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Carberry S, MacConaill S, Fortune DG. Couples' experiences of coping with Multiple Sclerosis: a qualitative systematic review and metasynthesis. Disabil Rehabil 2024:1-13. [PMID: 38859675 DOI: 10.1080/09638288.2024.2361804] [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: 01/17/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This systematic review sought to synthesise the qualitative literature exploring couples' experiences of dyadic coping, when one partner has Multiple Sclerosis (MS). METHODS The review protocol was pre-registered with PROSPERO. Five databases (PubMed, EMBASE, CINAHL, PsycINFO and Scopus) were searched for relevant papers from inception to January 2024. Seven hundred and ninety three papers were screened against pre-defined inclusion criteria. Data from 11 studies (n = 204) were quality assessed using the Critical Appraisal Skills Programme qualitative checklist and included in the metasynthesis. RESULTS The synthesis resulted in four themes related to couples' experiences of coping with MS: dance of accommodation, a sense of unity, outside of us and evolving as a unit. Communication attunement was perceived as key for couples to maintain cohesion in the relationship. Developing a shared narrative around MS helped couples to align their perspectives and co-ordinate their coping. The findings suggest that many couples coped by consciously maintaining a focus in the present. The wider system of social supports also appeared to frame the couples unique dyadic coping process in specific ways. CONCLUSIONS The findings from this synthesis provide support for the conceptualisation of MS as a shared experience to support couples' rehabilitation efforts.
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Affiliation(s)
- Serena Carberry
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Susan MacConaill
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Service Executive, CHO 3, Mid West Region, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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2
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Kaisey M, Solomon AJ. Multiple Sclerosis Diagnostic Delay and Misdiagnosis. Neurol Clin 2024; 42:1-13. [PMID: 37980109 DOI: 10.1016/j.ncl.2023.07.001] [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] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) misdiagnosis in the form of an incorrect diagnosis of MS, as well as delayed diagnosis in patients who do have MS, both influence patient clinical outcomes. Contemporary studies have reported data on factors associated with these diagnostic challenges and their frequency. Expediting diagnosis in patients with MS and reducing MS misdiagnosis in patients who do not have MS may be aided by educational efforts surrounding early MS symptoms and proper application of MS diagnostic criteria. Emerging novel MS diagnostic biomarkers may aid early and accurate diagnosis of MS in the future.
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Affiliation(s)
- Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A6600, Los Angeles, CA 90048, USA.
| | - Andrew J Solomon
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, University Health Center, Arnold 2, 1 South Prospect Street, Burlington, VT 05401, USA
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Williams MJ, Orlando C, Akisanya J, Amezcua L. Multiple Sclerosis in Black and Hispanic Populations: Serving the Underserved. Neurol Clin 2024; 42:295-317. [PMID: 37980120 DOI: 10.1016/j.ncl.2023.06.005] [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] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis has historically been characterized as a disease that affects young women of European ancestry, but recent studies indicate that the incidence and prevalence of the disease is much higher in Black and Hispanic populations than previously recognized. There is evidence that there is a more severe disease course in these populations. , but the intersection of genetic underpinnings and social determinants of health (SDOH) is poorly understood due to the lack of diversity in clinical research. Improving health disparities will involve multiple stakeholders in efforts to improve SDOH and raise awareness about research involvement and the importance of developing personalized health care plans to combat this disease.
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Affiliation(s)
- Mitzi J Williams
- Joi Life Wellness Multiple Sclerosis Center, 767 Concord Road, SE, Smyrna, GA 30082, USA.
