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Wenzel L, Haker M, Heesen C, Kasper J, Köpke S, Rahn AC. Evaluating Relapse Knowledge in People with Multiple Sclerosis: A Cross-Sectional Study on the Development and Validation of the Relapse Knowledge Questionnaire. Mult Scler Relat Disord 2024; 83:105381. [PMID: 38308915 DOI: 10.1016/j.msard.2023.105381] [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: 02/21/2023] [Revised: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) knowledge is a prerequisite for active patient engagement in medical decision-making. Treatment of relapses in MS is a clinical field with many uncertainties and each acute relapse requires decisions regarding possible options for action, indicating the need for patient involvement. However, there is no validated instrument assessing relapse knowledge in people with MS. Our study aims to develop a valid MS relapse questionnaire for use as an outcome instrument for educational interventions. METHODS A multidisciplinary panel developed the relapse knowledge questionnaire (RKQ) based on a previously developed questionnaire. We tested the RKQ on MS patients for comprehensibility, usability and acceptance in qualitative think-aloud interviews and conducted a cross-sectional quantitative online survey to validate the questionnaire. People with suspected or confirmed relapsing-remitting MS and a recent relapse experience were eligible for inclusion. We checked normal distribution of the RKQ score and determined the item difficulty. Construct validity was analysed using correlational analysis. RESULTS The final RKQ consists of 10 items. After minor changes of the RKQ during pre-testing (n = 2), pilot testing (n = 10) confirmed the usability and acceptance of the instrument. The subsequent validation study (n = 203) resulted in a mean item difficulty of 0.44, ranging from 0.18 to 0.83. Seven items were particularly difficult and answered incorrectly by more than 50 % of participants. Construct validity of the RKQ was satisfactory. The RKQ score correlated only weakly with participants' degree of education (|rp|>0.1), years since diagnosis (|rp|>0.1), and the intention to receive corticosteroids (|rp|>0.1). CONCLUSION This study indicates the validity of the RKQ and proposes that the RKQ is a suitable instrument to assess relapse knowledge in people with MS participating in educational interventions.
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Affiliation(s)
- Lisa Wenzel
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michel Haker
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), 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
| | - Jürgen Kasper
- Institute of Nursing Sciences and Health Promotion, Faculty of Health Sciences, OsloMet, Metropolitan University, Oslo, Norway
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
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Liu Z, Wei W, Zhang J, Yang X, Feng Z, Zhang B, Hou X. Single-cell transcriptional profiling reveals aberrant gene expression patterns and cell states in autoimmune diseases. Mol Immunol 2024; 165:68-81. [PMID: 38159454 DOI: 10.1016/j.molimm.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Multiple sclerosis(MS), primary Sjögren syndrome (pSS), and systemic lupus erythematosus (SLE) share numerous clinical symptoms and serological characteristics. We analyzed 153550 cells of scRNA-seq data of 17 treatment-naive patients (5 MS, 5 pSS, and 7 SLE) and 10 healthy controls, and we examined the enrichment of biological processes, differentially expressed genes (DEGs), immune cell types, and their subpopulations, and cell-cell communication in peripheral blood mononuclear cells (PBMCs). The percentage of B cells, megakaryocytes, monocytes, and proliferating T cells presented significant changes in autoimmune diseases. The enrichment of cell types based on gene expression revealed an elevated monocyte. MIF, MK, and GALECTIN signaling networks were obvious differences in autoimmune diseases. Taken together, our analysis provides a comprehensive map of the cell types and states of ADs patients at the single-cell level to understand better the pathogenesis and treatment of these ADs.
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Affiliation(s)
- Zhenyu Liu
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Wujun Wei
- Center for Clinical Laboratory Diagnosis and Research, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi Province, China
| | - Junning Zhang
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Xueli Yang
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Zhihui Feng
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Biao Zhang
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Xianliang Hou
- Laboratory Central, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China.
