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Hamouda I, Baumstarck K, Aim MA, Beltran Anzola A, Loundou A, Billette de Villemeur T, Boyer L, Auquier P, Rousseau MC. Mortality in French people with polyhandicap/profound intellectual and multiple disabilities. J Intellect Disabil Res 2024. [PMID: 38693627 DOI: 10.1111/jir.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND In recent decades, progress has been made in the care of people with polyhandicap/profound intellectual and multiple disabilities (PIMD) through a better understanding of the pathophysiology and the development of new care management and rehabilitation strategies adapted to these extreme pathologies. Although there is a lack of knowledge about the health status and care management of the oldest people, a better understanding of the natural course of life of people with polyhandicap/PIMD would consequently allow the optimisation of preventive and curative care management strategies. Few robust data on mortality and life expectancy have been documented for this population in France. Our aims are to estimate the median survival time and assess the factors associated with mortality in people with polyhandicap/PIMD receiving care in France. METHODS This study included people with polyhandicap/PIMD, followed by the French national cohort 'Eval-PLH' since 2015. These individuals were included in specialised rehabilitation centres and residential institutions. The people included in the first wave of the cohort (2015-2016) were eligible for the present study. Vital status on 1 January 2022 (censoring date) was collected in two ways: (1) spontaneous reporting by the participating centre to the coordinating team and (2) systematic checking on the French national death platform. According to the vital status, survival was calculated in years from the date of birth to the date of death or from the date of birth to the censoring date. The factors associated with mortality were evaluated using the Cox proportional regression hazards model. RESULTS Data from 780 individuals aged between 3 and 67 years were analysed. At the censoring date, 176 (22.6%) had died, and the mean survival was 52.8 years (95% confidence interval: 51.1-54.5). Mortality was significantly associated with a progressive aetiology, recurrent pulmonary infections, drug-resistant epilepsy and a higher number of medical devices. CONCLUSIONS This study shows for the first time the survival and impact of factors associated with mortality in people with polyhandicap/PIMD in France.
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Affiliation(s)
- I Hamouda
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - K Baumstarck
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - M-A Aim
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- UR 849, LPS - Social Psychology Laboratory, Aix-Marseille University, Aix-en-Provence, France
| | - A Beltran Anzola
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - A Loundou
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - T Billette de Villemeur
- Sorbonne Université, APHP.SU, Neuropédiatrie - Hôpital Trousseau - La Roche Guyon, Paris, France
| | - L Boyer
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - P Auquier
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - M-C Rousseau
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, Hyères, France
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Bessaguet H, Rousseau MC, Gautheron V, Ojardias E, Dohin B. Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap. PLoS One 2024; 19:e0300065. [PMID: 38451892 PMCID: PMC10919586 DOI: 10.1371/journal.pone.0300065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Scoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly performed to alleviate pain and provide more comfort. However, spine stabilization has not previously been proven to improve the severity health status of adolescents with polyhandicap according to specific clinical scales. OBJECTIVE This study describes and compares the severity health status of adolescents with polyhandicap before and after they underwent spinal fusion. METHODS A monocentric retrospective observational study was conducted in the university hospital centre of Saint-Etienne, France. We included between 2009 to 2020, 30 scoliotic adolescents with polyhandicap who underwent spinal fusion performed with the same surgical technique and the same surgeon. The main outcome was the variation in the Polyhandicap Severity Scale (PSS) score after surgery. Secondary outcomes were variations in PSS subscores, quality of life scores, fronto-sagittal X-ray parameters, and measures of surgical complication rates and lengths of stay. RESULTS Among 30 adolescents, 27 PSS analyses were performed. We found a significant improvement between pre- and postoperative PSS scores, mainly for pain and respiratory, digestive, and skin disabilities. These improvements were accompanied by significant reductions in pelvic obliquity, in frontal and sagittal curves. The mean hospital length of stay was 45 days. During postoperative period, patients received a personalized postoperative rehabilitation procedure with spasticity and pain treatments, physiotherapy, and verticalization (wheelchair sitting and positioning devices such as contoured seat intended to increase postural stability). The mortality rate was estimated at 7%. At least 1 complication per patient occurred. CONCLUSIONS We show that spinal fusion surgeries confer a significant improvement in the severity health status in scoliotic adolescents with polyhandicap.
