Quality of Life Perspectives of People With Amyotrophic Lateral Sclerosis and Their Caregivers

Der Einsatz von Patient-reported Outcome Measures (PROM) und die Perspektive digitaler Biomarker bei der Amyotrophen Lateralsklerose

Die systematische Erfassung des klinischen Zustands sowie der Erfahrung mit Behandlung oder Versorgung durch einen strukturierten Bericht des Patienten wird als „Patient-reported Outcome Measures“ (PROM) bezeichnet. Bei der Amyotrophen Lateralsklerose (ALS) haben sich PROM insbesondere zur Dokumentation funktioneller Defizite, z. B. mit der ALS-Funktionsskala, und weiterer komplexer Symptome im Rahmen von klinischer Forschung etabliert. In der Behandlungspraxis werden PROM dazu genutzt, den Verlauf und die Prognose der Erkrankung einzuschätzen. Mit PROM werden neue biologische Biomarker (z. B. Neurofilamente) und digitale Biomarker (z. B. durch den Einsatz von Sensorik) auf ihre patientenzentrierte Relevanz evaluiert. Durch die digitale Anwendung von PROM und die Verknüpfung mit digitalen Biomarkern kann eine engmaschigere Erhebung von zu Hause aus erfolgen und damit die Datenqualität erhöht werden. Patienten können selbst den Gesundheitszustand monitorieren sowie Behandlungs- und Versorgungsergebnisse dokumentieren. Damit nehmen sie zunehmend eine aktive Rolle in der individuellen Behandlung und Versorgung ein.

Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin

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.

Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis

Background

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, which separates the trachea and esophagus, can reduce the associated risks. Central-part laryngectomy (CPL) is a relatively minimally invasive surgery to prevent aspiration. No studies have been conducted on the long-term outcomes of surgery to prevent aspiration in patients with ALS. This case series aimed to determine the long-term outcomes of surgery to prevent aspiration and the use of a continuous low-pressure aspirator in patients with ALS by evaluating the frequency of intratracheal sputum suctions performed per day, intra- and postoperative complications, oral intake data, and satisfaction of patients and their primary caregiver to predict improvement in patients’ quality of life (QOL).

Methods

We report a case series of six patients with ALS who underwent CPL along with tracheostomy to prevent aspiration between January 2015 and November 2018. We evaluated their pre- and postoperative status and administered questionnaires at the time of last admission to the patients and their primary caregivers.

Results

The mean follow-up period after CPL was 33.5 months. Aerophagia was a common postoperative complication. The use of a continuous low-pressure aspirator resulted in reduced frequency of intratracheal sputum suctions. All cases avoided aspiration pneumonia. Oral intake was continued for 2–4 years after the tracheostomy and CPL. The satisfaction levels of the patient and primary caregiver were high.

Conclusion

Our case series suggests that the use of a continuous low-pressure aspirator in patients undergoing CPL improves oral intake and reduces the frequency of intratracheal sputum suctions, which improves the QOL of patients with ALS and their families and caregivers. CPL and continuous low-pressure aspiration should be considered as a management option for ALS with significant bulbar and respiratory muscle weakness/dysfunction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02619-z.

Sexuality and intimacy in ALS: systematic literature review and future perspectives

Several features of amyotrophic lateral sclerosis (ALS) impact on sexuality and intimate relationship; however, the issue has received poor attention so far. We performed a systematic literature review in order to provide an up-to-date account of sexuality in ALS. References were identified by searches of PubMed, Web of Science, Scopus and PsycINFO (1970-2017, English literature). The following were the key terms: 'sexual' OR 'sexuality' OR 'intimacy' OR 'marital' AND 'ALS' OR 'Amyotrophic Lateral Sclerosis' OR 'Motor Neuron Disease' OR 'MND'. Titles and abstracts were screened for relevance and a full-text analysis was performed on the selected articles. Studies were included if they referred to sexual well-being/activities/functions or intimate relationship between patients and their partners and management of such topic by clinicians. Eligibility assessment was performed independently by two reviewers. A thematic and level of evidence classification of studies was performed. Studies' design, objectives, measurements and outcomes were summarised. Thirty articles were included and four topics were identified: intimacy in the dyads; sexual activities in patients and with their partners; sexual function disturbances; and sexuality and cognitive-behavioural alterations. The quality of the studies varies, with globally poor level of evidence. Some sexuality issues have been only sparsely addressed, such as gender-related differences, same-sex relationships and sexual activities other than intercourse. Sexuality in ALS is still not adequately considered by clinicians and researchers. We present preliminary recommendations for improving sexuality and intimacy at any ALS multidisciplinary clinics.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study

Aim:

The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic.

Design and Setting:

Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic.

Methods:

The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals).

Results:

Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study—the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services.

Conclusion:

The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.