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Ben-Zacharia AB, Blessing O, Eckardt PA. Psychometrics of the Multiple Sclerosis and Magnetic Resonance Imaging Knowledge Patient Questionnaire: A Pilot Study. J Neurosci Nurs 2022; 54:171-176. [PMID: 35687725 DOI: 10.1097/jnn.0000000000000658] [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: 02/03/2023]
Abstract
ABSTRACT BACKGROUND: In the last few decades, the revised diagnostic criteria for multiple sclerosis (MS) and the development of numerous new MS therapies have created the possibility of early diagnosis and opportune MS management. However, these changes, and the mounting emphasis on patient choice and shared decision making, have not been accompanied by improvements in information provided to patients with MS (PwMS). Information provision for PwMS increases disease-related knowledge that may assist them in decision making and quality of life. The purpose of this study was to validate the Multiple Sclerosis and Magnetic Resonance Imaging Knowledge Questionnaire (MSMRIKQ) to improve patients' shared decision-making capabilities. METHODS: In this methodological study, the instrument development process was completed in 4 stages using principles of measurement theory: (1) establishing a pool of items after patient and clinician panels' review, (2) evaluating the validity of the scale-both face and content validity, (3) pilot testing the scale, and (4) post-pilot testing statistical analysis of items and scale reliability and validity. RESULTS: The 20-item instrument was finalized based on a panel of MS experts' and patients' comments. The final version of the MSMRIKQ was pilot tested with a sample of 46 PwMS. Face validity was established on all MSMRIKQ items. Individual item-level and scale-level content validity indices for universal agreement estimates were acceptable at item-level content validity index = 1 and scale-level content validity index = 1 for the 20 items. The Kuder-Richardson 20 reliability estimate for the entire scale was 0.58; the Kuder-Richardson 20 estimates for the subscales of MS and magnetic resonance imaging knowledge were 0.35 and 0.51, respectively. The split-half reliability with Spearman-Brown correction for the total scale was 0.60. The Poisson regression model was significant for predicting MS knowledge within this population. CONCLUSION: The MSMRIKQ is a basic knowledge instrument for clinical and research use.
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Multiple sclerosis disease-related knowledge measurement instruments show mixed performance: a systematic review. J Clin Epidemiol 2022; 149:60-82. [DOI: 10.1016/j.jclinepi.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
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Bessing B, Honan CA, van der Mei I, Taylor BV, Claflin SB. Development and psychometric properties of the Multiple Sclerosis Knowledge Assessment Scale: Rasch analysis of a novel tool for evaluating MS knowledge. Mult Scler 2021; 27:767-777. [PMID: 33739199 DOI: 10.1177/1352458520929626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS)-related knowledge is an important evaluation metric for health education interventions. However, few MS knowledge assessment tools are currently available for use. OBJECTIVES This study aims to develop a reliable and valid Multiple Sclerosis Knowledge Assessment Scale (MSKAS) for use in the MS community and the general public. METHODS The MSKAS was developed using a Delphi study methodology and was administered to participants in the first open enrolment of the Understanding Multiple Sclerosis (UMS) online course. Rasch analysis was used to examine its psychometric properties and develop the final scale. RESULTS Experts from across the MS community participated in the development of the MSKAS, resulting in an initial scale of 42 items. Five hundred and forty-three UMS participants completed the MSKAS; 89% were female and 30% were people with MS. The final unidimensional 22-item scale has a person separation index of 2.16, a person reliability index of 0.82, an item separation index of 11.19, and a Cronbach's alpha (kr-20) test reliability of 0.87. CONCLUSION The MSKAS is a unidimensional scale with good construct validity and internal consistency. The MSKAS has the potential to be useful for the assessment of MS knowledge in research and clinical practice.
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Affiliation(s)
- Barnabas Bessing
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Cynthia A Honan
- Division of Psychology, School of Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Rahn AC, Solari A, Beckerman H, Nicholas R, Wilkie D, Heesen C, Giordano A. "I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis. Int J MS Care 2021; 22:285-293. [PMID: 33424485 DOI: 10.7224/1537-2073.2020-027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice. Methods We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form. Results From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge. Conclusions The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.
