Responsiveness on metabolic syndrome criteria and hepatic parameters after 12 weeks and 24 weeks of multidisciplinary intervention in overweight adolescents

PURPOSE

This study aimed to evaluate the effect and individual responsiveness after 12 (12wk) and 24 weeks (24wk) of physical exercise (PE) and nutritional guidance (NG) on metabolic syndrome (MetS) criteria and hepatic parameters in overweight adolescents.

METHODS

The study comprised 94 overweight adolescents, aged between 10 and 16 years old, from both sexes, allocated into groups: PE and NG (PENGG, n = 64) and control with NG (NGCG, n = 30). Variables were collected at baseline, 12wk, and 24wk. Weight, height, abdominal circumference (AC), blood pressure, and peak oxygen consumption (VO_2peak), as well as insulin, triglycerides (TAG), high-density lipoprotein (HDL-c), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were evaluated. HOMA-IR and QUICKI were calculated. PE session consisted of 45 min of indoor cycling, 45 min of walking, and 20 min of stretching, three times a week. The NG consisted of three collective sessions in the first 12wk. Anova, effect size, and prevalence of responders were used for statistical analysis.

RESULTS

The PENGG12wk reduced anthropometric and metabolic measurements, while increased VO_2peak and HDL-c. The PEG24wk promoted anthropometric, blood pressure, metabolic, and VO_2peak improvements, but participants without PE returned to pre-exercise status and presented worsening AST and ALT concentrations. Frequencies of respondents in PENGG12wk versus (vs) NGCG12wk were, respectively, AC (69.1% vs 17.6%, p < 0.01), HDL-c (87.2% vs 23.5%, p < 0.01), TAG (67.3% vs 41.7%, p = 0.05) and ALT (45.5% vs 5,9%; p = 0.003).

CONCLUSION

Interventions with PE were effective to reduce MetS components in 12wk and maintenance in 24wk, showing anthropometric, metabolic, and VO_2peak improvements. Higher individual responses were observed in 12wk and in 24wk, important changes in overweight adolescent's therapy.

LEVEL OF EVIDENCE

Level I, evidence obtained from well-designed controlled trials randomization.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

Brazilian Registry of Clinical Trials (RBR-4v6h7b) and date of registration April 4th, 2020.

Epidemiology and outcome of status epilepticus in children: a Scottish population cohort study

AIM

To describe the epidemiology and outcomes of convulsive status epilepticus (CSE) since the introduction of buccal midazolam and the change in International League Against Epilepsy definition of CSE to include seizures of at least 5 minutes.

METHOD

All children presenting to paediatric emergency departments with CSE (2011-2017) in Lothian, Scotland, were identified. Data, collated from electronic health records, included patient demographics, clinical characteristics, acute seizure management, and adverse outcomes (for example admission to intensive care).

RESULTS

Six hundred and sixty-five children were admitted with CSE who had 1228 seizure episodes (381 males, 284 females; median age 3y 8mo; age range 0-20y 11mo). CSE accounted for 0.38% (95% confidence interval 0.34-0.42) of annual attendances at emergency departments. Annual prevalence was 0.8 per 1000 children aged 0 to 14 years. Thirty-four per cent of children had recurrent CSE. Sixty-nine per cent of seizures lasted 5 to 29 minutes (median duration 10min). Buccal midazolam was given to 30% of children with CSE and had no effect on need for ventilatory support. Seventy per cent of children with CSE required hospital admission. Four per cent resulted in adverse outcome and there were only two deaths. Recurrent seizures, longer duration, and unprovoked seizures increased the odds of adverse outcome.

INTERPRETATION

Adverse outcomes have decreased and the use of buccal midazolam is promising. Identifying high-risk groups provides an opportunity for early intervention. These data form the basis for an extensive evaluation of acute seizure management and monitoring long-term outcomes. What this paper adds The annual prevalence of convulsive status epilepticus in Lothian, Scotland, was 0.8 per 1000 children. There was a decrease in case-fatality proportion from 3-9% to 0.2%. Use of buccal midazolam has increased, with no increase in adverse outcomes.