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Affiliation(s)
- Hugo Bessaguet
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
| | - Marie-Christine Rousseau
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, San Salvadour Hospital, University Hospital of Paris, Hyères, France
| | - Vincent Gautheron
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
| | - Etienne Ojardias
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Lyon Neuroscience Research Center, Trajectoires Team, Inserm UMR-S 1028, CNRS UMR 5292, Lyon1 & Saint-Etienne Universities, Saint-Étienne, France
| | - Bruno Dohin
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
- Department of Pediatric Orthopedic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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Baumstarck K, Hamouda I, Aim MA, Anzola AB, Khaldi-Cherif S, Felce A, Maincent K, Lind K, Auquier P, Billette de Villemeur T, Rousseau MC. Health care management adequacy among French persons with severe profound intellectual and multiple disabilities: a longitudinal study. BMC Health Serv Res 2024; 24:99. [PMID: 38238747 PMCID: PMC10795329 DOI: 10.1186/s12913-024-10552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The care organization of persons with profound intellectual and multiple disabilities (PIMD) varies by country according to the health care system. This study used a large sample of French individuals with severe PIMD/polyhandicap to assess: 1) the adequacy of care setting over a 5-year period and 2) health care consumption. METHODS The longitudinal study used data from the French EVALuation PoLyHandicap (EVAL-PLH) cohort of persons with severe PIMD/polyhandicap who were receiving managed in specialized care centres and residential facilities. Two assessments were performed: wave 1 (T1) in 2015-2016 and wave 2 (T2) in 2020-2021. The inclusion criteria were as follows: age > 3 years at the time of inclusion; age at onset of cerebral lesion younger than 3 years old; and severe PIMD. The adequacy of the care setting was based on the following: i) objective indicators, i.e., adequacy for age and adequacy for health status severity; ii) subjective indicators, i.e., self-perception of the referring physician about medical care adequacy and educational care adequacy. Health care consumption was assessed based on medical and paramedical care. RESULTS Among the 492 persons assessed at the 2 times, 50% of individuals at T1 and 46% of individuals at T2 were in an inadequate care setting based on age and severity. Regarding global subjective inadequacy, the combination of medical adequacy and educational adequacy, 7% of individuals at T1 and 13% of individuals at T2 were in an inadequate care setting. At T2, a majority of individuals were undermonitored by medical care providers (general practitioners, physical medicine rehabilitation physicians, neurologists, orthopaedists, etc.). Important gaps were found between performed and prescribed sessions of various paramedical care (physiotherapy, occupational therapy, psychomotor therapy, etc.). CONCLUSIONS This study revealed key elements of inadequate care management for persons with severe PIMD/polyhandicap in France. Based on these important findings, healthcare workers, familial caregivers, patients experts, and health decision-makers should develop appropriate care organizations to optimize the global care management of these individuals. TRIAL REGISTRATION NCT02400528, registered 27/03/2015.
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Affiliation(s)
- Karine Baumstarck
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France.
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France.
| | - Ilyes Hamouda
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Marie-Anastasie Aim
- UR 849, LPS - Social Psychology Laboratory, Aix-Marseille University, 29 Av. Robert Schuman, 13621, Aix-en-Provence, France
| | - Any Beltran Anzola
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
| | - Sherezad Khaldi-Cherif
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Agnès Felce
- Hendaye Hospital, Route Corniche, 64700, Hendaye, Assistance Publique-Hôpitaux de Paris, France
| | - Kim Maincent
- Committee for Studies, Education and Care for People With Multiple Disabilities (Comité d'Études, d'Éducation Et de Soins Auprès Des Personnes Polyhandicapées, CESAP), 62 Rue de La Glacière, 75013, Paris, France
| | - Katia Lind
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Pascal Auquier
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Thierry Billette de Villemeur
- Service de Polyhandicap Pédiatrique, Roche Guyon Hospital, Assistance Publique Hôpitaux de Paris, 1 Rue Justinien Blazy 95780, La Roche-Guyon, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
| | - Marie-Christine Rousseau
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
