A questionnaire assessment of unmet needs for rehabilitation services and resources for people with multiple sclerosis: results of a pilot survey in five European countries. Needs Task group of MARCH (Multiple Sclerosis and Rehabilitation, Care and Health Services Research in Europe)

Unmet needs for rehabilitation service of middle-aged and older adult residents in Chengdu, Sichuan, China: A cross-sectional study

To investigate the unmet needs for rehabilitation services among middle-aged and older adults in Chengdu, Sichuan, China, and identify the associated factors. This cross-sectional study was conducted on middle-aged and older adults in Chengdu, Sichuan, China, between 2015 and 2016. The questionnaire included demographic data and questions about rehabilitation needs. Multivariable logistic regression analysis was used to identify the associated factors of unmet needs for rehabilitation services. Among 663 participants, 91.70% needed medical rehabilitation (608/663), 26.55% of who need auxiliary equipment (176/663), 77.07% of who need daily care and social participation (511/663), and 79.34% of who need recreational therapy activities (526/663), while < 30% required auxiliary equipment. Multivariate logistic regression analysis showed that residents who were married, had annual income < CNY 80,000, had no medical insurance, had three or more health problems, were aged ≥ 60, and the disability status were independently associated with unmet needs for rehabilitation services (all P < 0.05). Marital status, annual income, medical insurance, health problems, and disability might be factors independently associated with the unmet needs for rehabilitation services. Attention should be paid to the financial burden of the population on rehabilitation services, and in addition to the disabled, the slow patients should also be given priority.

Psychometric Properties of LUN-MS: A New Questionnaire to Identify the Unmet Needs of People With Multiple Sclerosis

Background

We developed a 29-item Questionnaire, Long-term Unmet Needs in MS (LUN-MS) to identify the unmet needs of people with multiple sclerosis (pwMS).

Objective

To assess acceptability, test-retest reliability, internal consistency, and validity of the LUN-MS.

Methods

Participants completed the LUN-MS and MSIS-29 twice, four weeks apart. Acceptability was assessed by looking at the response rate in each time point. Reliability was calculated by comparing the response during the two time points using Cohen's weighted kappa. Using principal component analysis, the dimensionality of the questionnaire's items was reduced, to five domains and the internal consistency of each domain was assessed using Cronbach's alpha. Concurrent validity was tested by comparing the total LUN-MS score against MSIS-29 and EQ-5D-3L using Pearson's product-moment correlation coefficient.

Results

Among 88 participants, rate of completion at time points-1 and 2 was 96 and 80% respectively. Test-retest reliability for individual items was between fair to near-perfect (weighted Cohen's kappa 0.39-0.81). The unmet needs could be divided into five internally consistent domains (Cronbach's alpha 0.83-0.74): neuropsychological, ambulation, physical, interpersonal relationship and informational. Concurrent validity with MSIS-29 (r = 0.705, P < .001) and EQ-5D-3L (r = 0.617, P < .001) were good.

Conclusion

LUN-MS is a reliable, valid, and acceptable tool to identify the unmet needs of pwMS.

Perceived facilitators, needs, and barriers to health related quality of life in people with multiple sclerosis: a qualitative investigation

Background

Multiple sclerosis (MS) is a chronic progressive neurological disease that influences an individual's physical, mental, emotional, and social functioning, otherwise known as health-related quality of life (HRQOL). To fully capture the impacts of MS on HRQOL, perspectives from the lived experience should be investigated.

Objective

The purpose of this study was to describe, in people with relapsing–remitting multiple sclerosis (RRMS), (1) the health and wellness needs and facilitators perceived to influence HRQOL, (2) determine which health needs are not being met, and (3) identify barriers to meeting health and wellness needs.

Methods

Participants with RRMS were recruited from a more extensive study for this cross-sectional, qualitative investigation guided by phenomenological theory. Semi-structured interviews were conducted until data saturation was reached (n = 15). The data were analyzed using a thematic analysis approach.

Results

Five themes emerged as facilitators of HRQOL; mental/emotional health, knowledge about MS, family/peer support, lifestyle behaviors, and social engagement. Identified barriers to achieving better HRQOL included limited access to specialized care, lack of communication/ empathy from providers, lack of comprehensive care, challenges caused by MS symptoms, and difficulty navigating the healthcare and insurance landscape.

Conclusions

Study participants described mental health and lifestyle behaviors as the primary promoters of overall HRQOL. Access to dietary guidelines, exercise instruction, and education about living healthy with MS were also identified as positive contributors to overall QOL. When these positive contributors are limited or absent, HRQOL was reported to decrease.

Living with a neglected neurological disease: a qualitative study of patients with multiple sclerosis in Malaysia

BACKGROUND

The needs of patients with multiple sclerosis have been well-studied in high-income, high-prevalence countries but few studies have been based in low- and middle-income countries where resources are relatively scarce. As such, little is known about the needs of patients living in these countries.

OBJECTIVE

The study seeks to develop an understanding of the needs of patients with multiple sclerosis living in Malaysia in order to generate insights and contribute to a global database of patients' experience.

