This review was conducted following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic reviews of PROMs. MEDLINE, EMBASE, and CINAHL databases were searched. Studies were included if their aim was to evaluate one or more psychometric properties or the interpretability of QoL or HRQoL PROMs in individuals with ALS. RESULTS We screened 2713 abstracts, reviewed 60 full-text articles, and included 37 articles. Fifteen PROMs were evaluated including generic HRQoL (e.g., SF-36), ALS-specific HRQoL (e.g., ALSAQ-40), and individualized QoL (e.g., SEIQoL) measures. Evidence for internal consistency and test-retest reliability were acceptable. For convergent validity, 84% of hypotheses were met. For known-groups validity, outcomes were able to distinguish between healthy cohorts and other conditions. Responsiveness results ranged from low to high correlations with other measures over 3-24 months. Evidence for content validity, structural validity, measurement error, and divergent validity was limited. CONCLUSION This review identified evidence in support of the ALSAQ-40 or ALSAQ-5 for individuals with ALS. These findings can guide healthcare practitioners when selecting evidence-based QoL and HRQoL PROMs for patients and provide researchers with insight into gaps in the literature.
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Affiliation(s)
- Faryal Zahir
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Alicia Hanman
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Nazmehr Yazdani
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Sabrina La Rosa
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Gemma Sleik
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Brooke Sullivan
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Ava Mehdipour
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Selina Malouka
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., IAHS, Hamilton, ON, L8S 1C7, Canada.
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Sanchez-Andrades MJ, Vinolo-Gil MJ, Casuso-Holgado MJ, Barón-López J, Rodríguez-Huguet M, Martín-Valero R. Measurement Properties of Self-Report Questionnaires for Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis of Commonly Used Instruments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3310. [PMID: 36834005 PMCID: PMC9959245 DOI: 10.3390/ijerph20043310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. There is no evidence on the analysis of the measurement instruments available to assess quality of life in these patients, following the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist; (2) Methods: A systematic review was performed in PubMed, Embase, PEDro, Web of Science and Cochrane. The psychometric properties of the questionnaires were determined by using the COSMIN checklist. Two searches were carried out. This systematic review was registered in PROSPERO (CRD42021249005); (3) Results: There were four published articles that analysed the measurement properties in patients with ALS for the following scales: Amyotrophic Lateral Sclerosis Assessment Questionnaire 40, Amyotrophic Lateral Sclerosis-Specific Quality of Life Questionnaire, Short Form 36 Healthy Survey, Epworth Sleepiness Scale and Sickness Impact Profile. Another five scales also met the inclusion criteria: ALS-Depression-Inventory, State Trait Anxiety-Inventory, World Health Organization Quality of Life, Schedule for the Evaluation of Individual Quality of Life, Amyotrophic Lateral Sclerosis Assessment Questionnaire 5. Most Patient Reported Outcome Measures (PROMs) present a low-quality synthesis of evidence. It was observed an excellent pooled reliability of 0.92 (95% Confidence Interval: 0.83-0.96, I2 = 87.3%) for four dimensions for questionnaires ALSAQ-40. (4) Conclusions: There is little evidence on generic instruments. Future studies are necessary to develop new tools.
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Affiliation(s)
- Maria Jose Sanchez-Andrades
- Department of Physiotherapy, Faculty of Health Science, Ampliacion de Campus de Teatinos, University of Malaga, C/Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- CMU Rehabilitation Intercentres-Interlevels Puerto Real and Cadiz Hospitals, Cádiz-La Janda Health District, 11006 Cadiz, Spain
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Javier Barón-López
- Department of Physiotherapy, Faculty of Health Science, Ampliacion de Campus de Teatinos, University of Malaga, C/Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain
| | - Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, Ampliacion de Campus de Teatinos, University of Malaga, C/Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain
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Aust E, Linse K, Graupner ST, Joos M, Liebscher D, Grosskreutz J, Prudlo J, Meyer T, Günther R, Pannasch S, Hermann A. Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin. J Neurol 2022; 269:5910-5925. [PMID: 35790562 PMCID: PMC9553779 DOI: 10.1007/s00415-022-11238-0] [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] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
For both patients with amyotrophic lateral sclerosis (ALS) and their next of kin (NOK), the maintenance of quality of life (QoL) and mental health is particularly important. First studies suggest significant discrepancies between QoL reports by patients and NOK, but little is known for advanced ALS stages. To address this issue, we screened 52 ALS patients in incomplete locked-in state (iLIS). Final results were obtained for 15 couples of iLIS patients and NOK. We assessed patients’ and NOK’s subjective QoL, depression and anxiety and NOK’s caregiver burden. Gaze controlled questionnaires allowed direct assessment of patients. Patients and NOK self-reported comparable, mostly moderate to high levels of QoL. Of note, NOK indicated stronger anxiety symptoms. Higher anxiety levels in NOK were associated with stronger caregiver burden and reduced QoL. No significant misjudgment of patient’s QoL by the NOK was evident, while patients overestimated NOK’s global QoL. However, NOK with severe caregiver burden and depression symptoms gave poorer estimations of patients’ QoL. This relationship is relevant, considering NOK’s impact on life critical treatment decisions. While the daily time NOK and patient spend together was positively correlated with NOK’s QoL and mental health, this was not reversely found for the patients. Our results suggest that NOK adapt less successfully to the disease and concomitant experience of loss and point to an urgent need for specialized psychosocial support. The findings emphasize the importance of direct psychological wellbeing assessment of both patients and NOK in clinical practice, enabled by eye-tracking technology for patients in iLIS.