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Hamouda I, Rousseau MC, Beltran Anzola A, Aim MA, de Villemeur TB, Auquier P, Baumstarck K, de Villemeur TB, Rousseau MC, Khaldi-Cherif S, Maincent K, Felce A, Baumstarck K, Auquier P, Dany L, Beltran A, Hamouda I, Aim MA, Boutalbi N, Kemlin I, Roger J, Julien P, Heng P, Willocq D, Valkov M, Pietra S, Lenormand S, Lind K. The French EVAL-PLH cohort of persons with polyhandicap. Sci Rep 2022; 12:12512. [PMID: 35869128 PMCID: PMC9305042 DOI: 10.1038/s41598-022-16596-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Polyhandicap is characterized by a combination of profound intellectual disability and serious motor deficit, resulting in the extreme restriction of autonomy and communication. The aim of the EVAL-PLH (EVALuation PoLyHandicap) study is to identify the impact of socioeconomic, environmental, and epidemiological determinants on the health status of the persons with polyhandicap and the daily lives of their caregivers. EVAL-PLH is a prospective cohort study. The study involved persons with severe polyhandicap (who were cared for at reeducation centers, residential facilities, and one specialized pediatric/neurological department of a university hospital), their familial caregivers and the institutional caregivers. Data collection included sociodemographics, heath status, and psychocomportemental information. Data have been collected at 2 points (2015-2016 and 2020-2021). The French EVAL-PLH cohort is the first cohort study focusing on persons with polyhandicap, their families, and the health care workers caring for them. The sustainability of the device is essential to assist patients, families, clinicians, and health decision-making authorities in the optimization of care management.
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Rousseau MC, Hully M, Milh M, Juzeau D, Pollez B, Peudenier S, Bahi Buisson N, Gautheron V, Chabrol B, Billette de Villemeur T. Clinical characteristics of COVID-19 infection in polyhandicapped persons in France. Arch Pediatr 2021; 28:374-380. [PMID: 33994267 PMCID: PMC8064873 DOI: 10.1016/j.arcped.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023]
Abstract
Aim Little is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap. Method This was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection. Results We collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients. Conclusion These findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.
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Affiliation(s)
- M-C Rousseau
- Service polyhandicap adultes, Hôpital San Salvadour (Assistance Publique Hôpitaux de Paris), BP 30 080, 83407 Hyères cedex, France.
| | - M Hully
- MD, Services de Neurologie et Rééducation Pédiatriques, Hôpital Necker Enfants Malades, APHP, 75015 Paris, France
| | - M Milh
- Service de Neuropédiatrie, Hôpital d'Enfants CHU Timone, 13005 Marseille, France
| | - D Juzeau
- Santé Publique, Co Fondatrice du réseau NeurodeV, 59000 Lille, France
| | | | - S Peudenier
- CRDI, Hôpital Morvan, CHRU Brest, 29200 Brest, France
| | - N Bahi Buisson
- Pediatric Neurology, Necker Enfants Malades University Hospital, Université de Paris, 75015 Paris, France; Institut Imagine, INSERM U 1163, Université de Paris, Paris, France
| | - V Gautheron
- Physical and Rehabilitation Medicine, Bellevue University Hospital, 42100 Saint-Étienne, France
| | | | - B Chabrol
- Service de Neuropédiatrie, Hôpital d'Enfants CHU Timone, 13005 Marseille, France
| | - T Billette de Villemeur
- Service de Neuropédiatrie, Pathologie du développement, hôpital Trousseau-La Roche Guyon, 95780 La Roche-Guyon, France
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Rousseau MC, Baumstarck K, Hamouda I, Valkov M, Felce A, Khaldi-Cherif S, Brisse C, Loundou A, Auquier P, Billette de Villemeur T; French Polyhandicap Group. Development and initial validation of the polyhandicap severity scale. Rev Neurol (Paris) 2021; 177:683-9. [PMID: 33069376 DOI: 10.1016/j.neurol.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Providing a new tool, based on the point of view of experts in polyhandicap, which assesses the global severity of the health status of polyhandicapped persons is necessary. We present herein the initial validation of the polyhandicap severity scale (PSS). METHODS The initial development of the tool was undertaken in two steps: item selection and validation process. The final set included 10 items related to abilities and 17 items related to comorbidities and impairments. The patient selection criteria were as follows: age>3 years, age at onset of cerebral lesion under 3 years old, with a combination of motor deficiency and profound intellectual impairment, associated with restricted mobility and everyday life dependence. External validity, reproducibility (20 patients), responsiveness (38 patients), and acceptability were explored. RESULTS During the 18-month study period, a total of 875 patients were included. Two scores were calculated: an abilities score and a comorbidities/impairments score (higher score, higher severity). The 2 scores were higher for: older patients, patients with a progressive etiology, patients with more devices and more medications, patients with higher dependency and lower mobility. Indicators of reproducibility and responsiveness were satisfactory. The mean time duration of fulfilling was 22minutes (standard deviation 5). CONCLUSIONS Quantifying the health severity of polyhandicapped persons is necessary for both healthcare workers and health decision makers. The polyhandicap severity scale provides the first reliable and valid measure of the health severity status for children and adults.
