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Martin S, Kihlbom U, Pasquini G, Gerli F, Niccolai C, Della Bella S, Portaccio E, Betti M, Amato MP, Achiron A, Kalron A, Aloni R, Schölin Bywall K. Preferences and attitudes regarding early intervention in multiple sclerosis: A systematic literature review. Mult Scler Relat Disord 2024; 92:106143. [PMID: 39489082 DOI: 10.1016/j.msard.2024.106143] [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: 04/02/2024] [Revised: 07/04/2024] [Accepted: 10/25/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disorder affecting the brain and spinal cord, characterized by immune-mediated myelin damage. Early intervention and detection programs have emerged as promising strategies to improve patient outcomes by identifying and treating MS in its earliest stages. OBJECTIVE This systematic literature review aims to provide an overview of the preferences, attitudes, and opinions of both patients and healthcare professionals regarding early intervention or early detection programs for MS. METHODS A comprehensive search strategy was employed in March 2023 across multiple databases (MEDLINE, Scopus, PsyInfo, PubMed), from 1990 to 2023. A total of 38 articles were selected for analysis based on predefined inclusion and exclusion criteria. RESULTS The majority of articles were published in recent years and represented different methods from case reports to randomized controlled trials, with fewer systematic literature reviews. Data collection approaches included patients, healthcare workers, or mixed samples with varying age ranges and gender ratios, frequently preferring women. These samples represented different preference study methods. The included studies were primarily conducted in the USA and the UK. Thematic analysis revealed several key themes : 1) differences emerged between healthcare professionals' and patients' perspectives 2) interventions for MS outside Disease-Modifying Therapies (DMTs) 3) severe side effects 4) communication, information, and knowledge 5) psychological and emotional aspects. CONCLUSIONS Understanding these diverse factors and subgroups within the MS population can inform more effective, personalized approaches to MS prevention and treatment.
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Affiliation(s)
- Sylvia Martin
- Uppsala University, Center for research and bioethics, Uppsala, Sweden.
| | - Ulrik Kihlbom
- Uppsala University, Center for research and bioethics, Uppsala, Sweden; Karolinska institutet, Stokholm, Sweden
| | | | | | | | | | | | | | - Maria Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; Department of NEUROFARBA University of Florence, Florence, Italy
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Tel-Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Tel-Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Tel-Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv, Israel
| | - Karin Schölin Bywall
- Uppsala University, Center for research and bioethics, Uppsala, Sweden; Mälardalens University, Väasterås, Sweden
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van der Ven E, Patra S, Riemann-Lorenz K, Kauschke K, Freese-Schwarz K, Welsch G, Krause N, Heesen C, Rosenkranz SC. Individualized activity recommendation based on a physical fitness assessment increases short- and long-term regular physical activity in people with multiple sclerosis in a retrospective cohort study. Front Neurol 2024; 15:1428712. [PMID: 39268074 PMCID: PMC11391639 DOI: 10.3389/fneur.2024.1428712] [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: 05/06/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024] Open
Abstract
Background Despite the evidence of beneficial effects of physical activity (PA), people with multiple sclerosis (pwMS) are less physically active than the general population. To increase PA in pwMS, we developed a structured individually tailored PA promotion program which is conducted within clinical practice in a university-based outpatient clinic since 2016. This study serves as retrospective quality control of this program. Objective In a retrospective cohort study, we assessed the physical fitness of pwMS and the impact of the program on short- and long-term PA changes and behavioral determinants. Methods The program consisted of four appointments each 2-4 weeks apart. Spiroergometric test results of female pwMS were compared to female non-MS controls who underwent a voluntary physical fitness analysis. The short version of the Freiburger questionnaire, self-developed questions and the modified Physical activity screening questionnaire (PASQ) were sent to all participants assessing the PA levels before the program, 3 months after the program (short-term), and at the time of the survey (long-term). Additionally, established questionnaires assessed behavioral determinants before the program and long-term. Results A total of 166 participants [mean age 38.32 (± 10.61 SD), mean EDSS 2.30 (±1.29 SD)] and mostly females (63.3%, n = 105) were included in the study and started the program. A total of 136 participants completed the program. Out of these 63.9% (n = 87) answered the questionnaires in 12.38 (±11.34 SD) months after finishing the program. At baseline female pwMS (n = 100) showed a lower physical fitness in comparison to non-MS controls (n = 26) (maximal workload (Watts): 138.86 ± 37.85 vs. 191.73 ± 45.25, p < 0.001; peak oxygen consumption (ml min-1 kg-1): 26.40 ± 7.23 vs. 31.56 ± 10.10, p = 0.020). pwMS were more regularly active in short- (62.1%) and long-term (55.2%) compared to baseline (24.2%, p < 0.001). Among the activated participants, we observed improved internal motivation (p = 0.002) and decreased perception of barriers (p = 0.006) compared to baseline. Conclusion PwMS showed a lower physical fitness in comparison to non-MS controls. An individually tailored PA promotion program might improve behavioral determinants and thereby increase short- and long-term PA levels of pwMS.