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Affiliation(s)
- Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sven-Thomas Graupner
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | - Daniel Liebscher
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | | | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany ,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sebastian Pannasch
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany ,Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany ,Translational Neurodegeneration Section “Albrecht Kossel,” Department of Neurology, University Medical Center Rostock, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
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Åkerblom Y, Zetterberg L, Larsson BJ, Nyholm D, Nygren I, Åsenlöf P. Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases. BMC Palliat Care 2021; 20:154. [PMID: 34641829 PMCID: PMC8507097 DOI: 10.1186/s12904-021-00848-6] [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] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Up to 85% of people with motor neuron disease (MND) report pain, but whether pain has negative impact on quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQOL) in patients with MND. Methods In this cross sectional study, 61 patients were recruited from four multidisciplinary teams in Sweden, whereof 55 responded to the pain measure (The Brief Pain Inventory – Short form) and were included in the main analyses. Disease severity was measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version, and individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting. Results Forty-one (74%) of the participants who answered BPI-SF (n = 55) reported pain. Thirty-nine (71%) of those reported pain during the past 24 h. The severity of pain was on average moderate, with eight participants (14%) reporting severe pain (PSI ≥ 7). Satisfaction with IQOL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQOL between those reporting pain/not reporting pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U = 249, p = 0.452). There was neither any correlation between pain severity and satisfaction with IQOL, nor between disease severity and satisfaction with IQOL. Conclusions The results add to the hypothesis that associations between non-motor symptoms such as pain prevalence and pain severity and IQOL in MND are weak. Pain prevalence was high and the results pointed to that some participants experienced high pain severity, which indicate that pain assessments and pain treatments tailored to the specific needs of the MND population should be developed and scientifically evaluated.
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Affiliation(s)
- Ylva Åkerblom
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | - Lena Zetterberg
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | | | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, 75185, Uppsala, Sweden
| | - Ingela Nygren
- Department of Neuroscience, Neurology, Uppsala University, 75185, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden.
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Quality of life among relatives of patients with amyotrophic lateral sclerosis: A prospective and longitudinal study. Palliat Support Care 2021; 20:203-211. [PMID: 34154691 DOI: 10.1017/s1478951521000778] [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: 11/06/2022]
Abstract
OBJECTIVE Relatives are often central in caring for patients with amyotrophic lateral sclerosis (ALS), involving considerable physical, emotional, and social challenges. The aim of this study was to describe individual quality of life (iQoL) among relatives of patients with ALS, from diagnosis through disease progression. METHOD A total of 31 relatives were included. Data collection was performed at five time points: 1-3 months after their relatives had been diagnosed with ALS and every 6 months for 2 years. Quality of life was determined using the Schedule of Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW), emotional distress with the Hospital Anxiety and Depression Scale (HADS), and the illness severity of the patients was determined with the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALS FRS-R). RESULTS The SEIQoL-DW involves participants nominating the important life areas. The most nominated areas were family, friends, health, and leisure. Although most relatives had overall good and stable iQoL, several had scores indicating poor iQoL on some occasions during the disease trajectory. The relatives' iQoL correlated with emotional well-being and the patient's physical function at different time points. SIGNIFICANT OF RESULT Social relations, emotional well-being, and rapid decline in the patient's physical function influence the relatives' iQoL. Measuring both emotional well-being and iQoL, with a focus on the relatives' own descriptions of perceived iQoL and those factors contributing to their iQoL during the disease trajectory may improve the possibility of identifying and supporting those relatives with poor iQoL.
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Velasco-Álvarez F, Fernández-Rodríguez Á, Vizcaíno-Martín FJ, Díaz-Estrella A, Ron-Angevin R. Brain-Computer Interface (BCI) Control of a Virtual Assistant in a Smartphone to Manage Messaging Applications. SENSORS (BASEL, SWITZERLAND) 2021; 21:3716. [PMID: 34073602 PMCID: PMC8199460 DOI: 10.3390/s21113716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022]
Abstract
Brain-computer interfaces (BCI) are a type of assistive technology that uses the brain signals of users to establish a communication and control channel between them and an external device. BCI systems may be a suitable tool to restore communication skills in severely motor-disabled patients, as BCI do not rely on muscular control. The loss of communication is one of the most negative consequences reported by such patients. This paper presents a BCI system focused on the control of four mainstream messaging applications running in a smartphone: WhatsApp, Telegram, e-mail and short message service (SMS). The control of the BCI is achieved through the well-known visual P300 row-column paradigm (RCP), allowing the user to select control commands as well as spelling characters. For the control of the smartphone, the system sends synthesized voice commands that are interpreted by a virtual assistant running in the smartphone. Four tasks related to the four mentioned messaging services were tested with 15 healthy volunteers, most of whom were able to accomplish the tasks, which included sending free text e-mails to an address proposed by the subjects themselves. The online performance results obtained, as well as the results of subjective questionnaires, support the viability of the proposed system.
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Affiliation(s)
- Francisco Velasco-Álvarez
- Departamento de Tecnología Electrónica, Universidad de Málaga, 29071 Málaga, Spain; (Á.F.-R.); (F.-J.V.-M.); (A.D.-E.); (R.R.-A.)