Pilot project of psychological services integrated into a pediatric epilepsy clinic: Psychology Adding Value - Epilepsy Screening (PAVES)

RATIONALE

Children and young people with epilepsy (CYPwE) are particularly vulnerable to developing social, emotional, behavioral, and learning difficulties, which, if not identified or addressed at an early stage, can impact adversely on quality of life and long-term psychosocial outcomes. This paper describes the development of a screening protocol and a pathway of early, 'stepped' intervention, which aims to address this issue, together with initial outcomes.

METHODS

The Strengths and Difficulties Questionnaire (SDQ) was completed by CYPwE and their parents prior to routine epilepsy clinic appointments. A traffic light system was devised to indicate the reported level of concern and a potential route through the early intervention pathway.

RESULTS

Of those CYPwE screened, 53% were found to be experiencing elevated levels of mental health difficulties, which had not previously been identified, and had the opportunity to access an appropriate early intervention. Initial feedback on the PAVES pathway has been positive, with high levels of feasibility and acceptability indicated by young people, parents, and clinicians.

CONCLUSIONS

The PAVES approach enables mental health difficulties to be identified and appropriate intervention accessed at an early stage, potentially improving long-term psychosocial outcomes for CYPwE. In addition, if found to be effective in larger trials, PAVES has potential to be adapted and generalized to other populations.

Children's understanding of epilepsy: A qualitative study

PURPOSE

To use a qualitative research approach to determine children's understandings of epilepsy and their epilepsy treatment.

METHODS

Children aged 7-16 years with physician-confirmed active epilepsy (i.e., having had an epileptic seizure in the past year and or currently taking antiepileptic drugs (AEDs), and not known to have an intellectual disability, were invited to participate. Children had semi-structured interviews separately on two occasions. Between the first and second interviews, an observation of a routine epilepsy clinic appointment of individual children was conducted, and was then discussed during the second interview. Participatory research tools were used in both child interviews to facilitate discussions. Interviews were audio recorded and transcribed, pseudonymized and entered into NVivo (version 12, QSR International). Data were analyzed using a thematic approach.

RESULTS

Twenty-three children of mean age 10.1 years (range 8-14), mean duration of epilepsy of 4.6 years (range 2-10) were enrolled. Twelve were 12 female; 7 had focal, 14 had generalized, and 2 had combined epilepsy; 20 were on monotherapy; and 16 had tried previous AEDs. All had an initial (first) interview; 20 were observed during a clinic appointment and had a second interview. Five broad themes emerged: understanding of epilepsy; understanding of seizures; understanding of medication; understanding of children's role in clinical appointments; influences on children's understanding. Children spoke about what epilepsy meant by describing the physical sensations of having a seizure or through the act of taking medication. Children described the role they had, or felt they should have, but reported challenges in being meaningfully involved in clinical appointments. While healthcare professionals were initial information nodes, epilepsy information from parents appeared to be more significant for children.

CONCLUSIONS

The perspectives of children with epilepsy are valuable for clinicians to understand; assumptions should not be made that children's views can be accessed via parents. Clinicians need to be constantly aware of children's views and ways of understanding and communicating about their epilepsy. To support this, the research - drawing on children's words, meanings, and stories - was used to inform an easily accessible, gender-neutral, animation about epilepsy that provides information about the condition, seizures, and medication (https://youtu.be/MO7xXL2ZXP8).

Thermally Induced Crossover from 2D to 1D Behavior in an Array of Atomic Wires: Silicon Dangling-Bond Solitons in Si(553)-Au

The self-assembly of submonolayer amounts of Au on the densely stepped Si(553) surface creates an array of closely spaced "atomic wires" separated by 1.5 nm. At low temperature, charge transfer between the terraces and the row of silicon dangling bonds at the step edges leads to a charge-ordered state within the row of dangling bonds with ×3 periodicity. Interactions between the dangling bonds lead to their ordering into a fully two-dimensional (2D) array with centered registry between adjacent steps. We show that as the temperature is raised, soliton defects are created within each step edge. The concentration of solitons rises with increasing temperature and eventually destroys the 2D order by decoupling the step edges, reducing the effective dimensionality of the system to 1D. This crossover from higher to lower dimensionality is unexpected and, indeed, opposite to the behavior in other systems.

