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Ponzio M, Tacchino A, Verri A, Battaglia MA, Brichetto G, Podda J. Profile and burden of the family caregiver: the caring experience in multiple sclerosis. An observational study. BMC Psychol 2024; 12:173. [PMID: 38528601 DOI: 10.1186/s40359-024-01678-w] [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: 07/18/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The broad implications of caring for a family member with a chronic medical condition, such as MS, can lead caregivers to experience a high burden of care. The aim of the study was to describe profile of MS caregivers and their burden and to explore potential factors influencing this burden. METHODS 200 family caregivers of a person with MS completed survey questionnaires across a cross-sectional study. Many information were collected: caregiver socio-demographic and health-related data, caregiving activities, knowledge of MS, coping strategies, mood, social support received and care recipient information. Caregiving burden was measured by the ZBI (Zarit Burden Interview). The extent to which the variables explained caregiver burden was analyzed using a hierarchical approach. RESULTS 68% of the caregivers reported a perceived burden of care (ZBI score > 20). Our results show that physical and mental related-health variables are important predictive factors of the care burden, explaining much of the observed variance (40.9%). CONCLUSION Family caregivers in MS continue to make up the shortfall produce by national health and welfare systems. We highlighted the importance of good physical and mental health in decreasing perceived burden. Working to alleviate psychological distress through mechanisms focus on reducing worries and perceived burden may be a valid approach.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy.
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
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Hendin B, Brook RA, Beren IA, Kleinman N, Fink C, Phillips AL, Lobo C. The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:91-101. [PMID: 37069893 PMCID: PMC10105615 DOI: 10.36469/001c.57593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 06/19/2023]
Abstract
Background: Research on employee care partners of patients with multiple sclerosis (MS) is limited. Objectives: The clinical and economic impact on employee care partners was evaluated by MS disease severity. Methods: Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010-Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners' demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. Results: Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (P<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (P<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (P<.05). Discussion: Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. Conclusions: Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity.
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Gómez-López A, Benito-León J, Labiano-Fontcuberta A, Moreno-García S, Salgado-Cámara P. Impact of a specific consultation for patients with progressive forms of multiple sclerosis on the response to their unmet care needs: a cross-sectional study. Mult Scler Relat Disord 2023; 72:104609. [PMID: 36940612 DOI: 10.1016/j.msard.2023.104609] [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: 10/10/2022] [Revised: 02/18/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND As their disease evolves, most patients with progressive forms of multiple sclerosis (MS) develop particular healthcare needs that are not always addressed with usual follow-up. To adapt neurological care to these patients, we created a specific consultation for patients with progressive MS in our centre in 2019. OBJECTIVES To explore the main unmet care needs of patients with progressive MS in our setting, and to establish the usefulness of the specific consultation to address them. METHODS Literature review and interviews with patients and healthcare professionals were conducted to identify the main unmet needs in routine follow-up. Two questionnaires were developed, assessing the importance of the unmet needs identified and the usefulness of the consultation to meet them, for patients under follow-up in the specific consultation and their informal caregivers. RESULTS Forty-one patients and nineteen informal caregivers participated. The most important unmet needs were the information about the disease, access to social services and coordination between specialists. A positive correlation was found between the importance of these unmet needs and the responsiveness to each of them in the specific consultation. CONCLUSIONS The creation of a specific consultation may improve attention to the healthcare needs of patients with progressive MS.
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Affiliation(s)
- A Gómez-López
- Multiple Sclerosis Unit. Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - J Benito-León
- Multiple Sclerosis Unit. Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - A Labiano-Fontcuberta
- Multiple Sclerosis Unit. Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Moreno-García
- Multiple Sclerosis Unit. Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Salgado-Cámara
- Multiple Sclerosis Unit. Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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McKenna O, Fakolade A, Cardwell K, Pilutti LA. A continuum of languishing to flourishing: exploring experiences of psychological resilience in multiple sclerosis family caregivers. Int J Qual Stud Health Well-being 2022; 17:2135480. [PMID: 36333904 PMCID: PMC9645274 DOI: 10.1080/17482631.2022.2135480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Resilience research in family caregiving in chronic neurological conditions is growing, but multiple sclerosis (MS) caregivers are noticeably absent from this body of work. MS caregivers represent a unique population due to the disease's early onset, prolonged life expectancy, and heterogeneity. As such, this study aimed to explore MS caregivers' conceptualizations of resilience, examine MS caregivers' experiences of resilience development, and determine which assets and resources influence resilience in this role. METHODS Twenty-four Canadian MS caregivers were recruited. Semi-structured in-depth interviews were conducted with questions derived from an ecological resilience framework. Data were analysed using reflexive thematic analysis. RESULTS Themes constructed a cyclical resilience model, beginning with encounters with hardship and extending to thriving adjustment. Subthemes included reports of additive challenges, impactful individual and community resources, and multi-level adaptive pathways. Within this cycle, the achievement of healthy adjustment exerted a positive feedback function and informed future responses to lifelong challenges. CONCLUSIONS Despite the salience of resilience processes within caregiver testimonies, inadequate resources at societal levels were evident. These findings afford researchers and decision-makers relevant information for designing and implementing resilience-building interventions for MS caregivers that attend to contextual factors and current systemic support deficiencies.