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Galvin M, Gavin T, Mays I, Heverin M, Hardiman O. Individual quality of life in spousal ALS patient-caregiver dyads. Health Qual Life Outcomes 2020; 18:371. [PMID: 33225955 PMCID: PMC7682006 DOI: 10.1186/s12955-020-01551-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Quality of life is a basic goal of health and social care. The majority of people with Amyotrophic Lateral Sclerosis (ALS) are cared for at home by family caregivers. It is important to recognize the factors that contribute to quality of life for individuals to better understand the lived experiences in a condition for which there is currently no curative treatment. Aim To explore individual quality of life of people with ALS and their informal caregivers over time. Methods Over three semi-structured home interviews, 28 patient-caregiver dyads provided information on a range of demographic and clinical features, psychological distress, caregiver burden, and individual quality of life. Quality of life data were analysed using quantitative and qualitative methods with integration at the analysis and interpretation phases. Results Individual Quality of Life was high for patients and caregivers across the interviews series, and higher among patients than their care partners at each time point. Family, hobbies and social activities were the main self-defined contributors to quality of life. The importance of health declined relative to other areas over time. Friends and finances became less important for patients, but were assigned greater importance by caregivers across the illness trajectory. Psychological distress was higher among caregivers. Caregiver burden consistently increased. Conclusion The findings from this study point to the importance of exploring and monitoring quality of life at an individual level. Self-defined contributory factors are relevant to the individual within his/her context. As an integrated outcome measure individual quality of life should be assessed and monitored as part of routine clinical care during the clinical encounter. This can facilitate conversations between health care providers, patients and families, and inform interventions and contribute to decision support mechanisms. The ascertainment of self-defined life quality, especially in progressive neurodegenerative conditions, mean health care professionals are in a better position to provide person-centred care.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.
| | - Tommy Gavin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,National ALS/MND Centre, Beaumont Hospital, Dublin, Ireland
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Associations of Patient Mood, Modulators of Quality of Life, and Pharmaceuticals with Amyotrophic Lateral Sclerosis Survival Duration. Behav Sci (Basel) 2020; 10:bs10010033. [PMID: 31936812 PMCID: PMC7016647 DOI: 10.3390/bs10010033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Associations of modulators of quality of life (QoL) and survival duration are assessed in the fatal motor neuron disease, Amyotrophic Lateral Sclerosis. Major categories include clinical impression of mood (CIM); physical health; patient social support; and usage of interventions, pharmaceuticals, and supplements. Associations were assessed at p < 0.05 and p < 0.001 significance thresholds using applicable methods (Chi-square, t-test, ANOVA, logistical regression, random forests, Fisher’s exact test) within a retrospective cohort of 1585 patients. Factors significantly correlated with positive (happy or normal) mood included family support and usage of bi-level positive airway pressure (Bi-PAP) and/or cough assist. Decline in physical factors like presence of dysphagia, drooling, general pain, and decrease in ALSFRS-R total score or forced vital capacity (FVC) significantly correlated with negative (depressed or anxious) mood (p < 0.05). Use of antidepressants or pain medications had no association with ALS patient mood (p > 0.05), but were significantly associated with increased survival (p < 0.05). Positive patient mood, Bi-PAP, cough assist, percutaneous endoscopic gastrostomy (PEG), and accompaniment to clinic visits associated with increased survival duration (p < 0.001). Of the 47 most prevalent pharmaceutical and supplement categories, 17 associated with significant survival duration increases ranging +4.5 to +16.5 months. Tricyclic antidepressants, non-opioids, muscle relaxants, and vitamin E had the highest associative increases in survival duration (p < 0.05). Random forests, which examined complex interactions, identified the following pharmaceuticals and supplements as most predictive to survival duration: Vitamin A, multivitamin, PEG supplements, alternative herbs, antihistamines, muscle relaxants, stimulant laxatives, and antispastics. Statins, metformin, and thiazide diuretics had insignificant associations with decreased survival.
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Elliott MA, Malvar H, Maassel LL, Campbell J, Kulkarni H, Spiridonova I, Sophy N, Beavers J, Paradiso A, Needham C, Rifley J, Duffield M, Crawford J, Wood B, Cox EJ, Scanlan JM. Eye-controlled, power wheelchair performs well for ALS patients. Muscle Nerve 2019; 60:513-519. [PMID: 31397910 PMCID: PMC6851551 DOI: 10.1002/mus.26655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Our pilot study tested the feasibility and performance of an eye-controlled power wheelchair for amyotrophic lateral sclerosis (ALS) patients. METHODS In this prospective pilot study, participants drove the wheelchair three times around an indoor course. We assessed the time to complete the course; starting and stopping on command; turning 90, 135, and 180 degrees; time to backup; and obstacle negotiation. Following their use of the wheelchair, subjects were given a questionnaire to assess user experience. RESULTS Twelve patients participated, and all were able to complete three trials without difficulty. Eight participants completed all of the individual tasks (eg, turning, stopping, etc.) without any errors. Overall performance ratings were high across all participants (4.6/5-excellent). CONCLUSIONS Our eye-controlled power wheelchair prototype is feasible and has a very favorable user experience. This system has the potential to improve the mobility and independence of ALS patients, and other groups with motor impairments.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Becky Wood
