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Borriello G, Chisari CG, Maimone D, Mirabella M, Paolicelli D, Assogna F, Caradonna S, Patti F. Cladribine effects on patient-reported outcomes and their clinical and biometric correlates in highly active relapsing multiple sclerosis at first switch: the observational, multicenter, prospective, phase IV CLADFIT-MS study. Front Neurol 2024; 15:1422078. [PMID: 39114529 PMCID: PMC11305121 DOI: 10.3389/fneur.2024.1422078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/05/2024] [Indexed: 08/10/2024] Open
Abstract
Patient-reported outcomes (PROs) are essential for understanding the effects of MS and its treatments on patients' lives; they play an important role in multiple sclerosis (MS) research and practice. We present the protocol for an observational study to prospectively assess the effect of cladribine tablets on PROs and their correlation to disability and physical activity in adults with highly active relapsing MS switching from a first disease modifying drug (DMD) to cladribine tablets in routine clinical practice at study sites in Italy. The primary objective will be to evaluate changes from baseline in the impact of highly active MS on self-assessed physical functioning 52 weeks after the switch to cladribine tablets using the Multiple Sclerosis Impact Scale-29 (MSIS-29). Secondary objectives will include self-assessed psychological impact of highly active MS in daily life and general health after the switch to cladribine tablets as well as changes in cognitive function, anxiety, and depression symptoms. Additional PRO measures will include the Hospital Anxiety and Depression Scale (HADS), the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire: Multiple Sclerosis (WPAI:MS), and the Patient-Reported Outcomes Measurement Information System (PROMIS). Wearable devices will acquire activity data (step counts, walking speed, time asleep, and energy expenditure). Additional clinical, radiological, and laboratory data will be collected when available during routine management. The findings will complement data from controlled trials by providing insight from daily clinical practice into the effect of cladribine tablets on the patient's experience and self-assessed impact of treatment on daily life.
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Affiliation(s)
- Giovanna Borriello
- Multiple Sclerosis Center, San Pietro Fatebenefratelli Hospital, Rome, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | - Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
- UOS Multiple Sclerosis, AOU Policlinico “G Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca per la Sclerosi Multipla “Anna Paola Batocchi”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Damiano Paolicelli
- Neurology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), Policlinico General Hospital, University of Study of Bari, Bari, Italy
| | | | - Sandro Caradonna
- Merck Serono S.p.A. Italy, An Affiliate of Merck KGaA, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
- UOS Multiple Sclerosis, AOU Policlinico “G Rodolico-San Marco”, University of Catania, Catania, Italy
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Emery H, Padgett C, Ownsworth T, Honan CA. "Oh it's changed, it's changed 10-fold": understanding the experience of self-concept change from the perspectives of people with multiple sclerosis. Disabil Rehabil 2023; 45:3262-3271. [PMID: 36106857 DOI: 10.1080/09638288.2022.2121865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/07/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The relevance of self-concept change in the process of psychosocial adjustment following multiple sclerosis (MS) diagnosis has become more apparent in recent years. The current study aimed to investigate the experience of self-concept change as described by an MS sample. METHODS Sixteen people (aged 26-67 years, 62.5% female) who had been living with MS for an average of 12 years, participated in a single online semi-structured interview. All interviews were audio-recorded and transcribed verbatim. RESULTS Thematic analysis guided by phenomenology produced three superordinate themes: 1) Changing life (salient external events that were related to changing views of self), 2) Changing self (the experience of self-concept change), and 3) Changing thoughts (the internal thought processes that served as the filter between changing life circumstances and changing self-views). Overall, external events appeared to facilitate a process of internally driven revaluations and redefinitions of self-concept both globally and within specific self domains. CONCLUSION Self-concept change due to MS emerges as a complex internal process, often arising from external challenges and changes in everyday life. These novel findings illustrate the need to better support people with MS to make sense of changes to their self-concept, particularly during key transitions across the illness.Implications for RehabilitationSelf-concept change following MS diagnosis and throughout the disease course has wide-ranging impacts on psychological adjustment.Several key external events contribute to changing the self-views of people living with MS.While external events prompt change, key internal processes likely facilitate the redefinition of self-concept.Targeted support during key transitional periods to assist pwMS to productively renegotiate and manage these changes to their self-concept is needed.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
| | - Christine Padgett
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & The Hopkins Centre, Griffith University, Mount Gravatt, Australia
| | - Cynthia A Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
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Cunningham R, Uyeshiro Simon A, Preissner K. Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis. Am J Occup Ther 2022; 76:23955. [PMID: 36178780 DOI: 10.5014/ajot.2022.050088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers. OBJECTIVE This Practice Guideline aims to help occupational therapy practitioners, as well as the people who manage, reimburse, or set policy regarding occupational therapy services, understand occupational therapy's role in providing services to adults with MS and their caregivers. This guideline can also serve as a reference for health care professionals, health care managers, educators, regulators, third-party payers, managed care organizations, and researchers. METHOD We examined, synthesized, and integrated the results of four systematic reviews into clinical recommendations. Three systematic reviews specified occupational domains as outcomes of interest, and one focused on interventions for caregivers of people with MS. RESULTS Twenty-one articles from the systematic reviews with strong or moderate strength of evidence served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Four interventions benefited participation in the domains of activities of daily living or sleep. Two interventions improved participation in the domain of instrumental activities of daily living. One intervention improved work participation. Two interventions benefited caregivers and the quality of the relationship between the caregiver and person with MS. Other potentially appropriate interventions or areas to address on the basis of existing or emerging evidence are discussed in the Limitations: Gaps in the Evidence and Conclusions sections. What This Article Adds: This Practice Guideline provides a summary and application of the current evidence supporting occupational therapy intervention for adults with MS. It includes case examples and decision-making algorithms to support occupational therapy practitioners in addressing client goals.
