Caregivers of people with multiple sclerosis: experiences of support

The aim of this pheno menological study was to gain an understanding of the experiences of a group of caregivers of people with multiple sclerosis (MS). Sixteen caregivers from Northern Ireland and the Republic of Ireland participated in focus group interviews. The theme of support, either sought or received, emerged as a major aspect of the experiences described. C aregivers’ feelings about, and experiences of, support appeared to change over time. Four common phases that caregivers experienced in relation to support were identified as: ‘rejecting’, ‘resisting’, ‘seeking’ and ‘accepting’ support. This paper will present and discuss these four phases. The study findings highlight the complexity of issues surrounding a caregiver’s decision to seek and accept support. It is hoped that the phases identified within this study are useful in depicting how caregivers of people with MS may progress through stages in their desire for, and acceptance of, support. Findings from this study are useful to healthcare professionals who work with people with MS and their caregivers by increasing awareness that a caregiver’s attitude toward and acceptance of support changes over time.

Interface pressure measurements: Visual interpretation of pressure maps with MS clients

PURPOSE

Pressure mapping systems provide useful information for pressure care assessment. Healthcare professionals tend to rely upon their colour-coded pressure maps to assist clinical decision-making, based on ranking these from best to worst pressure distribution. The current study investigated whether such ranking is an appropriate method of assessment when compared to use of the numerical output of average and maximum pressure values (mmHg), yielded by the system.

METHOD

This community-based correlational study involved 27 multiple sclerosis clients (15 wheelchair users; 12 non-wheelchair users). Pressure maps were recorded on each participant's current seating surface and on six pressure reducing cushions, using the Force Sensing Array pressure mapping system. Outcome measures included (1) rank order of pressure maps based on visual interpretation by two occupational therapists, (2) average pressure (mmHg) and (3) maximum pressure (mmHg). Visual ranking of the colour-coded pressure maps was correlated with average and maximum pressure values for each map.

RESULTS

Correlations between visual ranking of maps and maximum pressures were high for six out of seven surfaces (p < 0.05) for non-wheelchair users; however, they were much less between average pressures and visual interpretation for the same cohort. Similarly, correlations between visual ranking of maps and average pressures for wheelchair users was minimal and was only noted as being high (p < 0.05) on two surfaces when considering maximum pressures and visual interpretation.

CONCLUSIONS

This study contests the usefulness of the visual ranking of pressure maps in interpreting interface pressures with MS clients, especially with wheelchair users. Visual interpretation of pressure maps by clinicians may be useful in eliminating inappropriate support surfaces from a selection, or those that display easily identifiable 'extremes' of pressure values. Clinicians need to incorporate and interpret the numerical data as well as pressure maps when conducting their assessment and making provision.

Hammocking: the effect of cushion covers on interface pressure measurements

PURPOSE

To investigate the effects of the cushion covers on interface pressure measurements using pressure mapping technology.

METHODS

Sixty-one healthy participants were recruited for a laboratory-based study using a single group design. Participants were pressure mapped on a visco-elastic foam cushion and a foam and fluid pack cushion with their covers on and with their covers removed. An air-filled cushion was tested with two different types of covers, an incontinence cover and a 'Comfair' cover. Average and maximum pressures recorded at 6 mins by the Force Sensing Array pressure mapping system were used for statistical analysis.

RESULTS

There were no significant differences in maximum pressures for the three cushions tested with their covers on or with their covers removed. The cushion with the foam base and fluid pack did not demonstrate any significant differences in average pressure with the cover on or with the cover removed. However, the visco-elastic foam cushion showed significantly lower average pressures with the cover on (p=0.019). The air-filled cushion showed lower average pressures with the incontinence cover on, when compared to the Comfair cover (p=0.029).

CONCLUSION

Contrary to the belief that the process of hammocking may create surface tension within the cushion covers, which in turn may adversely affect the cushions ability to reduce interface pressure, the cushions tested in the current study did not show significantly lower interface pressure measurements with the covers removed. Therefore the covers did not adversely affect the cushion's ability to reduce interface pressure. The findings of this study require verification with disabled clients.

An investigation of the impact of the Force Sensing Array pressure mapping system on the clinical judgement of occupational therapists

OBJECTIVES

To examine the impact of pressure mapping technology on the clinical decisions of occupational therapists and to examine the role of the Braden Scale in assisting with the selection of pressure-reducing cushions.