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Barabasch A, Riemann-Lorenz K, Kofahl C, Scheiderbauer J, Eklund D, Kleiter I, Kasper J, Köpke S, Lezius S, Zapf A, Rahn AC, Heesen C. Impact of a multimedia website with patient experiences of multiple sclerosis (PExMS) on immunotherapy decision-making: study protocol for a pilot randomised controlled trial in a mixed-methods design. Pilot Feasibility Stud 2021; 7:16. [PMID: 33413658 PMCID: PMC7788927 DOI: 10.1186/s40814-020-00749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background A variety of management options (e.g. immunotherapies, lifestyle interventions, and rehabilitation) are available for people with relapsing-remitting multiple sclerosis (RRMS). Besides coping with the diagnosis, people with MS (pwMS) have to make complex decisions such as deciding about immunotherapies. In addition to factual information, reports of patient experiences (PEx) may support patients in decision-making. The added value of PEx in decision-making is not clear, and controlled studies are rare. Therefore, systematic methods are necessary to develop and analyse PEx. As there are no evaluated PEx for MS in Germany, we are currently creating a website presenting PEx structured according to topics and illustrated by video, audio, and text files. We aim to determine the feasibility of an intervention using PEx and evaluate whether PEx may help pwMS in their immunotherapy decision-making processes as a supplement to evidence-based information. Methods This project will follow the Medical Research Council framework for development and evaluation of complex interventions. After the development of a website with PEx, a randomised controlled pilot trial (pilot RCT) will be conducted in 2–3 MS centres, clinics, or rehabilitation centres including 55 pwMS and accompanied by a process evaluation. Patients with a RRMS diagnosis considering immunotherapy are eligible. The primary outcome is decision self-efficacy. Secondary outcomes include preparation for decision-making, decisional conflict, risk knowledge, confidence in active participation, affective forecasting, social support, and self-reported impact of eHealth on its users. Participants will be randomly assigned either to (i) an intervention group with 4 weeks access to an evidence-based patient information resource and the PExMS-website as an adjunct or to (ii) the control group with access to evidence-based information alone. A 6-member advisory panel involving representatives of pwMS, researchers, and neurologists, who accompany the whole project, will mentor this pilot RCT. Discussion The intervention was developed with systematic methods, created with active patient involvement and in critical appraisal by an expert advisory panel. The study is innovative as it contributes to the controversial evidence on the use of PEx in the context of evidence-based patient information. Trial registration ClinicalTrials.gov, NCT04236544 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00749-0.
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Affiliation(s)
- Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Patient representative, Hamburg, Trier, Germany
| | | | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, OsloMET, Oslo Metropolitan University, Oslo, Norway
| | - Sascha Köpke
- Institute for Clinical Nursing Science, University of Cologne, Cologne, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Schiffmann I, Freund M, Vettorazzi E, Stellmann JP, Heyer-Borchelt S, D'Hooghe M, Häußler V, Rahn AC, Heesen C. Assessing the effect of an evidence-based patient online educational tool for people with multiple sclerosis called UMIMS-understanding magnetic resonance imaging in multiple sclerosis: study protocol for a double-blind, randomized controlled trial. Trials 2020; 21:1008. [PMID: 33298133 PMCID: PMC7724874 DOI: 10.1186/s13063-020-04855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While magnetic resonance imaging (MRI) plays a major role in the lives of people with multiple sclerosis (pwMS), studies have shown that MRI-specific knowledge in pwMS is limited. Moreover, poor knowledge was associated with negative feelings towards MRI (e.g. anxiety concerning MRI scan). Because information sources about MRI in MS for pwMS are not available, we designed and evaluated an evidence-based online educational platform about MRI in MS called "Understanding MRI in MS" (UMIMS). Based on a pilot study in n= 79 subjects, an educational intervention was found to be feasible and effective. We hypothesize that MRI-specific knowledge can be increased by using UMIMS and that, subsequently, negative feelings towards MRI will be reduced and shared decision-making competences increased. METHODS This randomized, controlled, double-blinded trial (RCT) will recruit n = 120 pwMS. The intervention group will receive access to UMIMS. The control group will get access to a specifically developed control website, which visually imitates UMIMS and contains the standard information available by several MS self-help organizations. The change in MRI-specific knowledge assessed via the MRI-risk knowledge questionnaire (MRI-RIKNO) after the intervention is the primary endpoint at 2 weeks. Several secondary endpoints will be assessed at different timepoints throughout the study, e.g. emotions towards MRI, autonomy preferences, threat by MS and shared decision-making competences. The study includes a process evaluation. DISCUSSION The aim of this RCT is to prove that access to an education tool on MRI in MS will increase pwMS' MRI-specific knowledge and enhance shared decision-making when discussing decisions involving MRI results during patient-physician encounters. TRIAL REGISTRATION Clinicaltrials.gov NCT03872583 . Registered on 13 March 2019.