METHOD

12 patients with multiple sclerosis participated in this qualitative study and took part in a semi-structured interview. The interviews were transcribed and analysed using an iterative thematic analysis approach.

RESULTS

The experiences, challenges and needs of the patients were reported. Five themes were developed (Daily living, Financial, Emotional and psychological, Healthcare, and Family). These predominantly revolved around the struggles of coping and adapting to the symptoms and disabilities imposed by multiple sclerosis, their heavy reliance on personal finances to cope with the increased costs of living for themselves and their families, as well as the limited healthcare services and treatments available to help them to manage the physical and emotional symptoms of multiple sclerosis.

CONCLUSION

Patients with multiple sclerosis in Malaysia have complex needs that are neglected due perceived lack of importance of the disease and the poor understanding of multiple sclerosis in general. Patients rely heavily on their finances to improve their quality of life. This perpetuates health inequities and reform of the national health financing system is needed to provide patients with the healthcare and support they need.Implications for rehabilitationPatients with multiple sclerosis in Malaysia prioritize being able to cope and adapt to their disabilities in order to continue performing their activities of daily living.There is a need to increase the availability and accessibility of healthcare professionals that are experienced with the management of multiple sclerosis.Healthcare professionals need to improve their understanding of the patients' needs and what they consider to be important in order to provide therapy that is effective and relevant.Patients also require financial support to help them with the increased costs of living associated with MS as well as the costs of healthcare services such as physiotherapy and rehabilitation.

Investigating the care needs of those with endometriosis: Are we listening to the patients?

What do women with endometriosis need? What are the things that would make their lives easier? Where are the gaps in their care? Questions like these can only be answered by women themselves. The development of an unmet needs survey for women with endometriosis would facilitate the design of patient-centred interventions to meet these needs and ultimately improve quality of life.

Factors Associated with Postrelapse Rehabilitation Use in Multiple Sclerosis: A Pilot Survey

Background

Most people with multiple sclerosis (MS) have periodic and unpredictable relapses as part of their disease course. Relapses often affect functional abilities, resulting in diminished productivity and lower quality of life. Considering the effects, rehabilitation can play an important role in facilitating recovery; yet, the current literature suggests a lack of postrelapse rehabilitation services use. This study aims to document postrelapse rehabilitation services use and estimate the extent to which predisposing characteristics, perceived need, and enabling resources were associated with postrelapse rehabilitation services use in adults with MS.

Methods

This cross-sectional study used convenience sampling, and data from 73 adults with MS who recently had a relapse in the United States and Canada were analyzed.

Results

A total of 25 participants (34.2%) reported using postrelapse rehabilitation services. The regression model identified three variables associated with postrelapse rehabilitation services use: age (odds ratio [OR], 1.075), self-reported quality of life (considerably affected by the most recent relapse [OR, 5.717]), and presence of helpful health care providers (for obtaining postrelapse rehabilitation services [OR, 5.382]).

Conclusions

Most participants experienced a range of symptoms or limitations because of their most recent relapse, affecting their daily activity and quality of life. However, only one-third of the participants reported using postrelapse rehabilitation services, which focused on the improvement of their physical health. Regression modeling revealed that three population characteristics of the Andersen Behavioral Model of Health Services Utilization were associated with postrelapse rehabilitation services use.

Are Supportive Services Meeting the Needs of Australians with Neurodegenerative Conditions and Their Families?

Objective

To identify the needs for supportive care/palliative care services of people in Australia with four neurodegenerative disorders—motor neurone disease, multiple sclerosis, Parkinson's disease, Huntington's disease—and the needs of their families; and to determine the extent to which existing supportive and palliative care services models meet these needs.

Design

A mailed self-administered questionnaire to individuals with the four neurodegenerative diseases and their carers, in Western Australia, Victoria, and Queensland, using stratified proportional sampling from membership lists of the disease associations.

Participants

A total of 503 patients and 373 carers responded, representing a response rate of 25.6% and 19.0%, respectively. Exclusion criteria included those who had been recently diagnosed, and those too sick or disabled to participate.

Results

As patient dependency increased and more support was needed, both patients and carers exhibited higher distress symptoms and a poorer quality of life. Those who received more tailored services and more palliative care services were the most satisfied. The results highlighted the need for tailored and flexible models of care for these groups with unique care requirements.

Conclusions

This is the first empirical evidence of the needs and services used by these patient groups in Australia, and will form the basis for future developments of palliative and supportive care services for people with these four neurological conditions.

Access to and Use of Clinical Services and Disease-Modifying Therapies by People with Progressive Multiple Sclerosis in the United Kingdom

Background

According to current UK guidelines, everyone with progressive multiple sclerosis (MS) should have access to an MS specialist, but levels of access and use of clinical services is unknown. We sought to investigate access to MS specialists and use of clinical services and disease-modifying therapies (DMTs) by people with progressive MS in the United Kingdom.

Methods

A UK-wide online survey was conducted via the UK MS Register. The inclusion criteria were age 18 years or older, primary or secondary progressive MS, and a member of the UK MS Register. Participants were asked about access to MS specialists, recent clinical service use, receipt of regular review, and current and previous DMT use. Participant demographic data, quality of life, and disease impact measures were from the UK MS Register.