- Swedish Neuroscience InstituteSeattleWashington
| | - Emily J. Cox
- Providence Medical Research CenterSpokaneWashington
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12
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Lulé D, Kübler A, Ludolph AC. Ethical Principles in Patient-Centered Medical Care to Support Quality of Life in Amyotrophic Lateral Sclerosis. Front Neurol 2019; 10:259. [PMID: 30967833 PMCID: PMC6439311 DOI: 10.3389/fneur.2019.00259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
It is one of the primary goals of medical care to secure good quality of life (QoL) while prolonging survival. This is a major challenge in severe medical conditions with a prognosis such as amyotrophic lateral sclerosis (ALS). Further, the definition of QoL and the question whether survival in this severe condition is compatible with a good QoL is a matter of subjective and culture-specific debate. Some people without neurodegenerative conditions believe that physical decline is incompatible with satisfactory QoL. Current data provide extensive evidence that psychosocial adaptation in ALS is possible, indicated by a satisfactory QoL. Thus, there is no fatalistic link of loss of QoL when physical health declines. There are intrinsic and extrinsic factors that have been shown to successfully facilitate and secure QoL in ALS which will be reviewed in the following article following the four ethical principles (1) Beneficence, (2) Non-maleficence, (3) Autonomy and (4) Justice, which are regarded as key elements of patient centered medical care according to Beauchamp and Childress. This is a JPND-funded work to summarize findings of the project NEEDSinALS (www.NEEDSinALS.com) which highlights subjective perspectives and preferences in medical decision making in ALS.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Andrea Kübler
- Interventional Psychology, Psychology III, University of Würzburg, Würzburg, Germany
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Felgoise SH, Feinberg R, Stephens HE, Barkhaus P, Boylan K, Caress J, Clawson LL, Elman L, Goutman SA, Mccluskey L, Russell J, Tiryaki E, Weiss M, Simmons Z. Amyotrophic lateral sclerosis-specific quality of life-short form (ALSSQOL-SF): A brief, reliable, and valid version of the ALSSQOL-R. Muscle Nerve 2018; 58:646-654. [PMID: 30028537 DOI: 10.1002/mus.26203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The Amyotrophic Lateral Sclerosis (ALS)-Specific Quality of Life instrument and its revised version (ALSSQOL and ALSSQOL-R) have strong psychometric properties, and have demonstrated research and clinical utility. In this study we aimed to develop a short form (ALSSQOL-SF) suitable for limited clinic time and patient stamina. METHODS The ALSSQOL-SF was created using Item Response Theory and confirmatory factor analysis on 389 patients. A cross-validation sample of 162 patients assessed convergent, divergent, and construct validity of the ALSSQOL-SF compared with psychosocial and physical functioning measures. RESULTS The ALSSQOL-SF consisted of 20 items. Compared with the ALSSQOL-R, optimal precision was retained, and completion time was reduced from 15-25 minutes to 2-4 minutes. Psychometric properties for the ALSSQOL-SF and its subscales were strong. DISCUSSION The ALSSQOL-SF is a disease-specific global QOL instrument that has a short administration time suitable for clinical use, and can provide clinically useful, valid information about persons with ALS. Muscle Nerve 58: 646-654, 2018.
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Affiliation(s)
- Stephanie H Felgoise
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Richard Feinberg
- National Board of Medical Examiners, Philadelphia, Pennsylvania, USA
| | - Helen E Stephens
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin Boylan
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - James Caress
- Department of Neurology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Lora L Clawson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Elman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Russell
- Department of Neurology, Lahey Clinic, Burlington, Massachusetts, USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Department of Neurology, EC 037, P.O. Box 859, Hershey, Pennsylvania, 17033, USA
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Jakobsson Larsson B, Ozanne AG, Nordin K, Nygren I. A prospective study of quality of life in amyotrophic lateral sclerosis patients. Acta Neurol Scand 2017; 136:631-638. [PMID: 28523721 DOI: 10.1111/ane.12774] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTS The aim of this prospective and longitudinal study was to describe individual quality of life in patients with amyotrophic lateral sclerosis (ALS) and its correlations with physical function and emotional well-being from diagnosis and over time. MATERIALS AND METHODS Thirty-six patients were included in the study. Individual quality of life was measured with the Schedule of Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), illness severity was assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALS FRS-R), and emotional distress was measured using the Hospital Anxiety and Depression Scale (HADS). Data were collected from diagnosis and thereafter, every six months for a period of two years. Twelve patients completed the 24-month follow-up. RESULTS Family, friends and own physical health were important for overall quality of life, from diagnosis and during the disease progression. Most patients had good quality of life, which remained stable, despite changed physical functions. Several patients scored above the cut-off score for doubtful and clinical anxiety and depression early on after diagnosis, and there was a significant decrease in anxiety over time. Soon after diagnosis, there was a correlation between depression and quality of life. CONCLUSION The family, social relations and own physical health are important for overall quality of life in patients with ALS. Thus, supporting the family and facilitating so that patients can continue to stay in contact with friends are important aspects during the disease. Conducting an early screening for depression can be important for preventing decreased quality of life.
