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Sapmaz Atalar M, Genç G, Işık EE, Cangi ME, Pehlivan B, Bulut S. Can Voice Parameters Provide Cutoff Values to Predict Dysphagia in Individuals with Multiple Sclerosis? Dysphagia 2024:10.1007/s00455-024-10720-3. [PMID: 38872058 DOI: 10.1007/s00455-024-10720-3] [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: 11/07/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
In dysphagia assessment, along with well-defined measurements and signs, voice parameters can potentially support clinical decision as a marker, but more evidence is needed. This study aims to determine the voice parameters that can predict the risk of dysphagia and to determine optimal cutoff values in individuals with multiple sclerosis (IwMS). Seventy-six adults participated in the study, including 39 IwMS and 37 healthy individuals (HI). The study used the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS), Gugging Swallowing Screen (GUSS), and Voice Handicap Index (VHI-10) and recorded voice samples using Praat programme. Voice recordings were taken pre- and post-swallowing. The voice parameters analysed are fundamental frequency (F0), standard deviation F0 (SD F0), jitter (local), shimmer (local), and harmonic-to-noise ratio (HNR). Roc analysis was performed to examine the diagnostic accuracy performance of the risk for dysphagia/penetration. The parameters of IwMS pre-swallowing differed significantly from those of HI on the VHI-10, DYMUS, GUSS scores, and jitter (local), shimmer (local), and HNR. IwMS but not HI exhibited significant differences in shimmer (local) and HNR between the pre- and post-swallowing measurements. In IwMS, GUSS revealed significant differences in shimmer (local) pre- and post-swallowing between the groups with and without dysphagia/penetration. In the ROC analysis results, the area under the curve (AUC) for shimmer (local) pre-swallowing was 73.1% (cutoff = 1.69); post-swallowing, it was 78.6% (cutoff = 1.57). In conclusion, IwMS can be associated with differences in shimmer (local) and HNR parameters, low quality of life-related to voice, and dysphagia/penetration risk. The AUC values for shimmer (local) in IwMS pre- and post-swallowing may help to strengthen diagnostic decisions of dysphagia risk.
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Affiliation(s)
- Merve Sapmaz Atalar
- Department of Speech and Language Therapy, Hamidiye Faculty of Health Science, University of Health Sciences, İstanbul, Türkiye
| | - Gençer Genç
- Department of Neurology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Elif Ezgi Işık
- Department of Speech and Language Therapy, Hamidiye Faculty of Health Science, University of Health Sciences, İstanbul, Türkiye
| | - Mehmet Emrah Cangi
- Department of Speech and Language Therapy, Hamidiye Faculty of Health Science, University of Health Sciences, İstanbul, Türkiye.
| | - Beyza Pehlivan
- Department of Speech and Language Therapy, Hamidiye Faculty of Health Science, University of Health Sciences, İstanbul, Türkiye
| | - Serpil Bulut
- Department of Neurology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
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Webster A, Poyade M, Coulter E, Forrest L, Paul L. Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study. JMIR Serious Games 2024; 12:e51508. [PMID: 38669680 PMCID: PMC11087863 DOI: 10.2196/51508] [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: 08/02/2023] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. OBJECTIVE This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. METHODS Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. RESULTS People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. CONCLUSIONS VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS.
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Affiliation(s)
- Amy Webster
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, United Kingdom
| | - Elaine Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lisa Forrest
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Sapmaz Atalar M, Genç G, Bulut S. Drooling may be Associated with Dysphagia Symptoms in Multiple Sclerosis. Dysphagia 2024:10.1007/s00455-024-10666-6. [PMID: 38369562 DOI: 10.1007/s00455-024-10666-6] [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: 03/23/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024]
Abstract
During the process of the multiple sclerosis (MS), persons with multiple sclerosis (PwMS) may experience drooling (sialorrhea) issues that are frequently disregarded. The exact cause of drooling in PwMS is poorly understood. This study aims to assess potential risk factors for drooling seen in PwMS. The study included 20 PwMS with drooling and 19 PwMS without drooling. The participants' sociodemographic data and clinical parameters were noted. To evaluate dysphagia, fatigue, and hypersalivation, the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS), the Fatigue Severity Scale (FSS), and objective saliva flow rate measurement with cottons placed in Stensen ducts and under the tongue (swab test) were used, respectively. The study employed univariate and multivariate logistic regression models to identify the risk factors linked to drooling. Gender, age, disease duration, MS type, and Expanded Disability Status Scale scores did not differ between the two groups. There was a significant increase in the DYMUS and submandibular/sublingual (SM/SL) saliva flow rate values in PwMS with drooling (p = 0.009 and p = 0.019, respectively). However, in our study, hypersalivation was not observed in PwMS with or without drooling. In the univariate model, DYMUS, SM/SL saliva flow rate, and FSS were found to be risk factors for drooling in PwMS. But only DYMUS was shown to be a significant risk factor in the multivariate model obtained by the backward (Wald) elimination method (p = 0.023). Finally, our research is the first to demonstrate the relationship between drooling and the presence of dysphagia symptoms in PwMS. This is a very important study to determine the nature of drooling in PwMS. This finding shows that our study will serve as a reference for choosing the best method for drooling treatment.