| | - Christopher Orlando
- Department of Neurology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, USA. https://twitter.com/OrlandoMDMPH
| | - Jemima Akisanya
- Georgetown Department of Neurology, 10401 Hospital Drive, Suite 102, Clinton, MD 20735, USA. https://twitter.com/MimasMyelin
| | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 3000, Los Angeles, CA, USA
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Marrie RA, Chataway J, Bierer BE, Finlayson M, Martinez-Lapiscina EH, Panagoulias J, Sormani MP, Williams MJ, Amezcua L. Enhancing diversity of clinical trial populations in multiple sclerosis. Mult Scler 2023; 29:1174-1185. [PMID: 37555490 PMCID: PMC10413791 DOI: 10.1177/13524585231189677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Demographic characteristics, social determinants of health (SDoH), health inequities, and health disparities substantially influence the general and disease-specific health outcomes of people with multiple sclerosis (MS). Participants in clinical trials do not represent all people with MS treated in practice. OBJECTIVE To provide recommendations for enhancing diversity and inclusion in clinical trials in MS. METHODS We held an international workshop under the Auspices of the International Advisory Committee on Clinical Trials in MS (the "Committee") to develop recommendations regarding diversity and inclusivity of participants of clinical trials in MS. Workshop attendees included members of the Committee as well as external participants. External participants were selected based on expertise in trials, SDoH, health equity and regulatory science, and diversity with respect to gender, race, ethnicity, and geography. RESULTS Recommendations include use of diversity plans, community engagement and education, cultural competency training, biologically justified rather than templated eligibility criteria, adaptive designs that allow broadening of eligibility criteria over the course of a trial, and logistical and practical adjustments to reduce study participant burden. Investigators should report demographic and SDoH characteristics of participants. CONCLUSION These recommendations provide sponsors and investigators with methods of improving diversity and inclusivity of clinical trial populations in MS.
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Affiliation(s)
- Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK/Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Barbara E Bierer
- The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard, Cambridge, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain/Office of Therapies for Neurological and Psychiatric Disorders, Human Medicines Division, European Medicines Agency, Amsterdam, The Netherlands
| | | | | | | | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Motl RW, Kinnett-Hopkins D, Neal W, Flores E, Pekmezi D, Flores V. Targeted exercise for African-Americans with multiple sclerosis: Project TEAAMS. Contemp Clin Trials 2023; 126:107088. [PMID: 36669728 DOI: 10.1016/j.cct.2023.107088] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND We propose a randomized controlled trial (RCT) that examines the effects of a remotely-delivered, cultrally-tailored exercise training program for immediate and sustained improvements in patient-reported outcomes (PROs) of walking dysfunction, symptoms, and health-related quality of life (HRQOL) among African-Americans with multiple sclerosis (MS). METHODS/DESIGN The study will be conducted using a parallel group RCT design. The RCT examines the effects of a remotely-delivered, culturally-tailored exercise training program compared with an active control condition among 100 African-Americans with MS. The primary PROs focus on walking dysfunction. The secondary PROs include symptoms of fatigue, depression, anxiety, and HRQOL. The tertiary PROs include exercise behavior and mediator variables based on social cognitive theory. Participants will be randomly assigned into one of two conditions, intervention (Aerobic and Resistance Exercise Training) or active control (Stretching and Flexibility), using a random numbers sequence with concealed allocation. The conditions will be administered over four months by a trained behavioral coach who will be uninvolved in recruitment, screening, random assignment, and outcome assessment. We will monitor the outcomes of interest before and after the 4-month intervention period, and then again 4 months after intervention cessation for capturing stability of intervention effects. The data analysis will follow intent-to-treat principles with a linear mixed model. DISCUSSION If successful, this RCT will provide initial evidence for the uptake and implementation of the program in clinics/environments providing healthcare for African-Americans with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.
| | | | - Whitney Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edson Flores
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria Flores
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Mehraban S, Bahmani B, Boukani SA, Toosi M, Karami M, Carnero Contentti E. Patients experiences when receiving diagnosis of multiple sclerosis: A qualitative systematic review. Mult Scler Relat Disord 2023; 69:104473. [PMID: 36549103 DOI: 10.1016/j.msard.2022.104473] [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: 07/27/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged. The complex and unpredictable nature of MS disease makes the diagnosis process more difficult for the patient. The aim of this study was to review the lived experiences of patients with multiple sclerosis when receiving the diagnosis. METHODS We followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. A systematic search was performed using four databases including PubMed, Scopus, Web of Science, and psych info on April 2022. RESULTS We found 537 articles. After Applying relevant exclusion criteria removing duplicate and irrelevant articles, 13 studies were included in our systematic review after the abstract and full-text screening. Our findings collected data from 10 sub-themes in the following 3 themes to capture patients' experiences after receiving the diagnosis. These included: Emotional reactions to receiving the diagnosis; Communication with health professionals and knowledge about MS and Fear of being different. CONCLUSION It is important to understand patients' experiences with the disease and identifying problems to help and support families, patients, and health care personnel's. Therefore, it is necessary to design or implement therapeutic interventions for patients at the time of receiving the diagnosis to reduce psychological problems.