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Affiliation(s)
- B. Jakobsson Larsson
- Department of Neuroscience; Neurology; Uppsala University Hospital; Uppsala Sweden
| | - A. G. Ozanne
- Neurology; Clinical Neuroscience; Sahlgrenska Universitetssjukhus; Göteborg Sweden
| | - K. Nordin
- Department of Global Health and Primary Care; Uppsala University; Uppsala Sweden
| | - I. Nygren
- Department of Neuroscience; Neurology; Uppsala University Hospital; Uppsala Sweden
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15
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Caga J, Hsieh S, Highton-Williamson E, Zoing MC, Ramsey E, Devenney E, Ahmed RM, Kiernan MC. Apathy and its impact on patient outcome in amyotrophic lateral sclerosis. J Neurol 2017; 265:187-193. [DOI: 10.1007/s00415-017-8688-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
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16
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Hamidou Z, Baumstarck K, Chinot O, Barlesi F, Salas S, Leroy T, Auquier P. Domains of quality of life freely expressed by cancer patients and their caregivers: contribution of the SEIQoL. Health Qual Life Outcomes 2017; 15:99. [PMID: 28494773 PMCID: PMC5427569 DOI: 10.1186/s12955-017-0672-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background The purposes of this study, performed on a large sample of cancer patient-caregiver dyads, were: i) to simultaneously investigate, using an individualized quality of life (QoL) measure (Schedule for the Evaluation of Individual QoL, SEIQoL), the QoL domains freely expressed by cancer patients and their caregivers, and ii) to explore overlapping between the SEIQoL assessment and QoL assessment using traditional instruments. Methods The study employed a cross-sectional design including cancer patients who were going to receive chemotherapy treatment and their caregivers. Quality of life was assessed using condition-specific questionnaires (EORTC QLQ-C30 and CarGOQoL), generic health-related questionnaire (SF-36), and open individualized measure (SEIQoL). Results The final sample included 205 patient-caregiver dyads. From the SEIQoL, Family, Health, and Leisures were the most freely expressed QoL domains by patients and caregivers, but reported with different weights. Love life and financial issues were less spontaneously mentioned. The SEIQoL index was moderately correlated to the condition-specific QoL questionnaires (R lower than |0.40|) and to SF-36 (correlation coefficients: R ranging from 0.17 to 0.31). Conclusion Individualized QoL measures allow individuals to spontaneously express important, non-predefined domains. This study highlights the need to explore QoL using a combination of individualized questionnaires and standardized questionnaires, capturing complementary facets that patients consider important in their life.
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Affiliation(s)
- Zeinab Hamidou
- EA3279, Self-perceived Health Assessment Research Unit, Aix Marseille Université, 27 bd Jean Moulin, Marseille, cedex 05, F-13385, France.,National Clinical research Quality of Life in Oncology Platform, Nancy, France
| | - Karine Baumstarck
- EA3279, Self-perceived Health Assessment Research Unit, Aix Marseille Université, 27 bd Jean Moulin, Marseille, cedex 05, F-13385, France.
| | - Olivier Chinot
- Department of Neuro-Oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005, Marseille, France
| | - Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, Centre d'Investigation Clinique, 13385, Marseille, France
| | - Sébastien Salas
- Department of adult oncology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13005 Marseille, and CRO2, Aix Marseille Université, 13284, Marseille, France
| | - Tanguy Leroy
- Université Lumière Lyon 2, Social Psychology Research Group (GRePS EA 4163), Bron, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, Aix Marseille Université, 27 bd Jean Moulin, Marseille, cedex 05, F-13385, France
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Matlabi H, Ahmadzadeh S. Evaluation of individual quality of life among hemodialysis patients: nominated themes using SEIQoL-adapted. Patient Prefer Adherence 2017; 11:1-9. [PMID: 28031703 PMCID: PMC5179215 DOI: 10.2147/ppa.s117860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Quality of life (QoL) has become an important issue for patients with chronic renal failure diseases who are permanently undergoing hemodialysis. In this study, an adapted schedule for the evaluation of individual quality of life (SEIQoL-adapted) was used to evaluate QoL among hemodialysis patients, to explore their views about the most important aspects of life satisfaction. METHODS AND RESULTS A multiple approach design and convenience sampling were applied to recruit 53 patients from a hemodialysis unit in Iran. Data were collected through structured interviews and then analyzed using conventional content analysis. A total score for QoL was calculated using scale guideline. The most important aspects of life were health, family, financial status, living conditions, leisure activities, relationships and socializing, religious and spiritual issues, medical knowledge, and therapies or treatments. The calculated mean QoL score was 66.2, indicating a relatively high life satisfaction. Males had higher QoL scores than females in both married and single groups. Moreover, the relationships between the QoL scores and education, job and marital status were not statistically significant. CONCLUSION The SEIQoL-adapted revealed reasonable lay definitions of QoL in a group of patients following chronic renal failure. The patients' views of the aspects of life could be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions.
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Affiliation(s)
- Hossein Matlabi
- Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence: Hossein Matlabi, Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attare Neishabouri St, Tabriz, PO Box 5165665811, Iran, Tel +98 91 41 008927, Fax +98 41 33344731, Email
| | - Sharareh Ahmadzadeh
- Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Martinez-Martin P. What is quality of life and how do we measure it? Relevance to Parkinson's disease and movement disorders. Mov Disord 2016; 32:382-392. [PMID: 27911002 DOI: 10.1002/mds.26885] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/13/2022] Open
Abstract
Health-related quality of life is a patient-reported outcome that complements clinical evaluation and provides information about disease activity and effects of the treatment. The objective of this review is to present the conceptual framework, the measures, and some of their most relevant applications in the field of Parkinson's disease and movement disorders. Health-related quality of life is a subjective, individual, and multidimensional construct, and its main dimensions are physical, mental, and social, besides global perceptions of health and personal domains. Health-related quality of life measurement is carried out by means of questionnaires or scales, ideally self-applied by patients, and has a diversity of important applications for clinical practice, research, and health policy. Movement disorders and Parkinson's disease are complex conditions impacting all components of patients' health-related quality of life. The use of health-related quality of life tools provides important information on a variety of aspects that are important to patients while complementing clinical evaluations. In particular, studies using this kind of assessment can identify and monitor the most important health-related quality of life determinant factors, allowing tailored assistance and prioritized interventions. In addition, maintaining or improving the patients' health-related quality of life is an objective of care for chronic diseases and, therefore, it has to be monitored over time and as an outcome of clinical trials. Several methods are available for the interpretation of the change in scores of health-related quality of life measures, although a definitive agreement on the most appropriate method is yet to be determined. Presently, health-related quality of life assessment is an important outcome for research and management of chronic conditions such as Parkinson's disease and other movement disorders. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
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Felgoise SH, Zaccheo V, Duff J, Simmons Z. Verbal communication impacts quality of life in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:179-83. [DOI: 10.3109/21678421.2015.1125499] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stephanie H. Felgoise
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania and
| | - Vincenzo Zaccheo
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania and
| | - Jason Duff
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania and
| | - Zachary Simmons
- Departments of Neurology and Humanities, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Fullam T, Stephens HE, Felgoise SH, Blessinger JK, Walsh S, Simmons Z. Compliance with recommendations made in a multidisciplinary ALS clinic. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:30-7. [DOI: 10.3109/21678421.2015.1074703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kleinbub JR, Palmieri A, Broggio A, Pagnini F, Benelli E, Sambin M, Sorarù G. Hypnosis-based psychodynamic treatment in ALS: a longitudinal study on patients and their caregivers. Front Psychol 2015; 6:822. [PMID: 26136710 PMCID: PMC4469765 DOI: 10.3389/fpsyg.2015.00822] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects. Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression. Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients. Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS.