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Affiliation(s)
- Odessa McKenna
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Afolasade Fakolade
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Katherine Cardwell
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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5
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Burden of Multiple Sclerosis: Impact on The Patient, Family and Society. Mult Scler Relat Disord 2022; 63:103864. [DOI: 10.1016/j.msard.2022.103864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
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McKenna O, Fakolade A, Cardwell K, Langlois N, Jiang K, Pilutti LA. Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions. Health Expect 2021; 25:4-37. [PMID: 34676951 PMCID: PMC8849377 DOI: 10.1111/hex.13374] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted. Aim In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs. Design We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience. Results A total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent. Conclusions Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice. Patient or Public Contribution The findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.
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Affiliation(s)
- Odessa McKenna
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Katherine Cardwell
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nigèle Langlois
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Karen Jiang
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Douglas SL, Plow M, Packer T, Lipson AR, Lehman MJ. Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial. JMIR Res Protoc 2021; 10:e30617. [PMID: 34435971 PMCID: PMC8430872 DOI: 10.2196/30617] [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: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers. Objective This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis. Methods Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later. Results The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled. Conclusions Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving. Trial Registration ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008 International Registered Report Identifier (IRRID) DERR1-10.2196/30617
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Affiliation(s)
- Sara L Douglas
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Matthew Plow
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.,School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Amy R Lipson
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Michelle J Lehman
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Intas G, Petta M, Platis C, Chalari E, Stergiannis P. The Burden on Carers with Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:169-175. [DOI: 10.1007/978-3-030-78771-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Purpose of Review In spite of recent advances in treatment, many people with multiple sclerosis (MS) require ongoing care and support. Informal caregivers can experience burden as a result of their role, with possible implications for quality of life (QOL). We review recent research examining MS caregiver experience to (1) understand current risk factors for caregiver burden and (2) identify possible strategies for increasing carer well-being. Recent Findings MS caregiver experience is highly variable and can be predicted by a variety of care recipient, caregiver and contextual factors. Burden is not the only characteristic associated with care, with positive consequences also reported. Emerging research suggests a number of ways in which carers can be better supported. Summary Identifying and meeting the needs of MS caregivers offers the best way of delivering tailored support. Future research should focus on the development of psychosocial supports, while acknowledging the needs of those caring for different MS patient populations.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.
| | - Phil Maguire
- Department of Computer Science, Maynooth University, Maynooth, Co. Kildare, Ireland
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Hategeka C, Traboulsee AL, McMullen K, Lynd LD. Association of Unemployment and Informal Care with Stigma in Multiple Sclerosis: Evidence from the Survey on Living with Neurological Conditions in Canada. Int J MS Care 2019; 21:214-225. [PMID: 31680783 DOI: 10.7224/1537-2073.2017-108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Multiple sclerosis (MS) typically affects young adults during their primary productive years. We assessed the magnitude of, and factors associated with, employment status and informal care in people with MS in Canada. Methods Data were compiled from the nationally representative cross-sectional Survey on Living with Neurological Conditions in Canada (SLNCC), which included adolescents and adults (age ≥15 years). Employment status was categorized as currently working or not working. The frequency of informal care that people with MS received was categorized as none, less than daily, or daily. Logistic regression analyses were undertaken to identify factors associated with employment status and informal care requirements in people with MS. Results Of 4409 SLNCC respondents, 631 had MS, of whom 530 were included in the analysis. Of 358 respondents aged 18 to 65 years, 47.8% were not working because of MS; 44.0% reported receiving informal care, with more than half requiring daily care. For caregivers' employment, 15.5% reduced work and 8.2% stopped working because of caregiving. Greater feelings of stigmatization were associated with not working (adjusted odds ratio, 7.42 [95% CI, 2.59-21.28]) and greater informal care (adjusted odds ratio, 3.83 [95% CI, 1.84-7.96]), adjusting for sex, age, education, health-related quality of life, time since MS diagnosis, and comorbidity. Conclusions People who feel stigmatized because of their MS are more likely to be unemployed and to require more informal care. Further research is needed to understand the temporal nature of the association between stigma and employment, productivity loss, and informal care.