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Affiliation(s)
- Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Magalie Freund
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Susanne Heyer-Borchelt
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marie D'Hooghe
- Centre for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- National MS Centre Melsbroek, Melsbroek, Belgium
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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Wilkie DD, Solari A, Nicholas RSJ. The impact of the face-to-face consultation on decisional conflict in complex decision-making in multiple sclerosis: A pilot study. Mult Scler J Exp Transl Clin 2020; 6:2055217320959802. [PMID: 33194220 PMCID: PMC7594484 DOI: 10.1177/2055217320959802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background The role of face-to-face consultations in medicine is increasingly being
challenged. Disease activity, national guidelines, life goals e.g.
pregnancy, multiple therapies and side effects need to be considered on
starting disease modifying treatments (DMTs) in people with multiple
sclerosis (pwMS). Objectives We studied the impact of a face-to-face consultation on decision making,
using decisional conflict (DC) as the primary outcome. Methods Prospective cohort study of 73 pwMS attending clinics who were making
decisions about DMTs followed for one year. Prerequisites and consultation
features were measured with the SURE scale for DC used as the primary
outcome at baseline and at one year. Results The patient activation measure (PAM) was the only driver prior to the
consultation associated with DC (p = 0.02) showing those less engaged were
more likely to have DC. Overall, 51/73 (70%) of people made their treatment
decision or reinforced a former decision during the consultation. We found
making a treatment decision between the original consultation and the
follow-up was associated with resolving DC (p = 0.008). Conclusions Patient engagement impacts DC but the HCP delivering the optimal Shared
Decision Making (SDM) approach is additionally significant in reducing DC.
In complex decisions there is a clear role for face-to-face consultations in
current practice.
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Affiliation(s)
- David Daniel Wilkie
- Centre for Neuroscience, Faculty of Medicine, Imperial College London, London, UK
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Engels K, Schiffmann I, Weierstall R, Rahn AC, Daubmann A, Pust G, Chard D, Lukas C, Scheiderbauer J, Stellmann J, Heesen C. Emotions towards magnetic resonance imaging in people with multiple sclerosis. Acta Neurol Scand 2019; 139:497-504. [PMID: 30802931 DOI: 10.1111/ane.13082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/21/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES People with multiple sclerosis (pwMS) often have magnetic resonance imaging (MRI) examinations. While MRI can help guide MS management, it may be a source of anxiety for pwMS. We aimed to develop and validate a questionnaire on the "EMotions and Attitudes towards MRI" (MRI-EMA). MATERIAL AND METHODS The questionnaire was developed, tested in two samples of pwMS and validated in a sample of n = 457 pwMS using exploratory (EFA) and confirmatory factor analysis (CFA). RESULTS EFA revealed four factors underlying the questionnaire: fear of MRI scan, fear of MRI results, feeling of control over the disease and feeling of competence in the patient-physician encounter. CFA confirmed the model fit. Receiving the MRI results, but not undergoing the procedure was associated with anxiety. Seeing MRI results gave participants a feeling of control over the disease. Only 50% felt competent to discuss MRI findings with their physician. Fear of MRI results was especially high and feeling of competence low in participants with a short disease duration and little MRI experience. CONCLUSION PwMS do not feel competent when discussing the role, MRI plays in their care. Receiving MRI results caused anxiety and provides some pwMS with a-perhaps false-feeling of control over the disease. The MRI-EMA constitutes a new tool for the assessments of pwMS' feelings towards MRI, that can be applied in future research and clinical settings.