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Affiliation(s)
- Rebecca Cunningham
- Rebecca Cunningham, OTD, OTR/L, MSCS, is Assistant Professor of Clinical Occupational Therapy, USC Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles;
| | - Ashley Uyeshiro Simon
- Ashley Uyeshiro Simon, OTD, OTR/L, MSCS, is Associate Professor of Clinical Occupational Therapy, USC Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles
| | - Katharine Preissner
- Katharine Preissner, EdD, OTR/L, FAOTA, is Clinical Professor and Occupational Therapy Capstone Coordinator, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago
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Putnam M, Morgan K, Heeb R, Yan Y, Chen SW, Stark SL. Aging with Disability Symptoms and Ability to Participate in, and Satisfaction with, Social Participation among Persons Aged 45-64. Healthcare (Basel) 2022; 10:903. [PMID: 35628040 PMCID: PMC9141701 DOI: 10.3390/healthcare10050903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
Pain, fatigue, and depression, considered aging with disability (AwD) symptoms, are known to be substantially higher among middle-aged adults with long-term disability compared to their age peers. Participation has been recognized as an important component of health. This cohort survey study reports findings on the relationship between AwD symptoms and ability to participate in, and satisfaction with participation in, social roles and activities using PROMIS measures. Data were collected at three time points from individuals aged 45-64 with an average of two decades of disability duration and primarily living in the state of Missouri, USA. This study reports on Time 1 (T1) and Time 3 (T3), pre- and post-COVID-19 pandemic declaration, respectively. Multiple regressions using both individual AwD symptoms and a composite measure demonstrated that having more pain, fatigue, and depression was associated with worse participation outcomes. Lower physical function scores were also related to lower participation scores, as was being female and living with others, and having more income reduced participation. Better physical health and identifying as African American/Black were associated with higher participation scores. Our findings suggest that AwD symptoms, along with other sociodemographic and health factors, play a substantial role in the social participation outcomes for persons aging with disability and remain consistent over time.
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Affiliation(s)
- Michelle Putnam
- School of Social Work, Simmons University, 300 The Fenway, Boston, MA 01602, USA
| | - Kerri Morgan
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO 63108, USA; (K.M.); (R.H.); (S.-W.C.); (S.L.S.)
| | - Rachel Heeb
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO 63108, USA; (K.M.); (R.H.); (S.-W.C.); (S.L.S.)
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO 63108, USA;
| | - Szu-Wei Chen
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO 63108, USA; (K.M.); (R.H.); (S.-W.C.); (S.L.S.)
| | - Susan L. Stark
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO 63108, USA; (K.M.); (R.H.); (S.-W.C.); (S.L.S.)
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Cunningham R, Uyeshiro Simon A. Interventions for Instrumental Activities of Daily Living Among Adults With Multiple Sclerosis: A Systematic Review. Am J Occup Ther 2022; 76:23218. [PMID: 35226064 DOI: 10.5014/ajot.2022.049092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners need updated information about interventions that may improve or maintain functional changes in instrumental activity of daily living (IADL) engagement caused by multiple sclerosis (MS). OBJECTIVE To conduct a narrative synthesis of updated evidence on interventions within the scope of occupational therapy to improve or maintain performance of and participation in IADLs among adults with MS. DATA SOURCES CINAHL, MEDLINE in PubMed, Cochrane, OTseeker, and PsycINFO. Study Selection and Data Collection: This systematic review followed the Cochrane Collaboration methodology and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting a systematic review. Inclusion criteria were Level 1 or 2 evidence, published in English, published from January 2011 to December 2018, intervention within the occupational therapy scope of practice, and at least one IADL outcome measure. FINDINGS Nineteen randomized controlled trials (including pilot and feasibility trials) and 1 preintervention-postintervention study met inclusion criteria. Results of this review show strong strength of evidence for coaching interventions in addressing physical activity (PA) routines and moderate support in addressing medication routines. Moderate strength of evidence was found with mixed results for interventions involving coaching plus prescribed PA in improving PA participation. CONCLUSIONS AND RELEVANCE This systematic review supports occupational therapy practitioners addressing PA and medication health management and maintenance IADLs through the use of coaching interventions when treating people with MS. Other IADLs were addressed by the articles in this review but require more evidence to make clinical recommendations. What This Article Adds: Occupational therapy practitioners' skills in promoting habits and routines paired with utilization of evidence-supported coaching interventions can support independence with health management and reduce the negative impact of MS on daily activity participation.
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Affiliation(s)
- Rebecca Cunningham
- Rebecca Cunningham, OTD, OTR/L, MSCS, is Assistant Professor of Clinical Occupational Therapy, Herman Ostrow School of Dentistry, USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Ashley Uyeshiro Simon
- Ashley Uyeshiro Simon, OTD, OTR/L, MSCS, is Associate Professor of Clinical Occupational Therapy, Herman Ostrow School of Dentistry, USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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