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Affiliation(s)
- Merve Sapmaz Atalar
- Department of Speech and Language Therapy, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey.
| | - Gençer Genç
- Department of Neurology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serpil Bulut
- Department of Neurology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Erensoy İ, Yaşar Ö, Şahvelioğlu Ö, İnan K, Terzi M. Reliability and validity of the Turkish version of speech pathology-specific questionnaire for persons with multiple sclerosis (SMS-TR). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:841-848. [PMID: 36308425 DOI: 10.1080/17549507.2022.2134454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study is to validate the speech pathology-specific questionnaire for persons with Multiple Sclerosis (SMS) in Turkish. METHOD A total of 218 participants were included in the study. The study group was composed of 104 persons diagnosed with MS, and the control group was 114 healthy participants without any neurological deficits. The translated version of the SMS was administered to all participants. Test-retest reliability, internal consistency, construct validity, floor and ceiling effects were investigated. Dysphagia in multiple sclerosis questionnaire (DYMUS) was used for criterion validity. Finally, sensitivity and specificity of the SMS-TR was calculated using a ROC curve analysis. RESULT SMS-TR has an excellent internal consistency (Cronbach's alpha = 0.92). Item-total correlations range between 0.45 and 0.78. The intraclass correlation coefficient (ICC) obtained for the test-retest indicates a good level of reproducibility (ICC = 0.86). According to confirmatory factor analysis, the fit measures of the scale were found to be acceptable. A significant difference was found between the total SMS scores of the study group and the control group (20.6 ± 10.4 and 1.9 ± 2.8, P < 0.001, respectively). A statistically significant correlation was observed between SMS and DYMUS (r = 0.833, P < 0.001). There were no floor and ceiling effects found in the study group. According to the ROC curve analysis, the area under the curve of SMS-TR was 0.98. The optimal cut-off value was 8, with a sensitivity of 91.3% and a specificity of 95.6%. CONCLUSION SMS-TR is a valid and reliable patient-reported outcome measure suitable for the assessment of language, speech, and swallowing disorders in persons with MS. A score >8 is an indicator of language, speech, and swallowing pathology for persons.
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Affiliation(s)
- İbrahim Erensoy
- Department of Speech and Language Therapy, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Özlem Yaşar
- Department of Speech and Language Therapy, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Özge Şahvelioğlu
- Department of Speech and Language Therapy, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Kübra İnan
- Department of Speech and Language Therapy, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Terzi
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Khan Z, Gupta GD, Mehan S. Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges. J Clin Med 2023; 12:4274. [PMID: 37445309 DOI: 10.3390/jcm12134274] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India's treatment techniques vary. In addition, India's population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.
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Affiliation(s)
- Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
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Büyükaşık M, Özkeskin M, Özden F. The reliability and validity of the Turkish version of the Multiple Sclerosis Questionnaire for physiotherapists. Disabil Rehabil 2022; 44:2908-2914. [DOI: https:/doi.org/10.1080/09638288.2020.1847206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 08/30/2023]
Affiliation(s)
- Mehmet Büyükaşık
- Physical Therapy and Rehabilitation Department, İstanbul Okan University, Institute of Health Sciences, İstanbul, Turkey
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Physical Therapy and Rehabilitation Department, Ege University, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Elderly Care Department, Muğla Sıtkı Koçman University, Muğla, Turkey
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Arji G, Rezaeizadeh H, Moghadasi AN, Sahraian MA, Karimi M, Alizadeh M. Complementary and alternative therapies in multiple sclerosis: a systematic literature classification and analysis. Acta Neurol Belg 2022; 122:281-303. [PMID: 35060096 DOI: 10.1007/s13760-021-01847-3] [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: 05/09/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Multiple Sclerosis (MS) is a disease determined by inflammatory demyelination and neurodegeneration in the Central Nervous System (CNS). Despite the extensive utilization of Complementary and Alternative Medicine (CAM) in MS, there is a need to have comprehensive evidence regarding their application in the management of MS symptoms. This manuscript is a Systematic Literature Review and classification (SLR) of CAM therapies for the management of MS symptoms based on the International Classification of Functioning Disability and Health (ICF) model. METHOD Studies published between 1990 and 2020 IN PubMed, Science Direct, Scopus, Pro-Quest, and Google Scholar using CAM therapies for the management of MS symptoms were analyzed. RESULTS Thirty-one papers on the subject were analyzed and classified. The findings of this review clearly show that mindfulness, yoga, and reflexology were frequently used for managing MS symptoms. Moreover, most of the papers used mindfulness and yoga as a CAM therapy for the management of MS symptoms, which mostly devoted to mental functions such as fatigue, depression, cognition, neuromuscular functions such as gait, muscle strength, and spasticity, and sensory function such as balance, in addition to, reflexology is vastly used to management of mental functions of MS patients. CONCLUSION Evidence suggested that CAM therapies in patients with MS have the potential to target and enhancement numerous elements outlined in the ICF model. Although the use of CAM therapies in MS symptom management is promising, there is a need for strict clinical trials. Future research direction should concentrate on methodologically powerful studies to find out the potential efficacy of CAM intervention.
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Affiliation(s)
- Goli Arji
- School of Nursing and Midwifery, Health Information Technology Department, Saveh University of Medical Sciences, Saveh, Iran
| | - Hossein Rezaeizadeh
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Abdolrreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Alizadeh
- Department of Computer Engineering, Lorestan University, Khorramabad, Iran.
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El-Wahsh S, Layfield C, Bogaardt H, Kumfor F, Ballard KJ. Perspectives from the patient: A content analysis of communication changes, impact, and strategies to facilitate communication in multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:173-189. [PMID: 34493141 DOI: 10.1080/17549507.2021.1973101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Communication changes in multiple sclerosis (MS) are under-explored and under-recognised. Persons with MS (PwMS) are experts in their condition and play a valuable role in informing clinicians and researchers of their condition. This study aimed to investigate the perspectives of PwMS on: (1) MS-related communication changes, (2) the impact of these communication changes across key aspects of a person's life, including work/studies, relationships, and general quality of life, and (3) strategies used to facilitate communication in daily interactions.Method: Two-hundred and sixty PwMS were recruited internationally and completed an online questionnaire. Content analysis was used to analyse open-ended questionnaire responses.Result: One-hundred and ninety-seven (75.8%) participants reported communication changes, including language, cognitive, speech, voice, and fluency changes. Participants described a variety of personal and environmental factors that influence communication negatively, such as fatigue, stress, and heat. Communication changes were reported to impact on psychological wellbeing, interpersonal relationships, participation and identity in the workforce and career pathways, and tertiary studies. Around 40% of participants reported using a range of overt and covert strategies to manage communication changes. Only 11.2% (n = 22/197) of participants who reported communication changes accessed speech-language pathology (SLP) services.Conclusion: PwMS can experience a wide spectrum of communication changes. These communication changes can have a profound and far-reaching impact on psychological wellbeing and societal participation. Engagement with SLP services is limited compared to the reported prevalence of communication changes. There is a need to raise awareness of the role of SLP in service provision for PwMS to manage communication changes. This paper discusses and provides suggestions for SLP services for PwMS with communication changes. There is a timely need to develop evidence-based interventions to support PwMS manage communication changes and reduce their impact.