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Rousseau M, Baumstarck K, Khaldi-cherif N, Felce A, Valkov M, Brisse C, Loundou A, Auquier P, Billette de villemeur T. Health issues in polyhandicapped patients according to age: Results of a large French cross-sectional study. Rev Neurol (Paris) 2020; 176:370-9. [DOI: 10.1016/j.neurol.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022]
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Rousseau MC, Baumstarck K, Valkov M, Felce A, Brisse C, Khaldi-Cherif S, Loundou A, Auquier P, Billette de Villemeur T. Impact of severe polyhandicap cared for at home on French informal caregivers' burden: a cross-sectional study. BMJ Open 2020; 10:e032257. [PMID: 32014871 PMCID: PMC7045096 DOI: 10.1136/bmjopen-2019-032257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Polyhandicap (PLH), defined by a combination of profound intellectual impairment and serious motor deficits, is a severe condition with complex disabilities. In France, care of the large majority of PLH individuals is managed in specialised rehabilitation centres or residential facilities, but some of PLH individuals are cared for at home. The aims of this study were to assess the self-perceived burden among informal caregivers of PLH individuals and to identify potential determinants of this burden. DESIGN Cross-sectional study (Neuropaediatric Department, Trousseau Hospital, Paris, France). SETTINGS PLH children were recruited from a specialised paediatric/neurological department. PARTICIPANTS The selection criteria of caregivers were age above 18 years and being the PLH individual's next of kin. OUTCOMES MEASURES From March 2015 to December 2016, data were collected from the caregivers, including sociodemographical data, health status, psycho-behavioural data (quality of life, mood disorders and coping) and self-perceived burden. In addition, the health status of the PLH individual was collected. Relationships between the burden scores and potential determinants were tested (correlations coefficients, Mann-Whitney tests, generalised estimating equations models). RESULTS Eighty-four children were eligible; 77 families returned their questionnaire. The informal caregivers of PLH children experienced a high level of perceived burden (scores ranged from 55±20 to 81±12). Eighty per cent of them had more than 5 hours of daily caregiving and 51% of them had to get up more than twice during the night. The main factors associated with caregiver burden were age, financial issues, health status, daily care and coping strategies. The patients' health status was not associated with caregiver burden. CONCLUSIONS Some of the caregiver burden determinants might be modifiable. These findings should help healthcare workers and health-decision makers implement specific and appropriate interventions. TRIAL REGISTRATION NUMBER NCT02400528.