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Affiliation(s)
- Katharina Engels
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
| | | | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Gesa Pust
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation University College London (UCL) Institute of Neurology London UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre London UK
| | - Carsten Lukas
- Department of Neuroradiology, St. Josef‐Hospital Ruhr University Bochum Germany
| | | | - Jan‐Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
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Giordano A, Liethmann K, Köpke S, Poettgen J, Rahn AC, Drulovic J, Beckmann Y, Sastre-Garriga J, Galea I, Heerings M, Jongen PJ, Vettorazzi E, Solari A, Heesen C. Risk knowledge of people with relapsing-remitting multiple sclerosis - Results of an international survey. PLoS One 2018; 13:e0208004. [PMID: 30496233 PMCID: PMC6264873 DOI: 10.1371/journal.pone.0208004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adequate disease and treatment-related risk knowledge of people with Multiple Sclerosis (pwMS) is a prerequisite for informed choices in medical encounters. Previous work showed that MS risk knowledge is low among pwMS and role preferences are different in Italy and Germany. Objective We investigated the level of risk knowledge and role preferences in 8 countries and assessed putative variables associated with risk knowledge. Methods An online-survey was performed based on the Risk knowledge questionnaire for people with relapsing-remitting MS (RIKNO 2.0), the electronic Control Preference Scale (eCPS), and other patient questionnaires. Inclusion criteria of participants were: (1) age ≥18 years, (2) a diagnosis of relapsing-remitting MS (RRMS), (3) being in a decision making process for a disease modifying drug. Results Of 1939 participants from Germany, Italy, the Netherlands, Serbia, Spain and Turkey, 986 (51%) (mean age 38.6 years [range 18–67], 77% women, 7.8 years of disease duration) completed the RIKNO 2.0, with a mean of 41% correct answers. There were less than 50 participants in the UK and Estonia and data were not analysed. Risk knowledge differed across countries (p < 0.001). Variables significantly associated with higher risk knowledge were higher education (p < 0.001), previous experience with disease modifying drugs (p = 0.001), correct answer to a medical data interpretation question (p < 0.001), while higher fear for wheelchair dependency was negatively associated to risk knowledge (p = 0.001). Conclusion MS risk knowledge was overall low and differed across participating countries. These data indicate that information is an unmet need of most pwMS.
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Affiliation(s)
- Andrea Giordano
- Service of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Katrin Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany
- Pediatrics and Medical Psychology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jana Poettgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany
| | - Jelena Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Yesim Beckmann
- Department of Neurology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Neurology-Neuroimmunology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
| | - Marco Heerings
- National MS Foundation of the Netherlands, Rotterdam, The Netherlands
| | - Peter Joseph Jongen
- Department of Community & Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
- MS4 Research Institute, Nijmegen, The Netherlands
| | - Eik Vettorazzi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Solari
- Service of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Köpke S, Solari A, Rahn A, Khan F, Heesen C, Giordano A. Information provision for people with multiple sclerosis. Cochrane Database Syst Rev 2018; 10:CD008757. [PMID: 30317542 PMCID: PMC6517040 DOI: 10.1002/14651858.cd008757.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. These include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies, and non-pharmacological interventions, among others. While people with MS demand adequate information to be able to actively participate in medical decision making and to self manage their disease, it has been shown that patients' disease-related knowledge is poor, therefore guidelines recommend clear and concise high-quality information at all stages of the disease. Several studies have outlined communication and information deficits in the care of people with MS. However, only a few information and decision support programmes have been published. OBJECTIVES The primary objectives of this updated review was to evaluate the effectiveness of information provision interventions for people with MS that aim to promote informed choice and improve patient-relevant outcomes, Further objectives were to evaluate the components and the developmental processes of the complex interventions used, to highlight the quantity and the certainty of the research evidence available, and to set an agenda for future research. SEARCH METHODS For this update, we searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register, which contains trials from CENTRAL (the Cochrane Library 2017, Issue 11), MEDLINE, Embase, CINAHL, LILACS, PEDro, and clinical trials registries (29 November 2017) as well as other sources. We also searched reference lists of identified articles and contacted trialists. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-randomised controlled trials, and quasi-randomised trials comparing information provision for people with MS or suspected MS (intervention groups) with usual care or other types of information provision (control groups) were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed the risk of selection bias, performance bias, attrition bias, and detection bias. We contacted authors of relevant studies for additional information. MAIN RESULTS We identified one new RCT (73 participants), which when added to the 10 previously included RCTs resulted in a total of 11 RCTs that met the inclusion criteria and were analysed (1387 participants overall; mean age, range: 31 to 51; percentage women, range: 63% to 100%; percentage relapsing-remitting MS course, range: 45% to 100%). The interventions addressed a variety of topics using different approaches for information provision in different settings. Topics included disease-modifying therapy, relapse management, self care strategies, fatigue management, family planning, and general health promotion. The active intervention components included decision aids, decision coaching, educational programmes, self care programmes, and personal interviews with physicians. All studies used one or more components, but the number and extent differed markedly between studies. The studies had a variable risk of bias. We did not perform meta-analyses due to marked clinical heterogeneity. All five studies assessing MS-related knowledge (505 participants; moderate-certainty evidence) detected significant differences between groups as a result of the interventions, indicating that information provision may successfully increase participants' knowledge. There were mixed results on decision making (five studies, 793 participants; low-certainty evidence) and quality of life (six studies, 671 participants; low-certainty evidence). No adverse events were detected in the seven studies reporting this outcome. AUTHORS' CONCLUSIONS Information provision for people with MS seems to increase disease-related knowledge, with less clear results on decision making and quality of life. The included studies in this review reported no negative side effects of providing disease-related information to people with MS. Interpretation of study results remains challenging due to the marked heterogeneity of interventions and outcome measures.