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Affiliation(s)
- Sarah El-Wahsh
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire Layfield
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, Australia, and
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Al-Sharman A, Al-Khazaaleh HM, Khalil H, Aburub A, El-Salem K. The Relationship Between Sleep Quality, Sleep-Related Biomarkers, and Motor Skill Acquisition in People With Multiple Sclerosis: A Pilot Study. Phys Ther 2021; 101:6322543. [PMID: 34270772 DOI: 10.1093/ptj/pzab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Neurorehabilitation that involves learning new motor skills is one of the promising clinical methods for motor recovery in people with multiple sclerosis (PwMS); therefore, factors that influence the acquisition of motor skills in PwMS need to be investigated. Sleep disturbances are common in PwMS; however, no study has investigated the effect of sleep and sleep-related biomarkers on skill acquisition in PwMS. This study aimed to examine the effect of sleep and sleep-related biomarkers on motor acquisition in PwMS. METHODS Forty participants with MS and 40 controls were recruited in this study. To assess motor acquisition, each participant was asked to perform a novel game through a virtual reality (VR) system 5 times (blocks). The main outcome measures for each block were the required time to complete the VR game and the recorded errors. The difference in scores between Block 5 and Block 1 for both outcomes were considered to represent motor skill acquisition. Sleep was assessed by self-report using the Pittsburgh Sleep Quality Index (PSQI) and objectively using sleep monitor technology. Serotonin level was assessed using means of enzyme-linked immunosorbent assay using plasma samples. RESULTS There were significant positive correlations in both groups between motor skill acquisition and PSQI score. In PwMS, significant negative correlation between motor skill acquisition and sleep efficiency and significant positive correlation between motor skill acquisition and sleep latency were also observed. Interestingly, a significant negative correlation was observed between motor skill acquisition and the plasma serotonin level in both groups. Most of these correlations remained significant after controlling for disease severity, fatigue, baseline performance, and cognitive status. CONCLUSION Sleep quality may influence motor skill acquisition in PwMS. Circulatory serotonin level might explain this relationship. IMPACT Physical therapists are encouraged to be aware of sleep quality and sleep assessment. Sleep management strategies should be considered when treating PwMS.
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Affiliation(s)
- Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba Mefleh Al-Khazaaleh
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ala'S Aburub
- Physical Therapy Department, Faculty of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Heidari Z, Shahrbanian S, Chiu C. Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review. Disabil Rehabil 2021; 44:5758-5769. [PMID: 34338108 DOI: 10.1080/09638288.2021.1949051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Multiple sclerosis (MS) causes a range of different symptoms. Patients with MS (PwMS) have looked for alternative therapies to control their MS progress and treat their symptoms. Non-invasive therapeutic approaches such as massage can have benefits to mitigate some of these symptoms. However, there is no rigorous review of massage effectiveness for PwMS. The present systematic review aims to examine the effectiveness of different massage approaches on common MS symptoms, including fatigue, pain, anxiety, depression, and spasticity. MATERIALS AND METHODS A systematic search of related trials was conducted in electronic databases including Cochrane Library, PubMed, Scopus, Web of Science, and Google Scholar, using search terms related to Multiple Sclerosis and massage therapy. The PEDro scale was used to evaluate the methodological quality of reviewed studies. RESULTS A total of 12 studies met the inclusion criteria. We rated 5 studies as fair and 7 studies as good. Fatigue was improved by different massage styles, such as reflexology, nonspecific therapeutic massage, and Swedish massage. Pain, anxiety, and depression were effectively improved by reflexology techniques. Spasticity was reduced by Swedish massage and reflexology techniques. CONCLUSIONS Different massage approaches effectively improved MS symptoms such as fatigue, pain, anxiety, depression, and spasticity.Implications for rehabilitationThe present review results indicate that massage may have beneficial effects on motor and non-motor symptoms in MS.Massage could be considered a complementary and alternative treatment combined with conventional medicine in people with MS.Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology.
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Affiliation(s)
- Zakieh Heidari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Shahnaz Shahrbanian
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Prusynski RA, Gustavson AM, Shrivastav SR, Mroz TM. Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review. Phys Ther 2021; 101:6059293. [PMID: 33388761 DOI: 10.1093/ptj/pzaa230] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/02/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet, there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. METHODS PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology Classification of Evidence scale for causation questions. American Academy of Neurology criteria were used to assess confidence in the evidence for each outcome. RESULTS Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. CONCLUSIONS This systematic review concludes with moderate confidence that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. IMPACT This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195-6490, USA
| | - Allison M Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Siddhi R Shrivastav
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195-6490, USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195-6490, USA
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Kennedy W, Fruin R. The Importance of the Cognitive Aspects of Vocational Rehabilitation for Individuals With Multiple Sclerosis. J Patient Exp 2021; 7:842-844. [PMID: 33457508 PMCID: PMC7786701 DOI: 10.1177/2374373520969108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Individuals with multiple sclerosis (MS) face symptoms that affect them physically and cognitively; 80% of individuals diagnosed with MS are out of work within 10 years, and 58% are unemployed. It appears that a diagnosis of MS creates a barrier to individuals obtaining and maintaining work. To combat this, vocational rehabilitation (VR) has been utilized by individuals with MS but with limited success. This may be due to the lack of interventions that address cognitive symptoms that occur. Purpose: The purpose of this perspective is to review the interaction between individuals with MS and the components of VR and discuss implications that could potentially increase the success of individuals with MS obtaining work. Implications: Approximately 48.1% of clients with MS receiving services from state VR agencies obtain or retain employment compared to 60% of clients with other diagnoses. This disparity highlights a disconnect in VR services. It has been seen that individuals with MS who were employed at application were more likely to receive services that include cognitive retraining-type services. Including more opportunities for cognitive retraining-type services may decrease this disparity and help more individuals with MS maintain or obtain work.