[Flow density measurements using optical coherence tomography angiography : Impact of age and gender]

BACKGROUND

This article presents the normative data for flow density measured using optical coherence tomography (OCT) angiography and the impact of age and gender is evaluated.

METHODS

In this study 58 eyes from 58 healthy volunteers with no history of any ocular disease or ocular surgery were included. The OCT angiography imaging was performed using the RTVue XR Avanti with the AngioVue (Optovue, Fremont, CA). The macula was imaged using a 3 × 3 mm scan, and the flow density data in the superficial retinal OCT angiogram and deep retinal OCT angiogram were extracted and analyzed. The groups were compared using the Mann-Whitney U‑test and the degree of correlation between two variables was expressed as the Spearman's correlation coefficient (rSp.) RESULTS: The mean subject age was 38.3 ± 14.6 years. The flow density (whole en face) in the deep retinal OCT angiogram was significantly higher compared to the flow density in the superficial retinal OCT angiogram (p < 0.001). There was no significant difference in the mean flow density in superficial and deep OCT angiograms of the macula between males (n = 27) and females (n = 31). There was a significant correlation between the flow density in the deep retinal OCT angiogram and age (rSp. = -0.41, p = 0.001).

CONCLUSION

Whereas gender has no impact on the flow density measured using OCT angiography, there was a significant correlation between the flow density in the deep retinal OCT angiogram and age.

Pulsed electron gun for electron diffraction at surfaces with femtosecond temporal resolution and high coherence length

We present a newly designed 30 kV pulsed electron gun for ultrafast electron diffraction suited for pump-probe setups driven by femtosecond laser pulses. The electron gun can be operated both in transmission and reflection geometry. A robust design with a back illuminated Au photocathode, extraction fields of 7.5 kV/mm, and a magnetic focus lens ensures reliable daily use. Magnetic deflectors allow for beam alignment and characterization. Focusing of the UV pulse on the photocathode results in a small source size of photoemitted electrons and thus a high transverse coherence length of more than 50 nm in diffraction. A low difference of ΔE = 0.1 eV between the work function of the 10 nm Au photocathode and photon energy of the frequency tripled UV laser pulses results in an instrumental temporal resolution of 330 fs full width at half maximum. This resolution is discussed with respect to the number of electrons per pulse.

[Nerve injuries and traumatic lesions of the brachial plexus : Imaging diagnostics and therapeutic options]

CLINICAL/METHODICAL ISSUE

Traumatic lesions of peripheral nerves and the brachial plexus are feared complications because they frequently result in severe functional impairment. The prognosis is greatly dependent on the correct early diagnosis and the right choice of treatment regimen. It is important to distinguish between open and closed injuries.

STANDARD RADIOLOGICAL METHODS

Initial imaging must critically evaluate or prove nerve continuity and is commonly achieved by high-resolution ultrasonography. During the further course, reactive soft tissue alterations, such as constrictive scarring or neuroma formation can be detected. In the case of deep nerve and plexus injuries this can be excellently achieved by dedicated magnetic resonance neurography (MRN) sequences.

METHODICAL INNOVATIONS

The signal yield from brachial plexus imaging can be critically enhanced by the use of dedicated surface coil arrays. Furthermore, diffusion tensor imaging (DTI) may enable the regeneration potential of a nerve lesion to be recognized in the future.

PERFORMANCE

Multiple reports have shown that neurosonography enables a precise evaluation of peripheral nerve structures (up to 90% sensitivity and 95% specificity in nerve transection) and that the method can critically impact on therapeutic decision-making in 60%. Currently, there are only few quantitative data on the exact performance of MRN in traumatic nerve lesions; however, individual reports indicate a high level of agreement with intraoperative findings.