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Affiliation(s)
- Johann R Kleinbub
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy ; Center for Cognitive Neuroscience, University of Padova Padova, Italy
| | - Alice Broggio
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | | | - Enrico Benelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Marco Sambin
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova Padova, Italy
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Abstract
A variety of outcome measures are used in clinical practice and in research to assess patients with amyotrophic lateral sclerosis (ALS). However, there may be discordance between traditional outcome measures such as strength and physical function, and patient-perceived measures of well-being. One such self-perceived measure, reflecting the patient's view, is quality of life (QOL). QOL in patients with severe medical disorder is often underestimated by others. Patients with ALS often have high QOL, and this may persist throughout the disease due to shifting expectations and to reprioritization of factors contributing to QOL. QOL instruments can measure health-related QOL (HRQOL) or global QOL, and can be generic or disease-specific. HRQOL refers primarily to physical and mental health. Global QOL is much broader, and is also determined by non-health-related factors. The choice of a QOL instrument depends on whether the setting is routine patient care or clinical research, whether or not the outcome of a specific intervention is being assessed, and upon the expected efficacy or toxicity of the intervention. Global QOL instruments are best for individual clinical patient care or for comparing groups. HRQOL or a combination of HRQOL and global QOL instruments are most appropriate for assessing specific interventions.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, EC 037, Hershey, PA, 17033, USA,
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Cognitive strategies and quality of life of patients with high-grade glioma. Support Care Cancer 2015; 23:3427-35. [PMID: 25761757 DOI: 10.1007/s00520-015-2691-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 03/02/2015] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to analyze the psychological well-being, quality of life, and cognitive strategies activated by patients with high-grade glioma. We hypothesized that the self-perceived quality of life is modulated by physical and psychological factors and that in order to understand this modulation more psychometric approaches are necessary. Data were collected from a sample of 73 consecutive patients with a histological diagnosis of primary malignant brain cancer (grade IV glioblastoma and grade III anaplastic astrocytoma) hospitalized in a specialized Italian center. The Functional Assessment of Cancer Therapy (FACT) scale and the Schedule of Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) scale were used to assess quality of life. The mean FACT-Brain (Br) score was 122.37. Similarly, the median SEIQoL-DW score was 72.9 out of a maximum value of 100. No gender effect was found in relation to overall quality of life. Patients with high depression and/or anxiety scores reported lower quality of life (QoL) scores in all the instruments considered. We did not find any gender effect concerning depression and anxiety levels. However, we found that men and women, though having similar physical and functional well-being, reported different QoL determinants, since men seem to rely more on physical adjustment, while women activate more introspective strategies. Positive actions, family issues, negative thoughts, health, and positive thoughts were found to be the most reported themes. In conclusion, the present study strongly suggests that a positive psychological adjustment is possible also in the event of a severe diagnosis and during aggressive treatments, but QoL determinants might be considered too in order to help health professionals to understand patients' experience and to meet their needs.
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Connolly S, Galvin M, Hardiman O. End-of-life management in patients with amyotrophic lateral sclerosis. Lancet Neurol 2015; 14:435-42. [PMID: 25728958 DOI: 10.1016/s1474-4422(14)70221-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most health-care professionals are trained to promote and maintain life and often have difficulty when faced with the often rapid decline and death of people with terminal illnesses such as amyotrophic lateral sclerosis (ALS). By contrast, data suggest that early and open discussion of end-of-life issues with patients and families allows time for reflection and planning, can obviate the introduction of unwanted interventions or procedures, can provide reassurance, and can alleviate fear. Patients' perspectives regarding end-of-life interventions and use of technologies might differ from those of the health professionals involved in their care, and health-care professionals should recognise this and respect the patient's autonomy. Advance care directives can preserve autonomy, but their legal validity and use varies between countries. Clinical management of the end of life should aim to maximise quality of life of both the patient and caregiver and, when possible, incorporate appropriate palliation of distressing physical, psychosocial, and existential distress. Training of health-care professionals should include the development of communication skills that help to sensitively manage the inevitability of death. The emotional burden for health-care professionals caring for people with terminal neurological disease should be recognised, with structures and procedures developed to address compassion, fatigue, and the moral and ethical challenges related to providing end-of-life care.