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Affiliation(s)
- Winston Kennedy
- College of Public Health & Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Robert Fruin
- College of Public Health & Human Sciences, Oregon State University, Corvallis, OR, USA
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Büyükaşık M, Özkeskin M, Özden F. The reliability and validity of the Turkish version of the Multiple Sclerosis Questionnaire for physiotherapists. Disabil Rehabil 2020; 44:2908-2914. [PMID: 33226865 DOI: 10.1080/09638288.2020.1847206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To translate and cross-culturally adapt the Multiple Sclerosis Questionnaire for Physiotherapists (MSQPT) into Turkish, to evaluate its psychometric properties, including reliability and validity. METHODS All participants have completed the Turkish version of MSQPT and the Multiple Sclerosis International Quality of Life (MusiQoL). Fifteen days later, 30 patients refilled the Turkish MSQPT. Reproducibility and internal consistency were analyzed by the intraclass correlation coefficient (ICC) and Cronbach's α coefficient, respectively. Validity was evaluated by the Spearman correlation coefficient calculated by the association of the MSQPT score with the Expanded Disability Status Scale (EDSS) and MusiQoL scores. Also, the standard error of measurement (SEM95) and the minimum detectable change (MDC95) were calculated. RESULTS The global internal consistency was excellent (>0.90). The Cronbach's alpha coefficients of the activity, participation, and balance subscores were 0.931,0.829, and 0.508, respectively. The ICC value calculated for the total score and all three subscores were excellent (>0.80). SEM95 and MDC95 for the total score were 75.5 and 209.4, respectively. The correlation between the total score of MSQPT and the total score of MusiQoL was excellent (r = 0.776, p < 0.001). All scores of the Turkish MSQPT were highly correlated with the EDSS score, except participation subscore (r > 0.70, p < 0.001). CONCLUSION The Turkish version of the MSQPT is a reliable and valid assessment tool for multiple sclerosis patients.Implications for rehabilitationThe Multiple Sclerosis Questionnaire for Physiotherapists (MSQPT) was successfully translated and cross-culturally adapted into Turkish.The Turkish version of the MSQPT is a reliable and valid questionnaire for the evaluation of Turkish-speaking multiple sclerosis patients.Unlike the multiple sclerosis-specific quality of life measurement tools, the MSQPT focuses more extensively on the physiotherapists' needs.
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Affiliation(s)
- Mehmet Büyükaşık
- Physical Therapy and Rehabilitation Department, İstanbul Okan University, Institute of Health Sciences, İstanbul, Turkey
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Physical Therapy and Rehabilitation Department, Ege University, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Elderly Care Department, Muğla Sıtkı Koçman University, Muğla, Turkey
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Kirkland MC, Wadden KP, Ploughman M. Bipedal hopping as a new measure to detect subtle sensorimotor impairment in people with multiple sclerosis. Disabil Rehabil 2020; 44:1544-1555. [PMID: 32955951 DOI: 10.1080/09638288.2020.1820585] [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: 10/23/2022]
Abstract
BACKGROUND Bipedal hopping has the potential to detect subtle multiple sclerosis (MS)-related impairments, especially among patients who "pass" typical movement tests. In this narrative review, we outline the biomechanics of bipedal hopping and propose its usefulness as a novel outcome measure for people with MS having mild disability. METHODS We summarize articles that (1) examined the biomechanics of jumping or hopping and (2) tested the validity and/or reliability of hopping tests. We consolidated consistencies and gaps in research and opportunities for future development of the bipedal hop test. RESULTS Bipedal hopping requires immense power, coordination, balance, and ability to reduce co-contraction; movement components typically affected by MS. These impairments can be measured and differentiated by examining specific variables, such as hop length (power), symmetry (coordination), center of pressure (balance), and coefficient of variability (co-contraction/spasticity). Bipedal hopping challenges these aspects of movement and exposes sensorimotor impairments that may not have been apparent during walking. CONCLUSIONS Testing of bipedal hopping on an instrumented walkway may detect and monitor sensorimotor control in people with MS who do not currently present with clinical deficits. Early measurement is imperative for precise rehabilitation prescription to slow disability progression prior to onset of measurable gait impairment.Implications for rehabilitationJumping and hopping tests detect lower limb and balance impairments in children, athletes, and older adults.Bipedal hop test measures multiple domains: power, coordination, balance, and muscle timing.Bipedal hop test may expose subtle sensorimotor impairments in people with multiple sclerosis.Multiple variables measured can discern type of sensorimotor impairment to direct personalized rehabilitation programs.
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Affiliation(s)
- Megan C Kirkland
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Katie P Wadden
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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15
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Sarbaz Y, Beni KN, Hosseininejad A, Eftekharsadat B, Jahanjoo F. The effect of yoga practice on muscular strength improvement in patients with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/Aims Multiple sclerosis is a common condition in the central nervous system where patients experience many issues, including muscle weakness. This study offers an investigation of continuous hatha yoga exercises on patients with multiple sclerosis. Methods A total of 22 participants with multiple sclerosis were selected, 11 were allocated to the intervention group, and 11 to the control group. In both groups, surface electromyography and dynamometer were performed at the beginning and the end of the study. The intervention group undertook 90-minute sessions of hatha yoga training three times a week for 6 months and the control group did not do any particular exercise during this period. Results Dynamometer results indicated that yoga significantly improved the muscle strength of the participants with multiple sclerosis (before the intervention: 40.00 Nm ± 14.66 Nm vs 56.82 Nm ± 20.28 Nm after the intervention, P=0.037). However, there was no significant difference in muscle strength changes between the intervention and control groups (16.82 Nm ± 23.26 Nm vs -2.86 Nm ± 23.36 Nm, P=0.171). Yoga significantly increased participants muscle strength according to the surface electromyography signals (before the intervention: 39.91 V ± 8.86 V vs 54.09 v ± 8.95 V after the intervention, P=0.007). The muscle strength of the control group participants with multiple sclerosis decreased after 6 months, however it was not statistically significant (41.55 Nm ± 9.3 Nm vs 34.55 Nm ± 8.36 Nm, P=0.073). The comparison of changes showed that the surface electromyography signals in the intervention group were significantly higher than those of the control group (P=0.001). Conclusions: Yoga exercises, in addition to common multiple sclerosis treatment methods, can be considered as a complementary therapy to improve the physical aspects of multiple sclerosis symptoms.