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Neate SL, Taylor KL, Jelinek GA, De Livera AM, Brown CR, Weiland TJ. Taking active steps: Changes made by partners of people with multiple sclerosis who undertake lifestyle modification. PLoS One 2019; 14:e0212422. [PMID: 30817765 PMCID: PMC6394935 DOI: 10.1371/journal.pone.0212422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background Multiple sclerosis (MS), a demyelinating condition of the central nervous system with an unpredictable course, has a major impact on the lives of people with MS. Partners of people with MS may be significantly affected by the diagnosis, management and uncertainty around disease progression and may provide substantial support and care. Modification of lifestyle risk factors in conjunction with standard medical management has been associated with improved physical and mental quality of life. Adopting major lifestyle modification may have a multi-faceted impact on the person with MS and their partner. Experiences of partners of people with MS have been previously explored, but the experiences of partners of people with MS who adopt this strategy have not. As part of a larger study that aimed to explore partners’ lived experiences of and attitudes towards MS and lifestyle modification, this study reports the active steps and significant changes partners undertook to assist the person with MS and, at times, to also modify their own lives. Design Within an interpretive framework, using Heidegger’s phenomenological philosophy, a qualitative study of semi-structured interviews was conducted. Participants Aged greater than 18 years and in a spousal relationship with a person with MS who had undertaken an intensive residential lifestyle educational intervention promoting healthy lifestyle. Results Themes identified were: adjusting to lifestyle modification, understanding motivations and practical aspects of adjustment; seeking knowledge and support, exploring the ways partners sought positive support for themselves and the person with MS and abandoned negative influences; and embracing well-being, commitment and change, describing the major changes that partners made to their lives professionally and personally. Conclusions The experiences of these partners provide clinicians with insight into potential motivations and outcomes of lifestyle modification and suggest potentially positive aspects for those directly and indirectly affected by MS.
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Affiliation(s)
- Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
- * E-mail:
| | - Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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García-Domínguez JM, Martínez-Ginés ML, Carmona O, Caminero AB, Prefasi D, Maurino J, Ballesteros J. Measuring burden in caregivers of people with multiple sclerosis: psychometric properties of the CSI questionnaire. Patient Prefer Adherence 2019; 13:101-106. [PMID: 30666093 PMCID: PMC6330972 DOI: 10.2147/ppa.s180863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Understanding caregiver strain may be crucial to determine which interventions are most needed to mitigate the negative impact of caring for people with multiple sclerosis (MS). The Caregiver Strain Index (CSI) is a brief self-assessment tool for measuring the caregivers' perceived level of burden. Limited information is available on the psychometric performance of the CSI in MS. OBJECTIVE The objective of this study was to assess the factor structure and construct validity of the CSI in MS. METHODS A multicenter, cross-sectional study in adults with relapsing-remitting and primary-progressive MS (McDonald 2010 criteria) was conducted. A non-parametric item response theory (IRT) procedure, Mokken analysis, was conducted to assess the dimensional structure of the CSI. A parametric IRT model for dichotomous responses, Rasch model, was conducted to assess item characteristics. Discriminative validity was assessed comparing the distribution of its overall score between people with mild and moderate-severe disability according to the Expanded Disability Status Scale. RESULTS A total of 72 MS caregivers were studied. The prevalence of a high level of strain was 23.6% (n=17). Internal reliability was high (Cronbach's alpha =0.91). According to Mokken analysis, CSI represented a unidimensional construct of caregiver burden although two of the total 13 items (#1 and #13) could not be assigned to any factor by an automatic item selection procedure. Without these items, the scalability moved from a weak (Hi =0.37) to a medium scale (Hi =0.44). However, the item characteristic curve of the Rasch model showed a range of appropriate difficulty and the item and person parameters showed good fit (Andersen likelihood ratio test =18.40, df =11; P-value =0.07; all item values for the infit). The CSI score showed a good discriminative validity between the levels of disability of the care recipient. CONCLUSION The CSI questionnaire shows appropriate psychometric characteristics being a useful instrument to assess different aspects of burden in MS caregivers in clinical practice.