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Affiliation(s)
- Sheelah Connolly
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland.
| | - Miriam Galvin
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Republic of Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland; Department of Neurology, Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland
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Stephens HE, Felgoise S, Young J, Simmons Z. Multidisciplinary ALS clinics in the USA: A comparison of those who attend and those who do not. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:196-201. [PMID: 25602166 DOI: 10.3109/21678421.2014.994530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Optimization of quality of life (QoL) is perceived by many as the primary goal for patients with amyotrophic lateral sclerosis (ALS), often via multidisciplinary clinics (MDCs). The aim of this study was to examine the differences in QoL, physical function, and social problem-solving skills for individuals with ALS attending MDCs compared to non-attenders. An online survey was completed by 295 people with ALS in the United States. Results showed there were no differences between the groups in global QoL, measures of physical function, or social problem-solving skills. Attenders and non-attenders of MDCs reported similar use of treatments for their ALS, although attenders received more health care services from nurses, therapists, social workers, dieticians, and in-home care providers. In conclusion, oher instruments may be needed to assess the benefits of MDCs. Qualitative studies of attenders and non-attenders of MDCs may reveal important differences that could guide care.
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Abdulla S, Vielhaber S, Kollewe K, Machts J, Heinze HJ, Dengler R, Petri S. The impact of physical impairment on emotional well-being in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:392-7. [DOI: 10.3109/21678421.2014.932380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simmons Z. Loss and well-being in ALS: A different perspective on the challenge. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:163-4. [DOI: 10.3109/21678421.2014.902069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Arezzo JC, Seto S, Schaumburg HH. Sensory-motor assessment in clinical research trials. HANDBOOK OF CLINICAL NEUROLOGY 2014; 115:265-78. [PMID: 23931786 DOI: 10.1016/b978-0-444-52902-2.00016-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The assessment of changes in sensory-motor function in clinical research presents a unique set of difficulties. Clinimetrics is the science of measurement as related to the identification of a clinical disorder, the tracing of the progression of the condition under study, and calculation of its impact. The selection of appropriate measures for clinical studies of sensory-motor function must consider validity, sensitivity, specificity, responsiveness, reliability, and feasibility. Reasonable measures of motor function in clinical research include manual examination of muscle strength, electrophysiology, functional scales, patient-reported outcomes (e.g., quality of life), and for severe conditions such as ALS, survival. The assessment of sensory function includes targeted electrophysiology and QOL, as well as more focused measures such as quantitative sensory testing and the scoring of positive symptoms. Each individual measure and each combination of endpoints has its strengths and limitations.
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Affiliation(s)
- Joseph C Arezzo
- Department of Neuroscience, Albert Einstein College of Medicine, New York, USA; Department of Neurology, Albert Einstein College of Medicine, New York, USA.
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Pagnini F. Psychological wellbeing and quality of life in amyotrophic lateral sclerosis: A review. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 48:194-205. [DOI: 10.1080/00207594.2012.691977] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Amyotrophic lateral sclerosis (ALS), the most common adult motor neuron disease, is an acquired disorder that results in loss of function in multiple domains. Although there is no treatment that can halt or reverse this progressive condition, there are many opportunities for interventions that can lead to improved quality of life for the patient and caregiver. Physical and occupational therapy can assist with mobility and activities of daily living. Interventions by speech pathology can optimize nutrition and communication. Respiratory function can be managed noninvasively or invasively. Depression, hopelessness, anxiety, and other mental health issues can and should be aggressively addressed and treated. Many symptoms such as pseudobulbar affect, sialorrhea, constipation, spasticity, and cramps can be treated effectively with medications. Spirituality and religion are important issues to address, as are end-of-life concerns, including advance directives, hospice, and the dying process. In contrast to the discouraging view that "there is nothing we can do," a broad approach to management, through collaboration with a multidisciplinary team, will permit the ALS physician to make a meaningful difference in the lives of individuals living with ALS.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Pagnini F, Gibbons CJ, Castelnuovo G. The importance of an idiographic approach for the severe chronic disorders-the case of the amyotrophic lateral sclerosis patient. Front Psychol 2012. [PMID: 23181046 PMCID: PMC3503483 DOI: 10.3389/fpsyg.2012.00509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- F Pagnini
- Department of Psychology, Catholic University of Milan Milan, Italy ; Niguarda Ca' Granda Hospital Milan, Italy
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Tramonti F, Bongioanni P, Di Bernardo C, Davitti S, Rossi B. Quality of life of patients with amyotrophic lateral sclerosis. PSYCHOL HEALTH MED 2012; 17:621-8. [DOI: 10.1080/13548506.2011.651149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Burns TM, Graham CD, Rose MR, Simmons Z. Quality of life and measures of quality of life in patients with neuromuscular disorders. Muscle Nerve 2012; 46:9-25. [PMID: 22644588 DOI: 10.1002/mus.23245] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 12/12/2022]
Abstract
In this review we present an overview of quality of life (QOL) and QOL measures in neuromuscular disorders. We discuss the characteristics of QOL measures used in neuromuscular research, highlighting differences between generic versus disease-specific and global versus health-related QOL instruments. The phenomenon of response shift is reviewed. Commonly used QOL instruments are reviewed for amyotrophic lateral sclerosis, muscle diseases, myasthenia gravis, and polyneuropathy. We also review some of what is known about QOL for patients with these neuromuscular disorders.
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Affiliation(s)
- Ted M Burns
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA.