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Affiliation(s)
- Yashar Sarbaz
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Kamran Naderi Beni
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Azar Hosseininejad
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jahanjoo
- Department of Biostatistics and Epidemiology, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Rahmani M, Rahimian Boogar I, Talepasand S, Nokani M. Comparing the Effectiveness of Computer-Based, Manual-based, and Combined Cognitive Rehabilitation on Cognitive Functions in Relapsing-Remitting Multiple Sclerosis Patients. Basic Clin Neurosci 2020; 11:99-110. [PMID: 32483480 PMCID: PMC7253816 DOI: 10.32598/bcn.9.10.430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/25/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction This study aimed to compare the effectiveness of computer-based, manual-based, and combined cognitive rehabilitation to improve cognitive functions among patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Methods This was a quasi-experimental study with a pre-test-post-test, and a 2-month follow-up, as well as a control group design. Sixty female patients with RRMS were selected by convenience sampling technique. Then they were randomly assigned into three experimental groups (computer-based, manual-based, and combined cognitive rehabilitation, each group including 12 patients), a placebo group (12 patients), and a control group (12 patients). The interventions were conducted in 21 sessions for the experimental groups for 5 months. The placebo group received physical rehabilitation intervention, and the control group received no intervention. The study participants were assessed by Psychiatric-Neurological Profile, Mini-Mental State Examination, Kurtzke Expanded Disability Status Scale, Stroop Color and Word Test, Wisconsin Card Sorting Test, and Paced Auditory Serial Addition Test. The obtained data were analyzed by repeated-measures multivariate analysis of variance in SPSS. Results The effect of group factor was not significant (η2=0.129), but the effect of time (η2=0.884) and interaction effect of time and group (η2=0.295) were statistically significant (P<0.05). There was no significant difference between the effects of all three rehabilitation interventions (P>0.05). In the post-test totally and in Follow-up partially, all comparisons among three experimental groups with control and placebo groups were statistically significant (P<0.05). Conclusion Cognitive rehabilitation was effective in improving cognitive functions in patients with RRMS. Thus, these interventions are recommended for application, along with other treatment protocols to treat RRMS in clinical settings.
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Affiliation(s)
- Mehri Rahmani
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Mahdishahr, Semnan, Iran
| | - Isaac Rahimian Boogar
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Mahdishahr, Semnan, Iran
| | - Siavash Talepasand
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Mahdishahr, Semnan, Iran
| | - Mostafa Nokani
- Department of Clinical Psychology, Arak University of Medical Sciences, Arak, Iran
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Al-Sharman A, Khalil H, El-Salem K, Aldughmi M, Aburub A. The effects of aerobic exercise on sleep quality measures and sleep-related biomarkers in individuals with Multiple Sclerosis: A pilot randomised controlled trial. NeuroRehabilitation 2019; 45:107-115. [PMID: 31403958 DOI: 10.3233/nre-192748] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sleep disturbances are highly prevalent in people with multiple sclerosis(MS), and are associated with pain, fatigue, depression, and reduced quality of life (QoL). Importantly, sleep has been considered a critical brain state for motor learning and memory consolidation. Therefore, interventions that target sleep managementin people with MS are needed. OBJECTIVES To explore the effects of a six weeks moderate-intensity aerobic exercise intervention on sleep characteristics and sleep-related biomarkers specifically serotonin, melatoninand cortisol in people with MS using a pilot randomized controlled trial. METHODS Participants were randomly allocated to either a moderate-intensity aerobic exercise program (MAE, n = 20) or a home exercise program (HEP, n = 20). Participants were assessed at baseline and follow-up. Subjective and objective measures were used to assess sleep quality. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to subjectively assess sleep. While Actigraphy was used to objectivelyassess sleep. Blood samples were collected for measurement of cortisol, melatonin and serotonin from MS participants in both groups at 8:00 am±1 hour. RESULTS Seventeen participants in the MAE and 13 in the HEP group completed the study. Compared to the HEP group, people with MS who participated in a moderate-intensity aerobic exercise experienced significant improvements (P < 0.05) on the PSQI, ISI, and several objective sleep parameters measured using actigraphy. Only the serotonin levels increased significantly over the six-week period in the MAE group compared to the HEP group. The change score in serotonin (from baseline to follow up assessment) was significantly correlatedwith the change score in PSQI (r = -0.97, p < 001) and the change score in ISI (r = -0. 56, p = 0.015) only in the MAE group but not the HEP group. CONCLUSIONS Exercise may be a non-pharmacological, inexpensive, safe method to improve sleep quality in people with MS. The improvement in the serotonin level due to aerobic exercisemight explain one of the physiologic mechanisms driving these improvements.
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Affiliation(s)
- Alham Al-Sharman
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Jordan University of Science and Technology, Faculty of Medicine, Irbid, Jordan
| | - Mayis Aldughmi
- University of Jordan, School of Rehabilitation Sciences, Amman, Jordan
| | - Aseel Aburub
- Keele University, School of Health and Rehabilitation Sciences, Newcastle Under Lyme, United Kingdom
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18
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El-Wahsh S, Heard R, Bogaardt H. Development and validation of a speech pathology-specific questionnaire for persons with multiple sclerosis (SMS). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:553-563. [PMID: 30348018 DOI: 10.1080/17549507.2018.1499802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/07/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
Purpose: The aim of this study was to develop and validate the Speech pathology-specific questionnaire for persons with Multiple Sclerosis (SMS).Method: Forty-one items were generated through a literature review. Items were submitted to a preliminary psychometric validation process consisting of principal component analysis, internal consistency, test-retest reliability, and floor and ceiling effects using data from 164 participants. Criterion validity was assessed by comparing the SMS with the 12-item Short Form Health Survey (SF-12). Participants were recruited internationally through online channels and questionnaires were completed online.Result: The SMS contains 16 items describing three components: speech and voice, language, and swallowing. Internal consistency (Cronbach's alpha) of the three components was satisfactory (α = 0.89-α = 0.91). Criterion validity was evaluated using Spearman's rank correlation coefficient (ρ). A statistically significant weak to moderate correlation between the SMS and the SF-12 was identified (ρ = -0.004-ρ = -0.359). No floor or ceiling effects were present. The SMS demonstrated strong test-retest reliability. All items had an intra-class correlation coefficient ≥0.70.Conclusion: The SMS is a psychometrically robust patient-reported outcome measure to assess speech-language pathology symptoms in persons with MS.