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Affiliation(s)
| | | | - Olga Carmona
- Department of Neurology, Hospital de Figueres, Figueres, Spain
| | - Ana B Caminero
- Department of Neurology, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | - Daniel Prefasi
- Medical Department, Roche Farma, Madrid, Spain, @roche.com
| | - Jorge Maurino
- Medical Department, Roche Farma, Madrid, Spain, @roche.com
| | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, Universidad del País Vasco, Leioa, Spain
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13
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Killner L, Soundy A. Motivation and experiences of role transition in spousal caregivers of people with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lauren Killner
- Physiotherapist, School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Soundy
- Lecturer in physiotherapy, School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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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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15
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Neate SL, Taylor KL, Jelinek GA, De Livera AM, Brown CR, Weiland TJ. Psychological Shift in Partners of People with Multiple Sclerosis Who Undertake Lifestyle Modification: An Interpretive Phenomenological Study. Front Psychol 2018; 9:15. [PMID: 29445346 PMCID: PMC5797767 DOI: 10.3389/fpsyg.2018.00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/05/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction: Being in an intimate relationship with a person with multiple sclerosis (MS) may have a substantial impact on the partner's quality of life. Existing research has largely focused on negative impacts of MS for both people with MS (PwMS) and their partners and has sampled the population of partners of PwMS who have primarily adopted standard medical management only. Modifiable lifestyle factors have become increasingly recognized in the management of MS symptoms and disease progression. For partners of PwMS who have undertaken lifestyle modification as an additional strategy to minimize disease progression, the impacts, both positive and negative remain unexplored. This research is unique as it focuses on partners of PwMS who have attempted to adopt major lifestyle interventions outside of the prevailing paradigm of MS management. Aim: To explore and interpret the lived experiences of partners of PwMS who have adopted lifestyle modification, to understand partners' attitudes to and experiences of the effect of MS and lifestyle modification on their life, relationship and view of the future. Method: Design: a qualitative, interpretive, phenomenological study using semi-structured interviews. Participants: English-speaking; aged 18 years or more; in a spousal relationship for 12 months or more with a person with MS who had attended a residential lifestyle educational intervention and undertaken lifestyle modification. Analysis: Interviews were recorded, transcribed verbatim and thematically analyzed using NVivo™ software. Results: Twenty-one partners were interviewed. This paper reports one of the study's themes, the psychological shift experienced by partners of PwMS. Sub-themes included adaptation; loss and grief; difficult emotions; reframing, re-evaluating and re-prioritizing; hope and optimism; empowerment and taking control; and self-awareness, greater understanding and personal growth. Conclusion: Partners of PwMS who have undertaken lifestyle modification experienced a broad range of psychological adjustments. Whilst reflecting the potential difficulties that partners of PwMS may experience, this group experienced a range of positive psychological changes that add to the literature regarding partners' potential experiences and may provide hope for those in partnerships with people with MS. This study provides themes to potentially inform a quantitative study of a larger population of partners of PwMS.
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Affiliation(s)
- Sandra L Neate
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L Taylor
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - George A Jelinek
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M De Livera
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Chelsea R Brown
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tracey J Weiland
- Neuroepidemiolgy Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Abstract
Rett syndrome (RTT) requires total caregiver attention and leads to potential difficulties throughout life. The Caregiver Burden Inventory, designed for Alzheimer disease, was modified to a RTT Caregiver Inventory Assessment (RTT CIA). Reliability and face, construct, and concurrent validity were assessed in caregivers of individuals with RTT. Chi square or Fisher's exact test for categorical variables and t tests or Wilcoxon two-sample tests for continuous variables were utilized. Survey completed by 198 caregivers; 70 caregivers completed follow-up assessment. Exploratory factor analysis revealed good agreement for physical burden, emotional burden, and social burden. Internal reliability was high (Cronbach's alpha 0.898). RTT CIA represents a reliable and valid measure, providing a needed metric of caregiver burden in this disorder.