PRACTICAL RECOMMENDATIONS

In the initial work-up, especially in the case of peripheral, superficial and lesser nerve injuries, neurosonography is the preferred imaging approach to evaluate nerve integrity and the extent of nerve lesions. In the case of extensive nerve injury of proximal nerves and structures of the plexus as well as in the case of suspected root avulsion MRN is the method of choice.

Managing Older Patients Safely in the Time Critical Environment of an Emergency Department

Demand for emergency department (ED) services is increasing worldwide. The fastest growth in ED presentations is by patients aged ≥65 years, currently representing 18% of all attendances. Older patients present with more complex clinical conditions and multiple co-morbidities. This means they are likely to spend more time in ED, are more likely to be admitted to hospital, and are more likely to re-attend. The Safe Elderly Emergency Discharge (SEED) project aims to determine whether current models of emergency care ensure safe discharge and facilitate optimal health outcomes for older patients; and develop a tailored evidence-based care framework applicable to Australian and international settings. Risk screening for unsafe discharge will be conducted on patients aged ≥65 years discharged home from ED. Patients will be followed for 6 months post-ED presentation to monitor health outcomes and map their care journey. Demographic, clinical, and functional characteristics will be collected. The primary outcome is unsafe discharge, defined as unplanned re-presentation/admission within 30 days of the index presentation. Secondary outcomes include unplanned ED re-presentation/hospital admission within 6 months; patient experience; change in functional status; functional decline; health service utilisation; and death within 6 months. The effectiveness of the ED discharge risk screening tools for predicting unsafe discharge will be evaluated at 30 days and 6 months. SEED will determine the risk factors for unplanned ED re-presentation/hospital admission at 30 days for patients aged ≥65 years presenting to ED; which will inform the development of an evidence-based older patient care framework for EDs.

Swiss S1 guideline for the treatment of rosacea

Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.

Overview of shorthand medical glossary (OMG) study

BACKGROUND

Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable.

AIM

We sought to describe the frequency of inappropriate and ambiguous shorthand in discharge summaries.

METHODS

Eighty electronic discharge summaries from the four General Medical Units at the Royal Melbourne Hospital were randomly extracted from the hospital's electronic records. Extraction was stratified by the four units and by the four quarters between July 2012 and June 2013. All abbreviations were assigned into one of four categories according to appropriateness: 1. 'Universally accepted and understood even without context'; 2. 'Understood when in context'; 3. 'Understood but inappropriate and/or ambiguous'; and 4. 'Unknown'. These categories were determined by the authors, which included junior and senior medical staff.

RESULTS

The 80 discharge summaries contained 840 different abbreviations used on 6269 occasions. Of all words, 20.1% were abbreviations. Of the 6269 occasions of shorthand, 6.8% were categorised as 'Understood but inappropriate and/or ambiguous' or 'Unknown' (category 3 or 4), equating to 1.4% of all words, and an average of 5.4 words per discharge summary.

CONCLUSION

Abbreviations are common in electronic discharge summaries, occurring at a frequency of one in five words. While the majority of shorthand used seems to be appropriate, the use of inappropriate, ambiguous or unknown shorthand is still frequent. This has implications for safe and effective patient care and highlights the need for better awareness and education regarding use of shorthand in clinical notation.

Palliative care for patients with chronic obstructive pulmonary disease: exploring the landscape

Patients with chronic obstructive pulmonary disease experience a substantial symptom burden, high levels of psychosocial need and significant mortality. This epidemiological study reveals that the majority of patients are cared for in the public hospital system (64%) and generally die in hospital (72%) with a number of identifiable predictors of 6-month mortality. Our results suggest that palliative care services need to be redirected from a community-based admission focus to a model that is responsive to emergency and acute care hospital systems.

Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: a population-based analysis of Victorian hospital separations data

BACKGROUND/AIM

To evaluate the frequency and geographical variation in knee arthroscopy for adults (>25 years) with a concomitant diagnosis of osteoarthritis.