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Affiliation(s)
- Sascha Köpke
- University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyRatzeburger Allee 160LübeckGermanyD‐23538
| | - Alessandra Solari
- Fondazione I.R.C.C.S. ‐ Neurological Institute Carlo BestaNeuroepidemiology UnitVia Celoria 11MilanItaly20133
| | - Anne Rahn
- University Medical CenterInstitute of Neuroimmunology and Multiple SclerosisMartinistr 52HamburgGermany20246
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Christoph Heesen
- University Medical CenterInstitute of Neuroimmunology and Multiple SclerosisMartinistr 52HamburgGermany20246
| | - Andrea Giordano
- Fondazione I.R.C.C.S. ‐ Neurological Institute Carlo BestaNeuroepidemiology UnitVia Celoria 11MilanItaly20133
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Reen GK, Silber E, Langdon DW. Best Methods of Communicating Clinical Trial Data to Improve Understanding of Treatments for Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:762-766. [PMID: 30005747 DOI: 10.1016/j.jval.2017.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patients' understanding of treatment risks and benefits is a prerequisite for shared decision making. Yet, patients with multiple sclerosis (MS) do not accurately understand treatment information provided in regular clinical consultations. OBJECTIVES To identify the best methods of communicating clinical trial data to improve the understanding of treatments among patients with MS and to also examine the relationship between patients' understanding with decisional conflict, individual traits, and MS symptoms. METHODS A repeated-measures study was used. A sample of relapsing-remitting patients with MS was recruited from National Health Service sites in the United Kingdom. Patients were presented with hypothetical treatment risks and benefits from faux clinical trials. Treatments were communicated using absolute terms, relative terms, and numbers needed to treat/harm. The presence of baseline information with each method was also manipulated. Patients' understanding and conflict in treatment decisions were assessed. Individual traits and MS symptoms were also recorded. RESULTS Understanding was better when treatments were communicated in absolute terms (mean 3.99 ± 0.93) compared with relative terms (mean 2.93 ± 0.91; P < 0.001) and numbers needed to treat/harm (mean 2.89 ± 0.88; P < 0.001). Adding baseline information to all methods significantly improved understanding (mean 5.04 ± 0.96) compared with no baseline information (mean 1.50 ± 0.74; P < 0.001). Understanding was not related to conflict in treatment decisions (r = -0.131; P = 0.391). Numeracy, IQ, and cognitive impairments were significantly related to patients' understanding of treatments. CONCLUSIONS Treatment risks and benefits should ideally be communicated using absolute terms, alongside baseline information. Patients with MS with low numeracy, low IQ, and reduced cognitive skills should be supported during treatment education.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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Rahn A, Köpke S, Backhus I, Kasper J, Anger K, Untiedt B, Alegiani A, Kleiter I, Mühlhauser I, Heesen C. Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation. Int J Nurs Stud 2018; 78:26-36. [DOI: 10.1016/j.ijnurstu.2017.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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Heesen C, Pöttgen J, Rahn AC, Liethmann K, Kasper J, Vahter L, Drulovic J, Van Nunen A, Wilkie D, Beckmann Y, Paul F, Köpke S, Giordano A, Solari A. What should a person with relapsing-remitting multiple sclerosis know? - Focus group and survey data of a risk knowledge questionnaire (RIKNO 2.0). Mult Scler Relat Disord 2017; 18:186-195. [PMID: 29141808 DOI: 10.1016/j.msard.