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Affiliation(s)
- Eva van der Ven
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Patra
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Kauschke
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Freese-Schwarz
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Welsch
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sina Cathérine Rosenkranz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Silveira SL, Motl RW, Salter A, Marquez DX. Social Cognitive Theory Variables as Correlates of Physical Activity Behavior Among Hispanics With Multiple Sclerosis. Arch Phys Med Rehabil 2024; 105:1083-1088. [PMID: 38281577 DOI: 10.1016/j.apmr.2024.01.009] [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: 06/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To examine the association between social cognitive theory (SCT) variables and physical activity (PA) behavior in Hispanic adults with multiple sclerosis (MS). DESIGN Observational, survey study. SETTING General community. PARTICIPANTS Inclusion criteria: (a) age 18 years or older, (b) self-identify as Hispanic or Latino, (c) diagnosis of MS, and (d) English or Spanish as primary language. Two hundred forty-three individuals opened the survey, 24 individuals did not meet inclusion criteria, and 66 individuals were excluded due to not completing any of the SCT variable measures (N=153). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) PA was measured using the Godin Leisure Time Exercise Questionnaire (GLTEQ) total and Health Contribution Scores (HCS). SCT variables included standard measures of exercise self-efficacy, planning, goal setting, outcome expectations, social support, and functional impairment. RESULTS The final sample included 153 participants with a mean (SD) age of 43 (11) years, 78% identified as women, 57% were employed, and 63% had a college degree or higher. The mean (SD) MS disease duration was 11 (9) years, 74% of participants reported relapsing remitting MS, and median (interquartile range) Patient Determined Disease Steps (PDDS) score was 3.0 (3.0). Significant correlations were observed between all SCT variables and both GLTEQ total and GLTEQ HCS scores (P<.001). Forward stepwise regression with Akaike's Information Criterion (AICC) identified PDDS, age, exercise planning, exercise self-efficacy, and exercise goal setting as the most appropriate covariates and SCT variables to include in a multivariable model examining independent contributions on GLTEQ HCS scores. The multivariable, linear regression analysis indicated that PDDS (Standardized B=-.280, P<.001), exercise planning (Standardized B=.214, P<.05), and exercise self-efficacy (Standardized B=.183, P<.05) explained 42.4% of variance in GLTEQ HCS scores. CONCLUSIONS This study provides a contribution to the literature by identifying SCT variables that correlate with PA behavior among Hispanics with MS that may guide the creation of culturally appropriate PA programs.
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Affiliation(s)
- Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas, TX
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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Jeng B, DuBose NG, Martin TB, Šilić P, Flores VA, Zheng P, Motl RW. Updated Systematic Review and Quantitative Synthesis of Physical Activity Levels in Multiple Sclerosis. Am J Phys Med Rehabil 2024; 103:284-292. [PMID: 37408136 DOI: 10.1097/phm.0000000000002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE This article provided an updated quantitative synthesis of physical activity levels in persons with multiple sclerosis compared with controls and other clinical populations. DESIGN A systematic search through PubMed, Scopus, and PsycINFO was conducted for articles published between August 2016 and July 2022. Articles that included a group comparison of at least one measurement of physical activity between adults with multiple sclerosis and controls or other clinical populations were included in the meta-analysis. RESULTS Twenty-four studies met the inclusion criteria and yielded a total of 119 comparisons. There was a moderate difference in physical activity levels between persons with multiple sclerosis and controls (effect size = -0.56, P < 0.01), but no significant difference between persons with multiple sclerosis and other clinical populations (effect size = 0.01, P = 0.90). The pooled effect sizes comparing multiple sclerosis with controls ( Q104 = 457.9, P < 0.01) as well as with clinical populations ( Q13 = 108.4, P < 0.01) were heterogeneous. Moderating variables included sex, disability status, measurement method, outcome, intensity, and application of a multiple sclerosis-specific cut-point. CONCLUSIONS Physical activity levels remain significantly lower in persons with multiple sclerosis compared with controls, but the magnitude of difference has become smaller over the past decade. There is a need for continued development of effective physical activity programs that can reach the greater community with multiple sclerosis.