METHODS

This was a retrospective cohort study of hospital separations involving an elective knee arthroscopy in public and private hospitals in Victoria, Australia. Participants included patients receiving knee arthroscopies with a diagnosis code indicating osteoarthritis (OA) from 1 July 2008 to 30 June 2009. Records were excluded if the patient was under 25 years or their arthroscopy involved a ligament reconstruction. Crude rates per 100 000 population and negative binomial regression offset by total knee arthroscopy volume were used to analyse differences by region.

RESULTS

There were 9620 arthroscopic procedures meeting the inclusion criteria. There were 5500 (57.2%) admissions where the principal diagnosis was knee OA (gonarthrosis) and 3510 (36.5%) where the principal diagnosis indicated a mechanical derangement and there was a primary or associated diagnosis of OA. When we examined the incidence rate ratios (IRR) by region, after adjustment for relevant factors and accounting for the total knee arthroscopy volume within each region, we identified significant variation in knee arthroscopy rates for patients with OA. The region with the highest adjusted IRR was Barwon South Western (IRR: 1.26, 95% confidence interval (CI): 1.16-1.36) and the region with lowest adjusted incidence rate ratio was the Gippsland region (IRR: 0.89, 95% CI: 0.80-0.98).

CONCLUSIONS

We identified considerable geographical variation in arthroscopies for people with OA across Victoria. Further investigation is needed to understand whether this variation is a reflection of differences in OA prevalence, clinical decision-making or access.

Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals

BACKGROUND

The information needs of patients with chronic obstructive pulmonary disease (COPD) towards the end of life are poorly understood.

AIM

This study explored the views of patients with COPD and healthcare professionals, focusing upon information needs and treatment preferences.

METHOD

In-depth, semi-structured interviews were held with patients with COPD following admission to hospital with respiratory failure, and focus groups held with healthcare professionals from hospital and community settings.

RESULTS

Ten patients were interviewed, who had a median 4 previous hospital admissions, and had smoked for median 47 years. Five focus groups were held with 31 healthcare professionals (18 nurses, 7 doctors, 6 allied health). The theme underpinning all discussions was of tension between maintaining hope and negotiating the reality of the illness and its consequences. Within this theme, patients tended to be optimistic, viewed acute exacerbations as separate from their underlying chronic illness, and were keen for intensive treatments, including intubation if acutely unwell. They had little understanding of the complexities of decision-making around treatment escalation. Both patients and health workers believed that information around end of life should be offered routinely, but delivered in a manner that recognises and maintains a form of hope.

CONCLUSION

Patients and healthcare professionals believe information around illness course, future goals and treatment is important to care. An expanded view of hope may assist when providing such information, including when discussing goals of care in the setting of advanced illness.

One-dimensional collective excitations in Ag atomic wires grown on Si(557)

The interaction between adsorbate layers of transition metal atoms and strongly anisotropic surfaces can lead to various quasi-one-dimensional (1D) signatures, as demonstrated here for Ag adsorbed on Si(557). Using low energy electron diffraction in combination with scanning tunneling microscopy and electron energy loss spectroscopy, we correlated the structure with the properties of low dimensional collective excitations. Semiconducting structures with double periodicity along the chains are formed at Ag coverages below 0.3 ML. At higher coverages, the formation of wires with (√3 × √3) order sets in. Only these wires are metallic, as is evident from the appearance of plasmonic losses, which show 1D dispersion only along the wires. This 1D property even persists up to one monolayer, where a densely packed array of metallic (√3 × √3) stripes is formed. The triple steps between the wires are obviously insulating. Only plasmonic subband transitions are visible, which are characteristic for quasi-1D metallic stripes of finite width.

Variations in structures, processes and outcomes of community mental health teams for older people: a systematic review of the literature

OBJECTIVES

In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness.

METHOD

Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element.

RESULTS

Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature.

CONCLUSIONS

The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided.

Multidisciplinary care for Guillain-Barré syndrome

BACKGROUND

Guillain-Barré syndrome (GBS) can be a significant cause of new long-term disability, which is thought to be amenable to multidisciplinary care. However, the evidence base of its effectiveness is unclear.

AIM

The aim of this systematic review is to assess the effectiveness of multidisciplinary care in adults with GBS, the types of approaches that are effective (setting, type, intensity) and the outcomes that are affected.