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Affiliation(s)
- Sarah El-Wahsh
- Department of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Robert Heard
- Department of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Hans Bogaardt
- Department of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
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Al-Sharman A, Khalil H, El-Salem K, Alghwiri AA, Khazaaleh S, Khraim M. Motor performance improvement through virtual reality task is related to fatigue and cognition in people with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1782. [PMID: 31120581 DOI: 10.1002/pri.1782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/10/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (MS) who undergo rehabilitation need to perform new motor skills or relearn old motor skills. It is not clear whether people with MS retain the ability to improve motor performance or learning. Furthermore, factors that influence motor performance in people with MS need to be investigated. This study explored motor performance in people with MS using virtual reality (VR). The effect of fatigue and cognitive function on motor performance improvement in people with MS was investigated. METHODS Twenty MS participants and 20 controls were recruited into the study. To assess motor performance, each participant was asked to perform a VR game for five times (blocks). The main outcome was time to complete the VR game and number of recorded errors. To assess fatigue level and cognitive function, participants were asked to complete the Arabic versions of the Modified Fatigue Impact Scale (MFIS) and the Montréal Cognitive Assessment (MOCA), respectively. RESULTS MS participants and controls demonstrated a practice-related improvement in performance as shown by the main effect of block for each of the outcome measures (p < .001, time required to complete VR game; p < .001, errors recorded). Strong and significant negative correlations between recorded errors and MOCA (r = .75, p < .001) and between recorded errors and MFIS (r = .55, p = .011) were found in people with MS. CONCLUSIONS Ability to improve motor performance in people with MS is preserved and related to cognitive function and fatigue impact. Health-care professionals should be made aware of the negative impact of cognitive function and fatigue on motor performance. A multicomponent intervention that targets these factors is advisable. Future research, however, is required to determine the content and potential benefits of such an intervention in the MS population.
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Affiliation(s)
- Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alia A Alghwiri
- School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Shada Khazaaleh
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Khraim
- Neuroscience Department, Faculty of Graduate Studies, Jordan University of Science and Technology, Irbid, Jordan
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20
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Gitto L. Long Term Compliance for MS Patients in Treatment with Disease Modifying Drugs (DMDs). Open Neurol J 2019. [DOI: 10.2174/1874205x01913010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Multiple Sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults. Patients with MS face many challenges, both physical and emotional, and see an overall reduction in their autonomy.
There is no definitive treatment for MS, though Disease Modifying Drugs (DMDs) have proved effective in reducing the frequency and severity of relapses. Unfortunately, long-term adherence to these therapies is a significant challenge due to practical difficulties as well as a general distrust towards the drugs
.
Objective:
This study follows an original research carried out in 2008. In the first study, patients answered questions on their clinical history and expressed their judgment on the pharmacological treatment, their perceived effectiveness and factors that may undermine compliance. They have been recalled after two years to verify if the reported symptoms have changed and to assess how their knowledge of the disease and “acceptance” of the treatment have been modified.
Methods:
In spite of the relatively high number of patients participating in the first study (141 patients followed at a single neurological centre), only 16 patients have completed the questionnaire for the long-term survey. A detailed descriptive analysis has been carried out, as well as a pairwise correlation analysis.
Results and Conclusions:
The interviews carried out gave an insight into how patients’ behavior may have changed over time. Compliance rate is different in newly-diagnosed patients and long-term patients; the latter are more likely to be compliant, given their personal experience with the disease. Communications with neurologists and health personnel should aim at forming therapeutic alliances with patients and detecting their preferences for a qualitatively adequate assistance throughout their illness.
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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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Alsahebfosoul F, Rahimpourkoldeh S, Eskandari N, Shaygannejad V, Ganjalikhani Hakemi M, Dabiri A, Jafarnia M, Mirmossayeb O. Gene Expression of CD226 and Its Serum Levels in Patients With Multiple Sclerosis. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/cjns.4.14.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Al-Sharman A, Khalil H, Nazzal M, Al-Sheyab N, Alghwiri A, El-Salem K, AlDughmi M. Living with multiple sclerosis: A Jordanian perspective. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [DOI: 10.1002/pri.1709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Mohammad Nazzal
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Nihaya Al-Sheyab
- Faculty of Nursing, Department of Maternal and Child Nursing-Faculty member; Jordan University of Science and Technology; Irbid Jordan
| | - Alia Alghwiri
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
| | - Khalid El-Salem
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Mais AlDughmi
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
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Kamalian Lari S, Haghgoo HA, Farzad M, Hosseinzadeh S. Investigation of the Validity and Reliability of Balance Evaluation Systems Test (BESTest) in Assessment of Balance Disorders in People With Multiple Sclerosis. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev 2017; 17:53-72. [PMID: 29108826 DOI: 10.1016/j.autrev.2017.11.010] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
Abstract
Physical activity, by definition, is any skeletal muscle body movement that results in energy expenditure. In the last few decades, a plethora of scientific evidences have accumulated and confirmed the beneficial role of physical activity as a modifiable risk factor for a wide variety of chronic diseases including cardiovascular diseases (CVDs), diabetes mellitus and cancer, among others. Autoimmune diseases are a heterogeneous group of chronic diseases, which occur secondary to loss of self-antigen tolerance. With the advent of biological therapies, better outcomes have recently been noted in the management of autoimmune diseases. Nonetheless, recent research highlights the salient role of modifiable behaviors such as physical inactivity on various aspects of the immune system and autoimmune diseases. Physical activity leads to a significant elevation in T-regulatory cells, decreased immunoglobulin secretion and produces a shift in the Th1/Th2 balance to a decreased Th1 cell production. Moreover, physical activity has been proven to promote the release of IL-6 from muscles. IL-6 released from muscles functions as a myokine and has been shown to induce an anti-inflammatory response through IL-10 secretion and IL-1β inhibition. Physical activity has been shown to be safe in most of autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), inflammatory bowel diseases (IBD), as well as others. Additionally, the incidence of RA, MS, IBD and psoriasis has been found to be higher in patients less engaged in physical activity. As a general trend, patients with autoimmune diseases tend to be less physically active as compared to the general population. Physically active RA patients were found to have a milder disease course, better cardiovascular disease (CVD) profile, and improved joint mobility. Physical activity decreases fatigue, enhances mood, cognitive abilities and mobility in patients with MS. In SLE patients, enhanced quality of life and better CVD profile were documented in more physically active patients. Physically active patients with type 1 diabetes mellitus have a decreased risk of autonomic neuropathy and CVD. Both fibromyalgia and systemic sclerosis patients report decreased disease severity, pain, as well as better quality of life with more physical activity. Further, SSc patients improve their grip strength, finger stretching and mouth opening with increased level of exercise. The purpose of this paper is to review the clinical evidence regarding the safety, barriers to engagement, and impact of physical activity on autoimmune diseases.