Results

In total, 1298 individuals responded: 7% were currently taking a DMT, 23% had previously taken a DMT, and 95% reported access to an MS specialist. The most used practitioners were MS doctors/nurses (50%), general practitioners (45%), and physiotherapists (40%). Seventy-four percent of participants received a regular review, although 37% received theirs less often than annually. Current DMT use was associated with better quality of life, but past DMT use was associated with poorer quality of life and higher impact of disease.

Conclusions

Access to and use of MS specialists was high. However, a gap in service provision was highlighted in both receipt and frequency of regular reviews.

Frequency of and Factors Associated with a Proxy for Critical Falls Among People Aging with Multiple Sclerosis: An Exploratory Study

Background

Critical falls, defined in the literature as involving an inability to get up after the fall, have been associated with morbidity and mortality in older adults but have not been examined in people with multiple sclerosis (MS). To highlight the importance of the critical fall concept in MS, this exploratory study sought to identify the frequency of and factors associated with a proxy for critical falls in people with MS.

Methods

Of 354 adults with MS 55 years and older interviewed, 327 reported a story about their most recent fall that included information about fall-related experiences, including whether they received help to get up after a fall. We used this information as a proxy for critical falls in a logistic regression analysis.

Results

A total of 177 individuals (54.1%) received help to get up after their most recent fall. Logistic regression analysis revealed six factors associated with this proxy for critical falls: fall leading to a fracture (OR = 4.21), leg weakness (OR = 3.12), living with others (OR = 2.48), female sex (OR = 1.96), balance or mobility problems (OR = 1.90), and longer disease duration (OR = 1.04).

Conclusions

Receiving help after a fall is common for people aging with MS, suggesting that critical falls need to be further studied. Findings support the need for fall management education that includes action planning for proper assistance and balance and strength training to increase the ability to get up safely after a fall.

The most important psychological and psychosocial needs of Polish multiple sclerosis patients and their significant others

BACKGROUND

People with multiple sclerosis (MS) and their relatives often have multiple, complex needs which require support from a wide range of services. The aim of the study, the first of its kind in Poland, was to identify the most important needs of patients with MS and their significant others (SO).

METHODS

A questionnaire developed from focus groups consisting of 20 needs-related statements was administered in seven MS centers to 573 MS patients and 220 SO. The mean age of the patients was 42.61 years old; the mean MS duration was 9.43 years. The respondents were asked to rate the needs statements according to their importance on an 11-point scale. The questionnaire was similar for the MS patients and their SO.

RESULTS

The most important needs in the patient group were: to feel needed and efficient in life; to have easy access to professional rehabilitation; and to be sure that doctors are interested in my condition. The three most important needs in the SO group were: to know that relatives/friends feel needed and efficient in life; to have good living conditions; and to be sure that doctors are interested in my relative's/friend's condition. Correlation analysis revealed that in the patients group, there was a positive correlation between patient's age and the importance of factors such as the need for support and interest in their disease from the family doctor (P<0.004), receiving educational materials from an MS clinic (P<0.011), interest from the clinic in life issues of the patient (P<0.001), and the need for access to self-rehabilitation (P<0.003); while the need to continue working part-time was inversely correlated with age (P<0.009).

CONCLUSION

The needs of the MS patients and SO were similar. The data validate the importance of interdisciplinary care for the MS population.

Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis

BACKGROUND

Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. However, gender differences in psychosocial adjustment among caregivers have not been fully explored.

OBJECTIVE

The purpose of this study was to explore gender differences in the need for various supports and type of social support needed, caregiver strain, and quality of life among caregivers for individuals with MS.

METHODS

106 caregivers participated in this study. Independent sample t-tests and multiple regression analyses were conducted to examine gender differences in strain, need for supports, social support, and quality of life.

RESULTS

Analyses revealed gender difference among important psychosocial variables. Specifically, women reported higher levels of caregiver strain, higher needs for emotional support, and higher perceived social support. Additionally, multiple regression analyses revealed an inverse relationship between expressed emotional needs and quality of life for men, but not for women.

CONCLUSIONS

MS caregivers experience significant strain that diminishes quality of life. Social support and needs fulfillment can act to buffer this stress; however, results indicate that this varies by gender, with gender differences observed in strain, perceived support, and expressed needs among MS caregivers. The study implications for rehabilitation research are discussed.

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.

Using Religious Services to Improve Health

Purpose: The purpose of this study is to examine the use of religious services to improve health among middle-aged and older adults with multiple sclerosis (MS). Method: Data from the study “Aging With MS: Unmet Needs in the Great Lakes Region” were used to investigate religious service use among 1,275 adults with MS. Results: The findings indicate that nearly two thirds of the sample currently use religious services to improve their health or well-being. Individuals whose MS is stable and those who have had the disease longer are significantly more likely to use religious services to improve their health. Conclusions: Religious organizations should continue providing out-reach and increasing accessibility for individuals with disabling conditions. In addition, health care professionals should be aware of the importance of religious services to individuals with MS and do their part to facilitate participation for those who desire it.