METHODS

The search strategy comprised: The Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Central Register of Controlled Trials; MEDLINE, EMBASE, AMED, PEDro, LILACS and CINAHL (up to May 2010). Selected studies included randomized and controlled clinical trials that compared multidisciplinary care in GBS with a control (routine local service, lower level of intervention); or studies that compared multidisciplinary care in different settings or at different levels of intensity of therapy. Best evidence synthesis was based on methodological quality. Three observational studies were also reported but they make limited contribution to evidence base synthesis.

RESULTS

No randomized or controlled clinical trials were identified. Evidence from three low-quality observational studies provide some support for improved disability in the short term (6 months) with high intensity rehabilitation; and for improved participation and quality of life.

CONCLUSION

The gaps in existing research should not be interpreted as ineffectiveness of multidisciplinary care in GBS. Appropriate and methodologically robust study designs, responsive outcome measures; and more research in the setting, type and intensity of rehabilitation are needed.

The bone marrow compartment is modified in the absence of galectin-3

Galectin-3 (gal-3) is a β-galactoside binding protein present in multivalent complexes with an extracellular matrix and with cell surface glycoconjugates. In this context, it can deliver a variety of intracellular signals to modulate cell activation, differentiation and survival. In the hematopoietic system, it was demonstrated that gal-3 is expressed in myeloid cells and surrounding stromal cells. Furthermore, exogenous and surface gal-3 drive the proliferation of myeloblasts in a granulocyte–macrophage colony-stimulating factor (GM-CSF)-dependent manner. Here, we investigated whether gal-3 regulates the formation of myeloid bone marrow compartments by studying galectin-3^−/− mice (gal-3^−/−) in the C57BL/6 background. The bone marrow histology of gal-3^−/− mice was significantly modified and the myeloid compartments drastically disturbed, in comparison with wild-type (WT) animals. In the absence of gal-3, we found reduced cell density and diaphyseal disorders containing increased trabecular projections into the marrow cavity. Moreover, myeloid cells presented limited capacity to differentiate into mature myeloid cell populations in gal-3^−/− mice and the number of hematopoietic multipotent progenitors was increased relative to WT animals. In addition, bone marrow stromal cells of these mice had reduced levels of GM-CSF gene expression. Taken together, our data suggest that gal-3 interferes with hematopoiesis, controlling both precursors and stromal cells and favors terminal differentiation of myeloid progenitors rather than proliferation.

A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

OBJECTIVE

A stratified, randomised, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation programme in persons with multiple sclerosis (pwMS) in an Australian community cohort.

METHODS

Patients with definite MS and bladder issues (n=74) recruited from a tertiary hospital database were randomised to a treatment group (n=40) for an individualised bladder rehabilitation programme or to a control waitlist group (n=34). The Urogenital Distress Inventory (UDI6), Neurological Disability Scale (NDS) and the American Urological Association Symptom Index (AUA) assessed bladder impairment and 'activity limitation'; a single Quality of life (QoL) item in the AUA and the Incontinence Impact Questionnaire (IIQ7) measured restriction in 'participation'. Primary outcome measures were assessed at baseline and at 12 months.

RESULTS

Analysis of per protocol data from 58 patients (treatment n=24, control n=34) showed reduced disability in the treatment group, with significant differences (p<0.001) and large effect sizes (>0.5) in post-treatment UDI6, NDS, AUA total, AUA QoL and IIQ7 scores for the two groups. The treatment group compared with the control group showed improvement: 78% versus 27% for UDI6 and 59% versus 17% improved for IIQ7. More patients in the control group deteriorated over the study period on the UDI6 (30% vs 0%; p<0.001) and IIQ7 (39 vs 0%; p=0.001).

CONCLUSION

A multifaceted, individualised bladder rehabilitation programme reduces disability and improves QoL in pwMS compared with no intervention after 12 months of follow-up. Information on specific interventions in different bladder types in MS and the impact on QoL need further evaluation. Australian Clinical trials Registry ACTRNO12605000676617.