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A systematic review of anxiety amongst people with Multiple Sclerosis. Mult Scler Relat Disord 2016; 10:145-168. [PMID: 27919483 DOI: 10.1016/j.msard.2016.10.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurological disease, which poses significant psychological challenges. The purpose of this systematic review was to identify factors that are associated with anxiety in people with MS (PwMS). It aimed to examine the strength of evidence for factors associated with anxiety symptoms and identify limitations of existing studies. METHOD AND RESULTS One hundred and thirty one studies met inclusion criteria and were included in the review. A narrative synthesis was then conducted. Anxiety was found to be associated with a variety of demographic, physical, psychological, cognitive and social factors. A consistent finding was that anxiety was strongly associated with both high level of disability and low quality of life. A strong association between anxiety and depression was also found. CONCLUSION Implications for these results are discussed and a preliminary model of understanding anxiety in the context of MS is outlined. Given the overlap between anxiety and depression, a transdiagnostic treatment approach is suggested. In light of the shortcomings of extant studies, suggestions for future research are offered.
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Vermersch P, Faller A, Czarnota-Szałkowska D, Meesen B, Thalheim C. The patient's perspective: How to create awareness for improving access to care and treatment of MS patients? Mult Scler 2016; 22:9-17. [PMID: 27465612 DOI: 10.1177/1352458516650742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is currently no known cure for multiple sclerosis (MS). Four stakeholders play a major role in MS: healthcare professionals, regulators, payers and patients. OBJECTIVE In Europe, patients are represented by the European Multiple Sclerosis Platform (EMSP), which aims to improve MS management and patients' quality of life. RESULTS The EMSP has recently shown that there are major disparities in Europe in terms of access to care and treatment. Implementing the Code of Good Practice and a standardised MS nurse training may be useful in harmonising MS management across Europe. Additionally, the burden for novel therapeutic options to be approved by regulatory agencies has to decrease in order to provide faster access of treatment to patients. Data collection (e.g. national registers) also appears crucial to help research and shape the most effective policy in each country. Finally, people with MS should get appropriate (financial) support in order to complete their studies and find a job, as their active participation in society requires proper access to education and employment. Moreover, as they are the ones affected by MS, they seem to be best placed to represent themselves and their needs and should be consulted more often during decision-making processes by policy makers, regulators and payers.
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Affiliation(s)
- Patrick Vermersch
- University of Lille, CHRU de Lille, Lille International Research Inflammation Center (LIRIC), INSRRM U995, FHU Imminent, Lille, France
| | | | | | - Bianca Meesen
- Managing Director at Ismar Healthcare, Lier, Belgium
| | - Christoph Thalheim
- Deputy CEO and Director External Affairs, European Multiple Sclerosis Platform (EMSP), Schaerbeek/Brussels, Belgium
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The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active. Mult Scler Relat Disord 2016; 8:113-9. [PMID: 27456885 DOI: 10.1016/j.msard.2016.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/27/2016] [Accepted: 05/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) model on the Sexual Dysfunction (SD) of married sexually active women who suffer from Multiple Sclerosis (MS). This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues. STUDY DESIGN This randomized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran, Iran. The participating women who had a definite diagnosis of MS and SD, Expanded Disability Status Scale (EDSS) scores <7, and aged 18-55 years were randomly assigned to experimental (EG, n=43) and control group (CG, n=45). Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model (90-120min per session). MAIN OUTCOME MEASURES Sexual function was assessed three times (before the intervention, and 2 months and 3 months after the intervention) using the Female Sexual Function Index (FSFI). Chi-square test, Fisher's exact test, and Repeated Measures ANOVA were employed to analyze the data. RESULTS The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention (p<0.05). There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG. A significant increase in the mean score of 6 subgroups was seen in EG (p<0.05) but not in CG. CONCLUSION According to this study, utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS.
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Surya N. Rehabilitation of multiple sclerosis patients in India. Ann Indian Acad Neurol 2015; 18:S43-7. [PMID: 26538848 PMCID: PMC4604697 DOI: 10.4103/0972-2327.164828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive disease which is one of the leading causes of handicap in young subjects. The large range of symptoms associated with MS lead to continuing decline in neurologic status and quality of life. The coexistence of physical and cognitive impairments, together with the imprevisible evolution of the disease makes MS rehabilitation very challenging. The main objective of rehabilitation is, therefore, to ease the burden of symptoms by improving self-performance and independence. Inpatient, outpatient and Home rehabilitation with multidisciplinary team has been shown to be beneficial in improving disability. Individualized programs elaborated by a multidisciplinary team of experts are the key to success of rehabilitation. Family plays a big role and Family Based Rehabilitation will be important in long term rehab program in MS.