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Affiliation(s)
- Marie-Christine Rousseau
- Hôpital San Salvadour, Assistance Publique - Hôpitaux de Paris, Paris, Île-de-France, France
- EA 3279, Self-perceived Health Assessment Research Unit, Aix-Marseille Universite, Marseille, France
| | - Karine Baumstarck
- EA 3279, Self-perceived Health Assessment Research Unit, Aix-Marseille Universite, Marseille, France
| | - Maria Valkov
- Hôpital San Salvadour, Assistance Publique - Hôpitaux de Paris, Paris, Île-de-France, France
| | - Agnés Felce
- Hôpital Marin d'Hendaye, Assistance Publique Hopitaux de Paris, Paris, Île-de-France, France
| | - Catherine Brisse
- Comité d'Études, d'Éducation et de Soins Auprès des Personnes Polyhandicapées, Paris, France
| | | | - Anderson Loundou
- EA 3279, Self-perceived Health Assessment Research Unit, Aix-Marseille Universite, Marseille, France
| | - Pascal Auquier
- EA 3279, Self-perceived Health Assessment Research Unit, Aix-Marseille Universite, Marseille, France
| | - Thierry Billette de Villemeur
- Hôpital de La Roche Guyon, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
- Pathologie du développement, Sorbonne Université, UPMC, GRC ConCer-LD, Paris, France
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Rousseau M, de Villemeur TB, Khaldi-cherif S, Brisse C, Felce A, Loundou A, Baumstarck K, Auquier P, Leroy T, Haddadou S, Freihuber C, Amalou S, Bonheur J, Valence S, Nougues M, Luciani L, Nouet J, Coiffier C, Sellier P, Julien P, Grasset J, Delvert S, Gaulard M, Belorgey A, Si Abdelkader H, Mathieu S, Ardati M, Kammache I, Héron B, Isapof A, Afenjar A, Maincent K, Rodriguez D, Doummar D, Phan M, Moutard M, Willocq D, Valkov M, Teulade J, Pietra S, Grimont E, Lenormand S, Laracca E, Aynie V. Polyhandicap and aging. Disabil Health J 2019; 12:657-64. [DOI: 10.1016/j.dhjo.2019.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/20/2018] [Accepted: 01/18/2019] [Indexed: 02/04/2023]
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Rousseau MC, Baumstarck K, Auquier P, Billette de Villemeur T. Health characteristics and health care trajectory of polyhandicaped person before and after 1990. Rev Neurol (Paris) 2019; 176:92-99. [PMID: 31255322 DOI: 10.1016/j.neurol.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Polyhandicap is defined as the combination of severe mental impairment and severe motor deficit resulting in reduced mobility and an extreme reduction in autonomy. Over the last 20years, care management for these patients has become more structured, however, their care pathway is not always optimal. OBJECTIVE To describe/compare the health characteristics, treatment and history of the care pathways of subjects who received care before and after 1990. METHOD Multicentre cross-sectional study, population studied: patients with polyhandicap: (i) causal brain damage<3years, (ii) severe mental impairment, (iii) motor disability, (iv) reduced mobility, (v) extreme restriction of autonomy. DATA COLLECTED clinical and medical, care procedures, treatments, history of care pathways. RESULTS Patients are divided into 2 groups: 545 patients who received care after 1990 and 330 before 1990. Older patients present more recurrent urinary infections, slow transit, behavioural disorders and pain, and are prescribed a greater number of drugs. For those who received care before 1990, the age of admission to an establishment is lower, with one-third receiving a consultation dedicated to the transition from paediatric to adult teams. DISCUSSION/CONCLUSION The care sector for patients with polyhandicap makes it possible to meet their needs throughout their lives, however, there is still progress to be made in terms of formalisation and of coordinating the care pathway in order to facilitate the transition from paediatric to adult services/establishments.
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Affiliation(s)
- M-C Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, Hôpital San Salvadour, Assistance publique-Hôpitaux de Paris, Hyères, France; EA 3279 CEReSS, Santé publique et qualité de vie, Aix-Marseille Université, 13005 Marseille, France.
| | - K Baumstarck
- EA 3279 CEReSS, Santé publique et qualité de vie, Aix-Marseille Université, 13005 Marseille, France
| | - P Auquier
- EA 3279 CEReSS, Santé publique et qualité de vie, Aix-Marseille Université, 13005 Marseille, France
| | - T Billette de Villemeur
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, Hôpital San Salvadour, Assistance publique-Hôpitaux de Paris, Hyères, France; Sorbonne Université, UPMC, GRC ConCer-LD, AP-HP, Hôpital Trousseau, Service de Neuropédiatrie, Pathologie du développement, Paris, France; Centre de référence des déficits intellectuels de causes rares, Inserm U 1141, 75000 Paris, France
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Rousseau MC, Baumstarck K, Khaldi-Cherif S, Brisse C, Felce A, Moheng B, Loundou A, Billette de Villemeur T, Auquier P. Impact of severe polyhandicap on parents' quality of life: A large French cross-sectional study. PLoS One 2019; 14:e0211640. [PMID: 30716093 PMCID: PMC6361449 DOI: 10.1371/journal.pone.0211640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/17/2019] [Indexed: 02/02/2023] Open
Abstract
Background Polyhandicap (PLH) is a condition of severe and complex disabilities and is defined by a combination of profound intellectual impairment and serious motor deficits. Parents of PLH individuals are chronically confronted with stressful situations. The aims of this study are i) to assess and compare the quality of life (QoL) of a large panel of parents of PLH individuals with age- and gender-matched controls and ii) to identify potential determinants of parents’ QoL. Method We conducted a cross-sectional study. Parents were recruited from 4 specialized rehabilitation centres, 9 residential facilities, and a specialized paediatric/neurological department. The selection criteria were age above 18 years and being the mother/father of a PLH individual. The data collected from the parents included sociodemographic, health status, and psycho-behavioural data (including QoL); additionally, the health status of the PLH individuals was collected. Results The QoL scores of all dimensions were significantly lower for parents than for controls. The main factors modulating parents’ QoL were financial issues, health status, and coping strategies. The PLH individuals’ health status was not associated with parents’ QoL. Conclusions Some QoL determinants might be amenable. These findings should help health care workers and health decision makers to implement specific and appropriate interventions.