Delayed initial recovery and long lie after a fall among middle-aged and older people with multiple sclerosis

OBJECTIVES

To determine (1) the prevalence of lying on the floor or ground for ≥10 minutes (delayed initial recovery [IR]) and for >1 hour (long lie) after a fall; and (2) the factors associated with delayed IR among people with multiple sclerosis (PwMS).

DESIGN

A secondary analysis of data available from a national, cross-sectional descriptive study of PwMS. Information regarding postfall experiences was extracted from open-ended questions about participants' most recent fall.

SETTING

Community.

PARTICIPANTS

PwMS (N=700) aged ≥55 years were recruited from the North America Committee on Multiple Sclerosis Registry; 354 of them completed the interview, and 322 provided a fall story that included information regarding postfall experiences.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants' self-reports regarding time lying on the floor or ground after their most recent fall were used to determine delayed IR and long lie.

RESULTS

A total of 89 (27.6%) of 322 fallers reported delayed IR; 15 (4.7%) of them reported a long lie. Logistic regression analysis revealed 5 factors associated with delayed IR: longer disease duration (odds ratio [OR]=1.03; 95% confidence interval [CI], 1.00-1.05), fall leading to a fracture (OR=2.73; 95% CI, 1.11-6.72), received help to get up (OR=3.94; 95% CI, 2.07-7.50), depression (OR=1.96; 95% CI, 1.10-3.49), and leg weakness (OR=2.14; 95% CI, 1.13-4.03). No significant differences were found between fallers who reported a long lie and those who reported a delayed IR.

CONCLUSIONS

The findings suggest that while delayed IR is common, long lies are not prevalent among PwMS. The high prevalence of delayed IR highlights the importance of including fall management strategies in fall prevention programs for PwMS.

Satisfaction with service needs among people living with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and can cause difficulties in a number of areas of a person's life, including their ability to function in the community. Employment, finances, and transport are important elements to ensure continued functioning in the community and ongoing rehabilitation.

OBJECTIVE

This study examined satisfaction with the extent to which the above needs were addressed by service providers.

METHODS

It examined the role of gender, age, and symptom severity. A total of 2721 people with MS aged 19 and 92 years (M = 52.10, SD = 11.80) completed the study.

RESULTS

Areas of need included information about eligibility for services from government and local councils, for financial assistance and understanding welfare and benefits.

CONCLUSIONS

The results indicated that younger and mildly affected participants were least satisfied. Other areas of unmet need included transportation for the people more severely affected by MS and financial assistance to help people purchase mobility aids.

Unmet care needs of people with a neurological chronic disease: a cross-sectional study in Italy on Multiple Sclerosis

Background: Community-based studies are required to accurately describe the supportive services needed by people with multiple sclerosis (MS). Methods: A total of 1205 people with MS participated in a cross-sectional study evaluating their unmet health and social care needs through a questionnaire collecting information used in the study. It was specifically developed by a multi-disciplinary team. Results: Overall, 79% of the responders declared at least one health or social care needs. The most prevalent health care need was the psychological support (27.5%), whereas the transport was the social care need more frequent (over 41%) in our sample. The multivariate analysis highlighted that unmet health care needs depended mainly on clinical factors such as disease stage, influenced by disease duration, and disability degree, whereas the social care needs were related to both clinical and socio-demographic factors. Conclusion: These findings suggest that MS needs significantly change over time during the disease development and to find the best way to personalize PwMS management is crucial. Moreover, more public funding directed at improving the health-related quality of life of people with MS is needed. For this reason, we think that these results will provide important information and baseline data on how to build the national service strategies thereby making healthcare planning more efficient.

Unmet education, psychological and peer support needs of people with multiple sclerosis

OBJECTIVE

Multiple sclerosis is a complex neurological disease which can cause impairment in a range of aspects of an individual's life. It often requires a degree of adjustment and peer support. The aim of the present study was to examine satisfaction with educational, psychological and peer support services of people with MS across gender, age and symptom severity.

METHOD

Participants completed a needs analysis questionnaire using Likert scales to determine the level of satisfaction with the support services. The questionnaire was sent to participants (n=3502) throughout Australia as paper copy with reply paid envelope, or made available to them online via email links. A total of 2805 responded and completed the questionnaire (80% response rate). Of those, 79% were female and 21% were male. The participants ranged in age from 19 to 92 years, (M=52.10; SD=11.82).

RESULTS

In terms of psychological services, females were less satisfied with their access to relationship and family counseling. There was also a clear need for more varieties in peer support groups, times, as well as modes of communication, especially among young people and mildly affected groups. Symptom severity was associated with a greater need for almost all education and psychological support services.

CONCLUSION

The findings of this study highlight current areas of unmet needs and may be used to inform the design and development of future education, psychological and social support services to ensure they are relevant and useful, as well as providing direction for future research.

Unmet needs of patients feeling severely affected by multiple sclerosis in Germany: a qualitative study

BACKGROUND

The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general.

OBJECTIVE

The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS.

METHODS

The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis.

RESULTS

Unmet needs were identified in the main categories "support of family and friends," "health care services," "managing everyday life," and "maintaining biographical continuity." Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated.

CONCLUSIONS

To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support.

What do multiple sclerosis patients and their caregivers perceive as unmet needs?