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Affiliation(s)
- Nirmal Surya
- Director, Surya Neuro Centre, Mumbai, Maharashtra, India
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Rieckmann P, Boyko A, Centonze D, Elovaara I, Giovannoni G, Havrdová E, Hommes O, Kesselring J, Kobelt G, Langdon D, LeLorier J, Morrow SA, Oreja-Guevara C, Schippling S, Thalheim C, Thompson H, Vermersch P. Achieving patient engagement in multiple sclerosis: A perspective from the multiple sclerosis in the 21st Century Steering Group. Mult Scler Relat Disord 2015; 4:202-18. [DOI: 10.1016/j.msard.2015.02.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/30/2015] [Accepted: 02/21/2015] [Indexed: 11/29/2022]
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Effects of intrathecal triamincinolone-acetonide treatment in MS patients with therapy-resistant spasticity. Spinal Cord 2014; 53:109-13. [PMID: 25224601 DOI: 10.1038/sc.2014.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/10/2014] [Accepted: 08/01/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is an autoimmune disease affecting young people and is a major cause of disability. In the course of time, disability progresses and symptoms like spasticity may occur. Spasticity is a major cost factor in MS patients. Various agents are approved for the treatment of spasticity, but each of those agents may have several side effects. Intrathecally administered steroids (triamcinolone-acetonide (TCA)) may be efficient in treating spasticity in patients with lesions in the spinal cord and no response to first-line therapeutics. The aim of this study is to show effects of TCA treatment on clinical parameters in patients with MS. METHODS This multicentre open label study included 54 patients with MS. The clinical outcome parameters were spasticity, disability, maximum walking distance, bladder function and quality of life. All patients received physiotherapy in addition to TCA treatment to obtain optimal effects on clinical parameters. RESULTS Spasticity, maximum walking distance as well as disability improved significantly (P ⩽ 0.001) during TCA applications. Bladder function improved in every seventh patient. CONCLUSION We observed the effects of intrathecally administered TCA on different clinical parameters including bladder function. TCA administration is a safe method to treat different symptoms in MS patients. Longitudinal trials with repeated TCA cycles are needed to show long-term effects. Besides TCA treatment, physiotherapy contributes to the improvement of clinical parameters.
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Milanlioglu A, Özdemir PG, Cilingir V, Gülec TÇ, Aydin MN, Tombul T. Coping strategies and mood profiles in patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:490-5. [DOI: 10.1590/0004-282x20140089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/20/2014] [Indexed: 11/21/2022]
Abstract
Objective: The aim of the present study was to investigate the coping strategies, mood characteristics and the association between these aspects in patients diagnosed with multiple sclerosis and healthy subjects. Method: Fifty consecutive patients who were diagnosed with multiple sclerosis according to McDonald criteria and thirty-one healthy subjects were included in the study. In addition to the sociodemographic form, Expanded Disability Status Scale (EDSS), Coping Orientation for Problem Experiences Scale (COPE), and Profile of Mood States (POMS) tests were applied to the participants. Results: Non-functional coping strategies were significantly higher in the secondary-progressive type (p≤0.05). Depression-dejection, fatigue-inertia and total POMS scores were significantly higher in the secondary-progressive type (p≤0.05). Conclusion: The results of our study demonstrate the importance of rehabilitation programs that encourage exercise among patients with multiple sclerosis to increase vigor-activity levels.
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Basak T, Unver V, Demirkaya S. Activities of daily living and self-care agency in patients with multiple sclerosis for the first 10 years. Rehabil Nurs 2014; 40:60-5. [PMID: 24668765 DOI: 10.1002/rnj.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of the study was to present the effects of the disease and analyze the relationship between activities of daily living (ADL) and self-care in multiple sclerosis (MS) patients who have had the disease for the first 10 years. DESIGN This study was a descriptive cross-sectional study. METHODS A total of 67 patients who fit the inclusion criteria of the study and volunteered to participate were included in the sample. Data were collected using the Exercise of Self-Care Agency Scale and the Barthel Index. FINDINGS The mean age was 38.43±9.92. There was a statistically significant correlation between participants'educational backgrounds and self-care scores and between disease duration and Barthel index score (p<.05). CONCLUSIONS The self-care levels of patients who have had MS for the first 10 years are medium, and they tend to be mildly dependent in performing their ADL. The duration of MS is positively correlated with level of ADL. CLINICAL RELEVANCE In this study, it was shown that the duration of the disease in MS patients should be taken into account by rehabilitation nurses to implement effective nursing care.
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Affiliation(s)
- Tulay Basak
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
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Sørensen J, Lee A, Løvendahl B, Nørgaard M, Bay J, Rasmussen PV, Boesen F. Study protocol: to investigate effects of highly specialized rehabilitation for patients with multiple sclerosis. A randomized controlled trial of a personalized, multidisciplinary intervention. BMC Health Serv Res 2012; 12:306. [PMID: 22954027 PMCID: PMC3479000 DOI: 10.1186/1472-6963-12-306] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex, chronic and progressive disease and rehabilitation services can provide important support to patients. Few MS rehabilitation programs have been shown to provide health improvements to patients in a cost-effective manner. The objective of this study is to assess the effects in terms of changes measured by a variety of standardized quality of life, mastery, coping, compliance and individual goal-related endpoints. This combination provides the basis for analyzing the complexity of MS and outcomes of a personalized rehabilitation. METHODS/DESIGN Patients with MS referred to hospital rehabilitation services will be randomized to either early admission (within two months) or usual admission (after an average waiting time of eight months). They will complete a battery of standardized health outcome instruments prior to randomization, and again six and twelve months after randomization, and a battery of goal-related outcome measures at admission and discharge, and again one, six and twelve months after randomization. DISCUSSION The results of the study are expected to contribute to further development of MS rehabilitation services and to discussions about the design and content of such services. The results will also provide additional information to health authorities responsible for providing and financing rehabilitation services. TRIAL REGISTRATION Current Controlled Trials (ISRCTN05245917).
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Affiliation(s)
- Jan Sørensen
- Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, J, B, Winsløws Vej 9B, 1, 5000, Odense, Denmark.
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