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, Hyères, France.,EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Karine Baumstarck
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | | | - Catherine Brisse
- Comité d'Études, d'Éducation et de Soins Auprès des Personnes Polyhandicapées, Paris, France
| | - Agnès Felce
- Hôpital d'Hendaye, Assistance Publique Hôpitaux de Paris, Hendaye, France
| | - Benjamin Moheng
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Anderson Loundou
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Thierry Billette de Villemeur
- Sorbonne Université, UPMC, GRC ConCer-LD, Paris, France.,Service de Neuropédiatrie-Pathologie du développement, Centre de référence des déficits intellectuels de causes rares, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France.,Service de Polyhandicap Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital de La Roche Guyon, La Roche Guyon, France
| | - Pascal Auquier
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
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Abstract
PURPOSE Children with severe neurological disabilities are at an increased risk of acute, life-threatening events. We assessed physicians' attitudes when making decisions in these situations. METHODS We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants' attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I. RESULTS The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues. CONCLUSIONS Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations.
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Affiliation(s)
- Benjy Wosinski
- a Paediatrics department , Lausanne University Hospital , Lausanne , Switzerland
| | - Christopher J Newman
- b Paediatric Neurology and Neurorehabilitation Unit , Lausanne University Hospital , Lausanne , Switzerland
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13
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Rousseau MC, Billette de Villemeur T, Khaldi-Cherif S, Brisse C, Felce A, Baumstarck K, Auquier P. Adequacy of care management of patients with polyhandicap in the French health system: A study of 782 patients. PLoS One 2018; 13:e0199986. [PMID: 29979745 PMCID: PMC6034799 DOI: 10.1371/journal.pone.0199986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background The aims of this study were 1) to describe the health profiles and care management of polyhandicapped patients according to 2 modalities, specialized rehabilitation centers (SRC) and residential facilities (RF), and 2) to estimate the adequacy of care management of these patients. Methods This was an 18-month cross-sectional study including patients with a combination of severe motor deficiency and profound intellectual impairment. The patients were from 4 SRC and 9 RF. The following data were collected: sociodemographics, health status, care management, and adequacy of care management. Results A total of 782 patients were included: 410 (52%) were cared for in SRC and 372 (48%) in RF. Global objective adequacy (health severity and age category) was higher for patients cared for in SRC compared with patients cared for in RF (57 vs. 44%, p< = 10−3). Global subjective adequacy (self-perception of the referring physician and request of change in structure) was higher for patients cared for in SRC in comparison with patients cared for in RF (98 vs. 92%, p< = 10−3). Conclusions This study provides key elements of adequacy of care management modalities for polyhandicapped patients in France. Trial registration ClinicalTrials.gov NCT02400528
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, Hyères, France
- EA 3279, CEReSS—Health Service Research and Quality of Life Center, Aix Marseille Université, 27 bd Jean Moulin, Marseille, France
| | - Thierry Billette de Villemeur
- Sorbonne Université, UPMC, GRC ConCer-LD and AP-HP, Hôpital Trousseau, Service de Neuropédiatrie—Pathologie du développement, Paris, France
- Centre de référence des déficits intellectuels de causes rares, Inserm, Paris, France
- Hôpital de La Roche Guyon, Service de Polyhandicap Pédiatrique, Assistance Publique Hôpitaux de Paris, La Roche Guyon, France
| | | | - Catherine Brisse
- Comité d'Études, d'Éducation et de Soins Auprès des Personnes Polyhandicapées, Paris, France
| | - Agnès Felce
- Hôpital d’Hendaye, Assistance Publique Hôpitaux de Paris, Hendaye, France
| | - Karine Baumstarck
- EA 3279, CEReSS—Health Service Research and Quality of Life Center, Aix Marseille Université, 27 bd Jean Moulin, Marseille, France
- * E-mail:
| | - Pascal Auquier
- EA 3279, CEReSS—Health Service Research and Quality of Life Center, Aix Marseille Université, 27 bd Jean Moulin, Marseille, France