Background

Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients.

Methods

We evaluated what MS patients and caregivers perceive as unmet needs and compared patients’ opinions with caregivers’ opinions using a multidimensional questionnaire. The questionnaire was specifically designed for the study, taking into account different aspects of the global care perceived by patients and care givers, such as information about MS, medical treatment and rehabilitation, patients’ relationships with medical staff and their psychological and social life.

Results

We administered the questionnaire to 497 patients and 206 caregivers. Results showed that the majority of participants were satisfied with medical staff but expressed a desire that staff be more forthcoming with information about MS. As for medical treatment concerns, more patients found there to be useful a multidisciplinary approach than caregivers did. Both required psychological support for patients but patients felt a greater need for it at the time of diagnosis, whereas caregivers felt it was required post-diagnosis. Both reported significant strains on patient relationships at work but no effect on other social interactions.

Conclusions

A better understanding of MS patient needs, starting from the point of view of patients and caregivers, could have a great impact on quality of life and on management of the disease.

Multiple perspectives on the health service need, use, and variability among older adults with multiple sclerosis

SUMMARY The purpose of this paper is to present the findings from the first phase of a large study that is examining the unmet health-related service needs of people aging with MS. Fifty-one volunteers participated in seven focus groups-five with individuals with MS and their family members, and two with health care professionals. Content analysis indicated health promotion (both physical and social), community accessibility, and support to remain at home as the most commonly identified health-related service needs. Differences were observed between the groups of individuals with MS/family members and health professionals. Findings point to the importance of using a client-centered approach when working with persons with multiple sclerosis and their family members.

Feeling severely affected by multiple sclerosis: what does this mean?

BACKGROUND

The situation for people feeling severely affected by Multiple Sclerosis (MS) remains largely unexamined and the term 'severe MS' is not clearly defined.

AIM

Our study describes this sub-group of patients utilizing exclusively a subjective inclusion criterion to analyse their reasons for feeling severely affected and document their perceived unmet needs.

DESIGN

A questionnaire with open- and closed-ended items addressing only patients feeling severely affected was sent out nationwide. Expanded Disability Status Score (EDSS) and subjectively severe affectedness were analysed for correlation. After dichotomizing both scores by a median split, the answers were allocated to these groups and tested for significant differences.

SETTING/PARTICIPANTS

1,110 questionnaires were analysed regarding the closed-ended questions while a subsample of 40% (n = 445) was analysed regarding the open-ended questions. Average age of participants was 51.87 years. Average time since diagnosis was 16.6 years. Main course of the disease was secondary progressive (35.5%).

RESULTS

The most frequently mentioned reasons for feeling severely affected were lack of mobility (56.4%) and fatigue (27.4%). Significant percentages for unmet needs were seen in the categories of funding services (31.0%), better social integration (24.7%) and medical support (25.2%). A significant correlation was observed between EDSS and subjectively felt affectedness (p ≤ 0.01). Motor disorders explained differences in patient needs behind a higher EDSS score; higher severe affectedness referred to other issues like dependency and immobility.

CONCLUSIONS

EDSS is insufficient for usage as the sole instrument for measuring severe affectedness as it does not take into account other potential reasons. Complex patient needs necessitate multi-professional care as offered by palliative medicine.

A profile of support group use and need among middle-aged and older adults with multiple sclerosis

This study compared middle-aged and older adults with multiple sclerosis (MS, N = 1,275) according to their use of support groups and identified factors associated with perceived need. Over 64.6% (n = 824) of participants had attended a MS support group meeting at least once. Individuals who had never attended a group were more likely to reside in urban or suburban communities, report lower symptom interference, and fewer activity limitations. Women, individuals without a helper, and people with greater symptom interference were more likely to perceive a need for a support group. Findings raise questions for professionals involved in developing and implementing multiple sclerosis support groups.

Information needs of family caregivers of persons with cognitive versus physical deficits

This study compared information needs of caregivers of persons with dementia with caregivers of those who received rehabilitation treatment. Caregivers were provided a 48-item survey and asked to choose their top ten information needs. Dementia caregivers' (n = 33) top needs were dealing with forgetfulness/confusion (91%) and repeating questions/actions (61%) in care recipients. Rehabilitation caregivers' (n = 40) top needs were handling care recipients' mobility problems (75%) and dealing with their own stress (65%). Dementia caregivers focused on care recipients' needs related to behavioral symptoms, whereas rehabilitation caregivers focused on needs related to physical care of care recipients and their own needs.

Use of physical therapy services among middle-aged and older adults with multiple sclerosis

BACKGROUND

There is limited understanding of the utilization of and perceived need for physical therapy services among middle-aged and older adults with multiple sclerosis (MS). The resulting knowledge gap compromises efforts for physical therapy service planning for this population.

OBJECTIVE

The purpose of this study was to examine the use of and need for physical therapy services in a sample of adults with MS living in the Midwestern United States.

DESIGN

This was a cross-sectional, descriptive study.

METHODS

Data from telephone interviews with 1,065 people with MS, aged 45 to 90 years, were used for the study. A multinomial regression model was used to determine factors associated with use of physical therapy services (never, within the past year, more than a year ago). Logistic regression analysis examined factors associated with unmet needs for these services.