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk knowledge is relevant to make informed decisions in multiple sclerosis (MS). The risk knowledge questionnaire for relapsing-remitting MS (RIKNO 1.0) was developed and piloted in Germany. OBJECTIVE To produce a revised RIKNO 2.0 questionnaire using mixed methodology in a European setting. METHODS The questionnaire was translated in seven languages. MS patient and health professional (HP) expert feedback was obtained from Germany, Italy, Estonia, Serbia, and the UK. A German web-based survey of RIKNO 2.0 compared the tool with the MS Knowledge Questionnaire (MSKQ), each one used with two versions (with/without a "don't know" DN option). RESULTS While RIKNO 2.0 was considered difficult, it was rated as highly educational. One item was reframed, and two new items were added. The web-based German survey (n = 708 completers) showed that the DN version did not increase participation rate and did not produce significantly higher scores. Internal consistency (Cronbach alpha) without SN response was 0.73. RIKNO 2.0 scores showed normality distribution irrespective of the answering format. Item difficulty was high ranging from 0.07 to 0.79. Less than 50% of questions were answered correctly (mean 8.9) compared to 80.4% in the MSKQ (mean 20.1). Higher numeracy competency and education were significantly, albeit weakly, associated to higher scores for both RIKNO 2.0 and MSKQ. CONCLUSION Including "don't know" options in knowledge questionnaires does not increase percentage of correct replies. RIKNO 2.0 is a complex questionnaire to be used in an educational context and studies on patient information. The tool is now available in seven languages.
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Affiliation(s)
- C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Neurologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - A C Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - K Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - J Kasper
- Faculty of Health Sciences, Arctic University of Norway, 9073 Tromsø, Norway.
| | - L Vahter
- Department of Neurology, West-Tallinn Central Hospital, Paldiski mnt. 68, 10617 Tallinn, Estonia.
| | - J Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Dr. Subotića Starijeg 6, 11000 Beograd, Serbia.
| | - A Van Nunen
- National MS-Centrum, Melsbroek, Vereeckenstraat 44, 1820 Melsbroek, Belgium.
| | - D Wilkie
- Clinical Trials Unit, Department of Neurology, Imperial College, Room 10L18 (Lab Block, Charing Cross Campus, Hammersmith, London W6 8RF, UK.
| | - Y Beckmann
- Department of Neurology, Ataturk Training and Research Hospital, Faculty of Medicine, Konak Mahallesi, İnönü Cad. 269. Sok. No:102, 35150 Karabağlar, Izmir, Turkey.
| | - F Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - S Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
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Rath L, Vijiaratnam N, Skibina O. Assessing understanding of individual risk and symptoms of progressive multifocal leukoencephalopathy in patients prescribed natalizumab for multiple sclerosis. Intern Med J 2017; 47:194-199. [DOI: 10.1111/imj.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Louise Rath
- Neurology Department; Alfred Health; Melbourne Victoria Australia
| | | | - Olga Skibina
- Neurology Department; Alfred Health; Melbourne Victoria Australia
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Köpke S, Kasper J, Flachenecker P, Meißner H, Brandt A, Hauptmann B, Bender G, Backhus I, Rahn AC, Pöttgen J, Vettorazzi E, Heesen C. Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study. Clin Rehabil 2016; 31:250-261. [DOI: 10.1177/0269215516639734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%, P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.
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Affiliation(s)
- S Köpke
- Institute of Social Medicine, University of Lübeck, Lübeck, Germany
| | - J Kasper
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - P Flachenecker
- Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany
| | - H Meißner
- Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany
| | - A Brandt
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany
| | - B Hauptmann
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany
- Department of Therapeutic Sciences, MSH Medical School Hamburg, Hamburg, Germany
| | - G Bender
- RehaCentre Hamburg, Hamburg, Germany
| | - I Backhus
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AC Rahn
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Pöttgen
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Institute of Neuroimmunology & Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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