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Nissen S, Purssell E, Shaw K, Bailey C, Efstathiou N, Dunford C. Impaired mobility associated with an increased likelihood of death in children: A systematic review. J Child Health Care 2018; 22:147-158. [PMID: 29110529 DOI: 10.1177/1367493517732839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improved identification of children with an increased likelihood of death can support appropriate provision of integrated palliative care. This systematic review aims to consider immobility and the associated likelihood of death in children with disabilities, living in high-income countries. Two reviewers independently searched MEDLINE, Embase, Cochrane Library, OpenGrey and Science Citation Index (1990-2016) for studies that reported hazard ratios (HRs) and relative risk for the likelihood of death related to impaired mobility. Nine papers were included. Three studies reported functioning using the Gross Motor Function Classification Scale (GMFCS) and the remaining studies reported measures of functioning unique to the study. The strongest single prognostic factor for the likelihood of death was 'lack of sitting ability at 24 months', HR 44.4 (confidence interval (CI) 6.1-320.8) followed by GMFCS V HR 16.3 (CI 5.6-47.2) and 11.4 (CI 3.76-35.57) and 'not able to cruise by 24 months', HR 14.4 (CI 3.5-59.2). Immobility is associated with an increased risk of dying over study periods, but different referent groups make clinical interpretation challenging. Overall, the quality of evidence is moderate. The findings suggest that immobility can support identification of children who may benefit from integrated palliative care.
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Affiliation(s)
- Sally Nissen
- 1 Department of Child and Family Health, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Karen Shaw
- 3 University of Birmingham, Birmingham, West Midlands, UK
| | - Cara Bailey
- 3 University of Birmingham, Birmingham, West Midlands, UK
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Rousseau MC, Baumstarck K, Leroy T, Khaldi-Cherif C, Brisse C, Boyer L, Resseguier N, Morando C, Billette De Villemeur T, Auquier P. Impact of caring for patients with severe and complex disabilities on health care workers' quality of life: determinants and specificities. Dev Med Child Neurol 2017; 59:732-737. [PMID: 28432687 DOI: 10.1111/dmcn.13428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
AIM Individuals with severe and complex disabilities, defined by a combination of profound intellectual impairment and serious motor deficit resulting in extreme dependence, often remain in hospital or at residential facilities. The aim of this study was to identify the determinants of quality of life (QoL) of 238 health care workers (HCWs) caring for individuals with severe and complex disabilities. METHOD We conducted a cross-sectional study. The recruitment of the HCWs was performed in five French centres specializing in patients with severe and complex disabilities. The selection criteria were age above 18 years, being an institutional referent HCW (a resource person coordinating various issues for or about the patient), and agreeing to participate. Sociodemographic, health, professional variables, and psycho-behavioural (QoL, burn-out, and coping strategies) data were collected. RESULTS Of the 362 eligible HCWs, 65.7% returned the questionnaires. The scores of the physical and social dimensions of QoL were significantly lower, and the score of the psychological dimension significantly higher, than those of a comparison group. The main factors modulating QoL were age, financial difficulties, nature of coping strategy, and burn-out. INTERPRETATION This research provides preliminary evidence that caring for patients with severe and complex disabilities affects the QoL of HCWs. These results support the need for optimization of the work environments for HCWs.
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, Hyères, France.,Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Karine Baumstarck
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Tanguy Leroy
- Groupe de Recherche de Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | | | - Catherine Brisse
- Comité d'Études, d'Éducation et de Soins Auprès des Personnes Polyhandicapées, Paris, France
| | - Laurent Boyer
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Noémie Resseguier
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Claire Morando
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Thierry Billette De Villemeur
- Service de Neuropédiatrie et Polyhandicap Pédiatrique, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pascal Auquier
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
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