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Affiliation(s)
- Brenda Jeng
- From the Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
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Smith M, Williams G, Jordan M, Willson A, Barker R. The feasibility of a flexible exercise participation programme (FEPP) for individuals with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 28:e1988. [PMID: 36536530 DOI: 10.1002/pri.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with multiple sclerosis (MS) want health advice regarding participation in their choice of exercise. To address this need, a flexible exercise participation programme (FEPP) was developed, underpinned by the MS aerobic exercise guidelines and supported by a physiotherapist using behaviour change techniques. The aim of this study was to investigate the feasibility of the FEPP for individuals with minimal disability from MS. METHODS A feasibility study utilising a single group pre/post-intervention design was conducted. The 12-week FEPP was completed by 10 individuals with MS (EDSS 0-3.5). Exercise progression in duration, intensity or frequency of exercise (in line with MS exercise guidelines) was guided by a self-perceived weekly energy level score, and weekly telephone coaching sessions using behavioural change techniques. Trial feasibility was assessed via measures of process (recruitment and retention), resources/management (communication time; data entry) and scientific feasibility (safety; compliance). Secondary FEPP feasibility outcomes included the Goal Attainment Scale (GAS) T-score, exercise participation (weekly exercise diary), high-level mobility (HiMAT), vitality (Subjective Vitality Scale), biomarkers for inflammation (cytokines levels [IL2, IL4, IL6, IL10, TNF and IFNγ]), and acceptability (participant survey). RESULTS Process: In total, 11 (85%) of 13 eligible participants enroled at baseline with 10 (91%) completing the study. Resources/management: Coaching sessions included a baseline interview-mean 39 min (SD: 6.6) and telephone coaching-mean 10 min (SD: 3.8) per week. Outcome measure data collection time-mean 44 min (SD: 2.1). Scientific feasibility: Two participants experienced a fall during their exercise participation. Self-reported compliance was high (99%). GAS T-scores increased significantly, indicating achievement of exercise participation goals. Secondary outcomes showed trends towards improvement. DISCUSSION The FEPP was feasible, safe and highly acceptable for use with individuals with MS and warrants a larger trial to explore effectiveness.
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gavin Williams
- Discipline of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Margaret Jordan
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Annie Willson
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Littooij E, Doodeman S, Holla J, Ouwerkerk M, Post L, Satink T, Ter Steeg AM, Vloothuis J, Dekker J, de Groot V. Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool. Clin Rehabil 2021; 36:415-428. [PMID: 34730459 PMCID: PMC8850761 DOI: 10.1177/02692155211046463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the experience of clients and clinicians in working with a tool
to help set goals that are personally meaningful to rehabilitation
clients. Design We have applied the tool in the outpatient rehabilitation setting. Clients’
and clinicians’ experiences in working with the tool were evaluated in
individual, semi-structured interviews and focus group interviews,
respectively. Thematic analysis was used to analyze the data. Setting A university medical center and a rehabilitation center. Subjects Clients with a first-time stroke (n = 8) or multiple
sclerosis (n = 10), and clinicians
(n = 38). Intervention The tool to help set meaningful goals consisted of a session (i) to explore
the client's fundamental beliefs, goals and attitudes and (ii) to identify a
meaningful overall rehabilitation goal. The results of that session were
used by the multidisciplinary rehabilitation team (iii) to help the client
to set specific rehabilitation goals that served to achieve the meaningful
overall rehabilitation goal. Results Both clients and clinicians reported that the tool helped to set a meaningful
overall rehabilitation goal and specific goals that became meaningful as
they served to achieve the overall goal. This contributed to clients’
intrinsic rehabilitation motivation. In some clients, the meaningfulness of
the rehabilitation goals facilitated the process of behavior change. Both
clients and clinicians made suggestions on how the tool could be further
improved. Conclusion In the opinion of both clients and clinicians, the tool does indeed result in
goal setting that is personally meaningful. Further development,
implementation and evaluation of the tool is warranted.
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Affiliation(s)
- Elsbeth Littooij
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Suzan Doodeman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
| | - Jasmijn Holla
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Maaike Ouwerkerk
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands.,Nieuw Unicum, the Netherlands
| | - Lenneke Post
- Department of Spiritual Care, Amsterdam University Medical Centers, the Netherlands.,Faculty of Religion and Theology, VU University, the Netherlands
| | - Ton Satink
- Department of Occupational Therapy & Research Group Neurorehabilitation, HAN University of Applied Sciences, the Netherlands
| | | | - Judith Vloothuis
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
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