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Affiliation(s)
- Shafigh Mehraban
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahman Bahmani
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Soliman Ahmad Boukani
- Department of Counseling, Faculty of Education and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Maryam Toosi
- Department of Psychology, Buinzahra Branch, Islamic Azad University, Qazvin, Iran
| | - Mina Karami
- Department of Clinical Psychology, Medical Science Branch, Islamic Azad University, Tehran, Iran
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Kinnett-Hopkins D, Motl R. Social cognitive correlates of device-measured and self-reported physical activity in Black and White individuals with multiple sclerosis. Disabil Health J 2022; 15:101344. [PMID: 35725690 DOI: 10.1016/j.dhjo.2022.101344] [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: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is increasing research interest regarding physical activity behavior among persons with multiple sclerosis (MS), yet there is little known about physical activity and its correlates in Black persons with MS. OBJECTIVE This cross-sectional study assessed associations among social cognitive theory (SCT) variables and device-measured and self-reported physical activity in samples of Black and White persons with MS. METHODS Participants included 67 Black and 141 White persons with MS who wore an ActiGraph accelerometer on a belt around the waist measuring moderate-to-vigorous physical activity (MVPA) for seven days and completed a battery of questionnaires. Questionnaires included demographic and clinical characteristics, leisure-time exercise, exercise self-efficacy, overcoming barriers self-efficacy, function, social support, exercise outcome expectations, and goal setting and planning. RESULTS Black participants with MS engaged in significantly less MVPA, but not sedentary behavior or light physical activity, than the White participants with MS. Black participants further had significantly lower levels of exercise self-efficacy and outcome expectations than the White sample. All SCT correlates were significantly correlated with self-reported physical activity, but only exercise and barriers self-efficacy, perceived function, and exercise goal setting were associated with device-measured MVPA. The difference in physical activity between Black and White participants with MS was accounted for by differences in exercise self-efficacy and outcome expectations. CONCLUSIONS Researchers should consider developing behavioral interventions that target exercise self-efficacy and outcome expectations as SCT variables for increasing physical activity in Black persons with MS.
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Affiliation(s)
| | - Robert Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
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Amezcua L, Rivera VM, Vazquez TC, Baezconde-Garbanati L, Langer-Gould A. Health Disparities, Inequities, and Social Determinants of Health in Multiple Sclerosis and Related Disorders in the US: A Review. JAMA Neurol 2021; 78:1515-1524. [PMID: 34605866 DOI: 10.1001/jamaneurol.2021.3416] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance There is empirical evidence that social determinants of health (SDOH) impact health outcomes in Black and Hispanic and Latinx individuals in the US. Recently, SDOH have risen to the top as essential intervention targets that could help alleviate racial and ethnic disparities. Neuromyelitis optica spectrum disorder (NMOSD) disproportionately affects Black individuals, and multiple sclerosis (MS) has seen a recent shift in select racial groups. It is unclear to what degree SDOH have been investigated and contribute to racial and ethnic health disparities and inequities. Observations This narrative review provides a contemporary synthesis of SDOH associated with racial and ethnic health disparities and inequities in MS, NMOSD, and other autoimmune disorders, such as myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease. These immune-mediated neurological diseases were chosen for their capacity to be a high burden to society and because of complementary SDOH-associated challenges among minority populations. A paucity of research addressing inequities and the role of SDOH in MS and NMOSD was noted despite findings that Black individuals have a higher risk of developing MS or NMOSD and associated mortality compared with White individuals. Greater health disparities were also found for those with lower income and education, lower health literacy, and negative illness perceptions in MS. No studies in MOG-Ab disorders were found. Conclusions and Relevance Increased efforts are needed to better understand the role of SDOH in racial and ethnic health disparities and inequities in MS, NMOSD, and emerging autoimmune disorders. This includes developing research frameworks aimed at understanding the magnitude and interrelationships of SDOH to better develop system-based multilevel interventions across the spectrum of care for these neurological conditions.
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Affiliation(s)
- Lilyana Amezcua
- Keck School of Medicine, Department of Neurology, University of Southern California, Los Angeles
| | - Victor M Rivera
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | | | - Lourdes Baezconde-Garbanati
- Keck School of Medicine, Department of Preventive Medicine, Institute for Health Promotion and Disease Prevention, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Annette Langer-Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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