DESIGN

Case studies.

SETTING

Community.

SUBJECTS

Forty clients.

INTERVENTIONS

Clients were pressure mapped on their current seating surface and on four pre-selected cushions by the principal researcher. An occupational therapist completed the Braden Scale and a decision tree to assist in recommending a suitable pressure-reducing cushion.

MAIN OUTCOME MEASURES

Interface pressure maps, Braden Scale, and the cushion recommended, using a decision tree to guide clinical judgement.

RESULTS

Thirty per cent (12) of the 40 cushions recommended were changed when the pressure maps from the Force Sensing Array (FSA) system were viewed. In 70% (26) of cases, the maps supported the cushion recommended. In 25% (10) of the cases, the maps showed that the client's current seating surface was unsuitable. After viewing the pressure maps, a surface other than the client's current surface was recommended in 47% (19) of the cases. There was a lack of agreement between the risk level of the clients as identified by the Braden Scale score, and the risk level of the clients as identified by the occupational therapist using a decision tree and the FSA maps.

CONCLUSION

Pressure mapping technology has a positive impact on clinical decisions regarding the provision of pressure-reducing cushions. Future research should examine the predictive validity of this technology. The Braden Scale may underpredict the risk level of the clients.

Pressure mapping systems: reliability of pressure map interpretation

BACKGROUND

Pressure mapping systems offer a new technology to assist with pressure care assessment. Data output from such systems can be presented in three forms: numerical data, a three-dimensional grid and a colour-coded pressure map.

OBJECTIVES

To (1) investigate whether sole use of the pressure map was a reliable method of interpreting interface pressures when compared with use of the numerical data; (2) establish the inter- and intra-rater reliability of using pressure maps to assess pressure and determine whether reliability depended upon system operator experience; and (3) examine whether reliability extended to the range of seating surfaces being tested.

DESIGN

A reliability study assessing the ranking of pressure maps recorded by the Force Sensing Array pressure mapping system.

SETTING

A university occupational therapy department and a community NHS trust.

SUBJECTS

Fifteen occupational therapists with experience in pressure mapping and 50 occupational therapy students with no practical experience of pressure mapping.

INTERVENTIONS

Two sets of pressure maps were pre-recorded with an able-bodied adult seated on a variety of surfaces, with maps on each individual surface recorded over a 20-minute period at 2-minute intervals. Subjects ranked both sets of maps in terms of 'best to poorest' distribution of pressure.

MAIN OUTCOME MEASURES

Rank orders of (1) pressure maps; (2) average interface pressures (mmHg); (3) maximum interface pressures (mmHg).

RESULTS

The use of pressure maps to interpret interface pressures was a reliable method. Significant agreement existed within (p < 0.001) and between groups of operators and reliability extended over the range of seating surfaces tested.

CONCLUSIONS

The practice of using pressure maps to interpret interface pressures in seating as opposed to using the associated numerical data can be supported. This was shown to be a reliable method of assessment by both experienced and less experienced operators across a range of seating surfaces.

The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review

PRIMARY OBJECTIVE

To appraise recent studies regarding the needs and experiences of caregivers of individuals with multiple sclerosis (MS).

DESIGN

The following computerized databases were searched: CINAHL, BIDS IBSS, ASSIA, MEDLINE, PSYCHINFO, British Nursing Index, ISI Web of Science, Zetoc, AMED (1990-April 2002). The computer-based search was supplemented by manual searches of the reference lists of all retrieved studies and review articles. Inclusion and exclusion criteria were formulated.

RESULTS

Twenty-four studies from across the world that met the inclusion criteria were reviewed. The majority of studies were descriptive in nature. The studies covered a variety of topics, including how carers assist people with MS, the effect of providing care on a carer's physical and psychological well-being, social life, financial situation and overall quality of life, and how carers cope with the stresses of providing care.

CONCLUSIONS

Providing care for a person with MS has a major impact on all areas of the caregiver's life. Perceived social support has been shown to have a beneficial impact on the caregiver. Limitations in design and variation in methodology of studies limits the generalizability of findings. There is a need for further research, in particular the development of reliable and valid disease-specific caregiver assessment instruments.