RESULTS

Thirty-six percent of the sample reported never using physical therapy services, 33% reported using physical therapy services within the past year, and 31% reported using physical therapy services more than a year prior to the interview. Factors associated with recent use of physical therapy services included living in an urban or suburban community, deteriorating MS status, experiencing problems with spasticity (ie, hypertonicity), having difficulty moving inside the house, being hospitalized in the past 6 months, and seeing a family physician. These same factors were associated with unmet needs. Limitations Physical therapy service use was self-reported. Data were collected in 5 Midwestern states from people 45 years of age or older, which may limit generalizability.

CONCLUSIONS

Factors associated with use of and need for physical therapy services reflect issues of access (geographical, referrals), MS status, and mobility difficulties.

Multiple sclerosis: patients' information sources and needs on disease symptoms and management

OBJECTIVE

To investigate the current information sources of patients with multiple sclerosis (MS) in the early stages of their disease and to identify patients' preferred source of information. The relative amounts of information from the different sources were also compared.

METHODS

Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources.

RESULTS

A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources.

CONCLUSION

This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future.

PRACTICE IMPLICATIONS

More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.

Integrated care for MS patients

PURPOSE

The problem of complex healthcare to MS patients, together with the rising prevalence of MS and escalating costs, has caused healthcare policy makers to consider innovative approaches to controlling costs and improving the quality of care. An integrated care approach may provide a means for better coordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for MS patients.

METHOD

A literature search was conducted to trace relevant literature on integrated care for MS patients published between 1995 and 2003.

RESULTS

Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in healthcare for MS patients, there are few published studies which have evaluated its implementation with MS patients.

CONCLUSIONS

Even though the potential advantages of integrated care are well known, the applicability of this approach for MS patients has still to be demonstrated.

A health profile of adults with multiple sclerosis living in the community

Objective

To describe the frequency of impairments, disabilities, and related services used in a community sample of adults with multiple sclerosis (MS) to estimate the service needs of this population.

Methods

A community-based postal survey conducted using a self-completion questionnaire consisting of MSQOL-54 questionnaire, Nottingham Extended Activities of Daily Living (NEADL) and some demographic items as well as items to ask about MS-related symptoms and/or problems and using available services. Adults with a diagnosis of MS confirmed by a neurologist were recruited via primary care services in Southern Derbyshire, UK.

Results

Questionnaires were sent to 310 adults with MS and 201 completed questionnaires were returned – a response rate of 65%. The most commonly reported symptoms and/or problems were fatigue, sexual problems, urinary problems, and painful muscle spasms. Most respondents reported at least one contact with their general practitioner (GP) during the previous 12 months. However, contacts with other services potentially able to alleviate specific symptoms and/or problems were low.

Conclusions

The findings suggest under-use of existing health care services by those who experience potentially treatable symptoms and/or problems associated with MS. More needs to be done to raise awareness among people with MS and their carers about the services available to them. Given the very high proportion of people with MS known to make contact with primary care services, GPs have a vital role in providing this information.

Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45-90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45-90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating.

What people with multiple sclerosis perceive to be important to meeting their needs

AIM

This paper is a report of the findings of a survey in which people with multiple sclerosis identified what they believed would be helpful in meeting their current needs.

BACKGROUND

People with multiple sclerosis have low levels of satisfaction with the health and social care that they receive, but previous studies suggest that they have a broad range of physical, psychological and social needs.

METHOD

A total of 714 people with different levels of disease impact who were participating in a prospective study evaluating multiple sclerosis specialist nurses were asked, 'What one thing would be most helpful in meeting your current needs?' The question was included in the postal questionnaire used for the study (mailed in 2001 and 2002). The overall response rate for usable returns (at both time points) was 42%. Descriptive statistics on the frequency of codes and categories generated by content analysis were compiled and compared in relation to demographic and disease characteristics.

FINDINGS

A total of 445 people responded to the question. Seven categories were identified: medical treatment (29%, n = 126); socio-environmental support and adaptation (19%, n = 81); enhanced care provision (18%, n = 79); information provision (9%, n = 38); rehabilitation therapies (7%, n = 29); non-professional care (6%, n = 28); and psychological support (3%, n = 15). Nine per cent of responses (n = 39) were not coded as their meanings were unclear. Socio-environmental support, rehabilitation and non-professional care were more frequently identified by those with greater disease impact. Information was identified as a stronger need for those in lower disease impact groups.

CONCLUSION

The findings could provide the basis for developing a multiple sclerosis-specific service satisfaction tool. This could be helpful in assessing the quality of provision, given current variations in the coverage and quality of care provided. Nurses could use such a tool to assess the quality of care in a given population, thereby highlighting gaps in service provision.

Risk factors for falling among people aged 45 to 90 years with multiple sclerosis

OBJECTIVE

To determine the factors associated with an increased likelihood of reporting a fall in the past 6 months among people between the ages of 45 and 90 who have multiple sclerosis (MS).

DESIGN

Cross-sectional descriptive design by using telephone surveys.

SETTING

States of Minnesota, Wisconsin, Illinois, Indiana, and Michigan.