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Thormann A, Sørensen PS, Koch-Henriksen N, Thygesen LC, Laursen B, Magyari M. Chronic comorbidity in multiple sclerosis is associated with lower incomes and dissolved intimate relationships. Eur J Neurol 2017; 24:825-834. [DOI: 10.1111/ene.13297] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/21/2017] [Indexed: 01/28/2023]
Affiliation(s)
- A. Thormann
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Department of Neurology; The Danish Multiple Sclerosis Registry; Rigshospitalet; Copenhagen Denmark
| | - P. S. Sørensen
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - N. Koch-Henriksen
- Department of Neurology; The Danish Multiple Sclerosis Registry; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Epidemiology; Clinical Institute; University of Aarhus; Aarhus Denmark
| | - L. C. Thygesen
- The Danish National Institute of Public Health; University of Southern Denmark; Copenhagen K Denmark
| | - B. Laursen
- The Danish National Institute of Public Health; University of Southern Denmark; Copenhagen K Denmark
| | - M. Magyari
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Department of Neurology; The Danish Multiple Sclerosis Registry; Rigshospitalet; Copenhagen Denmark
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18
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Abstract
AIMS To better understand the impact of the clinical course of multiple sclerosis (MS) and disability on employment, absenteeism, and related factors. MATERIALS AND METHODS This study included respondents to the North American Research Committee on Multiple Sclerosis Registry spring 2015 update survey who were US or Canadian residents, aged 18-65 years and reported having relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), or primary progressive MS (PPMS). The RRMS and SPMS participants were combined to form the relapsing-onset MS (RMS) group and compared with the PPMS group regarding employment status, absenteeism, and disability. Multivariable logistic regression was used to examine the relationship between employment-related outcomes and factors that may affect these relationships. RESULTS Of the 8004 survey respondents, 5887 (73.6%) were 18-65 years of age. The PPMS group (n = 344) had a higher proportion of males and older mean age at the time of the survey and at time of diagnosis than the RMS group (n = 4829). Female sex, age, age at diagnosis, cognitive and hand function impairment, fatigue, higher disability levels, ≥3 comorbidities, and a diagnosis of PPMS were associated with not working. After adjustment for disability, the employed PPMS sub-group reported similar levels of absenteeism to the employed RMS sub-group. LIMITATIONS Limitations of the study include self-report of information and the possibility that participants may not fully represent the working-age MS population. CONCLUSIONS In MS, employment status and absenteeism are negatively affected by disability, cognitive impairment, and fatigue. These findings underscore the need for therapies that prevent disability progression and other symptoms that negatively affect productivity in persons with MS to enable them to persist in the workforce.
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Affiliation(s)
- Amber Salter
- a Division of Biostatistics , School of Medicine, Washington University in St Louis , St Louis , MO , USA
| | - Nina Thomas
- b Genentech, Inc , South San Francisco , CA , USA
| | - Tuula Tyry
- c Dignity Health , St Joseph's Hospital and Medical Center , Phoenix , AZ , USA
| | - Gary Cutter
- d Department of Biostatistics , The University of Alabama at Birmingham School of Public Health , Birmingham , AL , USA
| | - Ruth Ann Marrie
- e Department of Internal Medicine and Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
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19
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Amankwah N, Marrie RA, Bancej C, Garner R, Manuel DG, Wall R, Finès P, Bernier J, Tu K, Reimer K. Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts. Health Promot Chronic Dis Prev Can 2017; 37:37-48. [PMID: 28273039 PMCID: PMC5607528 DOI: 10.24095/hpcdp.37.2.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031). METHODS Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions. RESULTS The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period. CONCLUSION MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts.
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Affiliation(s)
- Nana Amankwah
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine (Neurology) and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Public and Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ron Wall
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philippe Finès
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Julie Bernier
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Kim Reimer
- Population Health Surveillance and Clinical Prevention, British Columbia Ministry of Health, Victoria, British Columbia, Canada
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20
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Giordano A, Cimino V, Campanella A, Morone G, Fusco A, Farinotti M, Palmisano L, Confalonieri P, Lugaresi A, Grasso MG, Ponzio M, Veronese S, Patti F, Solari A. Low quality of life and psychological wellbeing contrast with moderate perceived burden in carers of people with severe multiple sclerosis. J Neurol Sci 2016; 366:139-145. [PMID: 27288793 DOI: 10.1016/j.jns.2016.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Vincenzo Cimino
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Angela Campanella
- Scientific Direction, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Giovanni Morone
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Augusto Fusco
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Michela Ponzio
- Department of Research, Fondazione Italiana Sclerosi Multipla (FISM), Via Operai 40, 16149 Genoa, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Oddino Morgari 12, 10125 Turin, Italy.
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
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