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Hardiman O, van den Berg LH, Kiernan MC. Clinical diagnosis and management of amyotrophic lateral sclerosis. Nat Rev Neurol 2011; 7:639-49. [PMID: 21989247 DOI: 10.1038/nrneurol.2011.153] [Citation(s) in RCA: 402] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that results in progressive loss of bulbar and limb function. Patients typically die from respiratory failure within 3 years of symptom onset. The incidence of ALS in Europe is 2-3 cases per 100,000 individuals in the general population, and the overall lifetime risk of developing the disease is 1:400. ALS is familial in 5% of cases, and shows a Mendelian pattern of inheritance. ALS is recognized to overlap with frontotemporal dementia. Diagnosis is made on clinical grounds, using internationally recognized consensus criteria, after exclusion of conditions that can mimic ALS. The Revised ALS Functional Rating Scale is currently the most widely used assessment tool; scores are used to predict survival, and have been employed extensively in clinical trials. Riluzole remains the only effective drug, and extends the average survival of patients by 3-6 months. Optimal treatment is based on symptom management and preservation of quality of life, provided in a multidisciplinary setting. The discovery of further effective disease-modifying therapies remains a critical need for patients with this devastating condition.
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Affiliation(s)
- Orla Hardiman
- Department of Neurology, School of Medicine, Room 5.41, 5th Floor, Biomedical Science Building, Trinity College Dublin, Dublin 2, Ireland.
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Emotional adjustment in amyotrophic lateral sclerosis (ALS). J Neurol 2011; 259:334-41. [PMID: 21808983 DOI: 10.1007/s00415-011-6191-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 12/13/2022]
Abstract
Despite the devastating motor impairment, a significant number of patients with amyotrophic lateral sclerosis (ALS) maintain a good psychosocial adjustment. Here we investigated whether this is specific for ALS or a more general characteristic of terminal disease. Psychosocial adjustment was investigated in 30 ALS patients, 29 cancer patients in palliative treatment and 29 age-, gender- and level of education-matched healthy controls. Subjective quality of life (sQoL), degree of depressive symptoms and coping were evaluated as measures of psychosocial adjustment. Personality factors were described. ALS and cancer patients showed a good psychosocial adjustment. Subjective QoL and depression did not differ significantly. Both patient groups presented a good sQoL. The level of mild depressive symptoms in both patient groups was similar and none showed clinically relevant depression. ALS patients expressed fewer active coping strategies than cancer patients which were explained by gender differences. Both patient groups showed comparable psychosocial adjustment to their disease. Overall, in terminally ill patients the psychological response to the prognosis is not associated with neurobiological changes (e.g., associated with subclinical deficits in ALS) or with physical decline.
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Ng L, Talman P, Khan F. Neuropsychological sequelae in motor neurone disease: outcomes of a peer support programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.8.429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Louisa Ng
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, and Honorary Clinical Senior Lecturer, Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Paul Talman
- Barwon Health, The Geelong Hospital, Victoria
| | - Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital and Principal Fellow, Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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O'Doherty LJ, Hickey A, Hardiman O. Measuring life quality, physical function and psychological well-being in neurological illness. ACTA ACUST UNITED AC 2011; 11:461-8. [PMID: 20192883 DOI: 10.3109/17482960903552488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is little in the literature comparing experiences of patients with disabling and uniformly terminal illness (e.g. amyotrophic lateral sclerosis) and illness characterized by episodic disability and prognostic uncertainty (e.g. multiple sclerosis). This study aimed to compare experiences of disability, quality of life (QoL) and psychological well-being in ALS and MS. One hundred patients with ALS and MS were interviewed at baseline and at six months. Variables measured included function, health related QoL, individualized QoL and psychological distress. Despite the divergent illness experiences of ALS and MS patients, groups did not differ on individualized QoL or mental well-being, and distress was in the normal range. Despite marked deterioration in ALS patients' health, there was no change in mental well-being and QoL. Psychological well-being appeared more important in maintaining QoL (individualized QoL and mental aspects of health related QoL) than physical factors. At the individual level, there was evidence of psychological adaptation to deteriorating function, which underlined the role of specific illness related challenges in determining perceived life quality and emotional well-being. In conclusion, the complex interplay between psychosocial and illness specific factors such as certainty with regard to prognosis has considerable implications for well-being and life quality. Recognizing such factors is essential when designing clinical interventions to promote adjustment and self-management among patients with neurological conditions.
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Affiliation(s)
- Lorna Jane O'Doherty
- Department of General Practice, The University of Melbourne, Victoria, Australia.
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Differences in quality of life modalities give rise to needs of individual support in patients with ALS and their next of kin. Palliat Support Care 2010; 8:75-82. [PMID: 20163763 DOI: 10.1017/s1478951509990733] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine health-related quality of life (HRQoL), individual QoL, anxiety and depression in patients with amyotrophic lateral sclerosis (ALS) and their next of kin in relation to patients' physical function over time. METHODS 35 patients and their next of kin were studied using the Short Form-36 Health Survey (SF-36), Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), and Hospital Anxiety and Depression Scale (HADS) and patients also by the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised and the Norris scale every fourth to sixth month, one to four times. RESULTS Changes were found over time in both patients and their next of kin in the SF-36 but not in the SEIQoL-DW or HADS. Patients rated worse than their next of kin in the SF-36 physical subscales and next of kin rated worse than the patients in the global QoL score in SEIQoL-DW. Health, hobbies, and total relations were important areas in the SEIQoL-DW among all participants, but some important areas also differed between the patients and their next of kin. In most important areas among the pairs, the next of kin estimated their functioning/satisfaction worse than patients estimated their functioning/satisfaction. SIGNIFICANCE OF RESULTS There were few changes over time in the QoL among the participants. Although most of the estimates in patients and their next of kin were equal, there were also some differences. These results emphasize the importance of support for both patients and their next of kin and that support ought to be given on both individual bases and together in pairs. The SEIQoL-DW might give signposts in the care through the course of the disease about what should be focused on to increase satisfaction of the important areas of life and might help the person to find coping strategies to handle his or her life situation.
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