PARTICIPANTS

Total of 1089 people with MS identified through the National Multiple Sclerosis Society and the MS registry maintained by the North American Research Committee on Multiple Sclerosis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Self-reported fall to the ground in the past 6 months.

RESULTS

Exactly 52.2% of participants reported a fall in the past 6 months. Factors associated with an increased risk of a fall included being male, fear of falling, variable or deteriorating MS status in the past year, never or occasional use of a wheelchair, problems with balance or mobility, poor concentration or forgetfulness, and incontinence of bladder.

CONCLUSIONS

There are a number of factors associated with an increased risk of falling among people aging with MS that are amenable to intervention and therefore warrant the attention of health care providers serving that population.

Palliative care and support for people with neurodegenerative conditions and their carers

AIM

to identify and compare the needs for supportive care/palliative care services of people in Australia with Motor Neurone Disease (MND), Multiple Sclerosis (MS), Huntington's Disease (HD) and Parkinson's Disease (PD) and the needs of their carers.

DESIGN

national, descriptive survey of service use and support needs for 503 patients and 373 carers. Patients and carers were recruited from the databases of the disease associations in three Australian states. Patients were excluded if recently diagnosed or too sick or disabled to complete the survey. This was a specification of the ethics committee overseeing this project.

FINDINGS

the MND and HD groups had the greatest needs for support and appeared most receptive to a palliative approach. The MS group was least likely to have a carer and more likely to live alone. HD and PD groups had the highest rates of anxiety and HD groups had the highest rate of depression.

CONCLUSIONS

patients and carers who received more tailored services and more palliative care services were the most satisfied. Therefore, results highlight the need for tailored and flexible models of care for these groups with unique care requirements.

Supportive and palliative care needs identified by multiple sclerosis patients and their families

AIM

To identify the supportive needs of individuals with multiple sclerosis (MS) and their families. DESIGN, SAMPLE AND METHOD: In-depth interviews were carried out with people living with MS in the community, their family members and health professionals. The data were transcribed verbatim and recurring themes identified.

FINDINGS

The analysis of interviews revealed four themes: disbelief and devastation; losses and forced life choices; tracking down services and information; and sadness and relief.

CONCLUSION

Given the duration, range of symptoms and distress often associated with MS, the findings of this research raise the important question of the role of palliative services in supporting the person with MS and his/her family.

Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing

Health-related quality of life (HRQoL) has been more intensively studied in multiple sclerosis (MS) than in any other neurological disorder. Traditional medical models of impairment and disability are an incomplete summary of disease burden. Quality of life can be thought of as the sum of all sources of satisfaction (including anticipated sources) minus all threats (including anticipated threats). Many psychosocial factors-including coping, mood, self-efficacy, and perceived support-influence the quality of life of patients with MS more than biological variables such as weakness or extent of MRI lesions. Neuropsychiatric complications such as cognitive impairment and fatigue are also important predictors, even in those patients in the early stages of the disease. We review generic and specific HRQoL measures to help clinicians choose the most appropriate therapies. Subjective (self-report) HRQoL measures may serve to alert clinicians to areas that would otherwise be overlooked. Studies of new interventions should include an assessment of HRQoL not just impairment or disability alone.

Health needs assessment tools: Progress and potential

Objectives:Health needs has attracted the interest of policy-makers, health economists, and health professionals as modern health services try to satisfy individual and population health needs to optimize resource utilization. Health needs can be assessed by administering various types of survey or interview-based instruments. If health needs are to be satisfied in changing health agendas in developed and developing countries, it is essential to employ valid and reliable tools. Despite the importance of needs assessment, no comprehensive review of tools is currently available. We carried out a literature search to define and categorize existing health needs assessment tools.

Methods:We reviewed medical and social search engines for items containing specific health needs–related words to identify needs tools across a range of specialties. Papers were reviewed in terms of design, subject matter, psychometric features, and method of administration method.

Results:Thirty-one employed in 52 studies including cancer, mental health, palliative care, multiple sclerosis, and cardiovascular disease tools were identified.

Conclusions:This report summarizes available health needs instruments in a range of diseases to assist researchers in accessing health needs resources more easily and to encourage further research in this field.

Quality of life measures for the palliative care of people severely affected by multiple sclerosis: a systematic review

Although there is increasing interest in measuring the quality of life (QoL) of people with multiple sclerosis (MS), relatively little is known about the issues of importance to people severely affected by MS. In the first of two systematic reviews, we searched the literature to identify measures that have been used to assess health-related QoL in people with MS, and described their measurement properties in terms of validity, reliability, responsiveness to change, and appropriateness for QoL assessment in people severely affected by MS. In the second review, we identified care domains important to people with MS, by reviewing survey, focus group and interview studies involving people with MS and/or their caregivers. Forty-six studies evaluating 12 disease-specific and ten generic QoL measures for patients, and one disease-specific measure for caregivers, satisfied all inclusion criteria. Sixteen focus group or interview studies and 51 questionnaire-based studies evaluated domains of care important to people with MS, and seven qualitative and 11 questionnaire-based studies assessed domains of care important to their caregivers. From these studies, we identified 15 domains of care important to people with MS and 12 domains important to caregivers. QoL measures differed markedly in their coverage of these care domains. Moreover, each measure fulfilled some but not all criteria of validity, reliability, responsiveness, and appropriateness. Further work is needed to clarify the domains of care relevant to people with severe MS, and to measure health-related QoL in this population.

Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics

OBJECTIVE

To investigate the impact of upper extremity deficit in subjects with tetraplegia.

SETTING

The United Kingdom and The Netherlands.

STUDY DESIGN

Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations. MAIN OUTCOME PARAMETER: Indication of expected improvement in quality of life (QOL) on a 5-point scale in relation to improvement in hand function and seven other SCI-related impairments.

RESULTS

In all, 565 subjects with tetraplegia returned the questionnaire (overall response of 42%). Results in the Dutch and the UK group were comparable. A total of 77% of the tetraplegics expected an important or very important improvement in QOL if their hand function improved. This is comparable to their expectations with regard to improvement in bladder and bowel function. All other items were scored lower.

CONCLUSION

This is the first study in which the impact of upper extremity impairment has been assessed in a large sample of tetraplegic subjects and compared to other SCI-related impairments that have a major impact on the life of subjects with SCI. The present study indicates a high impact as well as a high priority for improvement in hand function in tetraplegics.

Clinic-based needs assessment of individuals with multiple sclerosis and significant others: implications for program planning--psychological needs

The purpose of this study was to identify the psychological/psychosocial needs of patients with multiple sclerosis (MS) and their significant others (SOs) who attended an MS clinic. A quantitative questionnaire, developed from focus groups, consisted of 23 needs statements in the psychological/psychosocial needs category. Participants were randomly selected from the clinic's database. The questionnaire was completed by 353 MS patients and 240 significant others. Content analysis of the psychological category produced four themes: general psychological needs, psychological needs related to specific resource needs, psychological needs related to interaction with the medical community, and psychological needs statements displaying a difference between MS and SO responses. The data indicate the importance of psychological intervention in the care of MS patients and its implications for program planning.

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.

Evaluation of the effectiveness of professionally guided self-care for people with multiple sclerosis living in the community: a randomized controlled trial

OBJECTIVE

The aim of the study was to assess the efficacy of a patient-focused professionally guided self-care programme for the management of multiple sclerosis (MS) in the community.

DESIGN

This was a single-blind randomized controlled trial.

SETTING

The study was conducted with people with MS living in the community.

PARTICIPANTS

Two hundred and seventy-eight people with MS were invited to take part in the study. One hundred and eighty-nine people consented to take part (68%). Of these 183 began the study and 169 (92.3%) completed it. Seventy-three individuals were in the intervention group and 96 were in the control group.

INTERVENTION

The intervention comprised discussion of self-care based on client priorities, using an information booklet about self-care.

MAIN OUTCOME MEASURES

These included the Barthel Index, a measure of mobility, the SF-36, and the Standard Day Dependency Record (SDDR) which measures the need for assistance with daily activities. Assessments were conducted at baseline and again six months later.

RESULTS

Changes in health status were small. However, at follow-up the intervention group had better SF-36 health scores, in mental health (p = 0.04), and vitality (p = 0.05) and considered help with daily activities to be less essential, as measured by the SDDR (p = 0.04), than the control group. Participants in the intervention group had maintained levels of independence at follow-up (p = 0.62) while the control group showed a significant decrease in independence (p= 0.001).

CONCLUSION

This intervention could be a useful aid for health professionals who are supporting people with MS living in the community.

The Southampton Needs Assessment Questionnaire (SNAQ): a valid tool for assessing the rehabilitation needs of disabled people

OBJECTIVE

To validate the Southampton Needs Assessment Questionnaire (SNAQ) for use with disabled people during face-to-face interviews.

DESIGN

The SNAQ was designed to be used in a cross-sectional survey of disabled people with a physical disability with a follow-up study one year later. Content and criterion validity was examined using 32 disabled people who took part in the pilot study. Construct validity and internal reliability was examined using data from 93 disabled people who took part in the main survey. Responsiveness of the questionnaire was evaluated using the data gathered during a follow-up study of 77 people had taken part in the original study.

OUTCOME MEASURES

The OPCS Disability Severity Scales (OPCS) and the Functional Independence Measure (FIM) were used to measure level of disability of participants, the Nottingham Health Profile (NHP) and the UK version of the SF-36 to examine perceived health status.

PARTICIPANTS

People with a primary physical disability, aged 16-65, randomly selected from two disability registers in southern England.

MAIN RESULTS

Content and criterion validity were established. Construct validity and internal reliability of the SNAQ was good. Inter-rater reliability was not tested since only one researcher conducted the interviews. Test-retest reliability was not formally tested because of the probability that participants would learn from the first needs assessment questionnaire and that different results on a retest occasion could arise from this. The SNAQ was sensitive in picking up changes over time.

CONCLUSION

The SNAQ has shown good validity (content, coverage and construct), internal reliability, sensitivity and responsiveness. Further studies are needed to define the consequences of meeting or not meeting the rehabilitation needs of disabled people. Inter-rater reliability remains to be established.