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Cardwell KL, Koch L, McKenna OJ, Pilutti LA, Fakolade A. Mapping Resilience: Structural Equation Modeling of Psychological Resilience in Multiple Sclerosis Care Partners. Int J MS Care 2023; 25:245-251. [PMID: 37969910 PMCID: PMC10634600 DOI: 10.7224/1537-2073.2023-078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Care partners are essential supports to individuals with multiple sclerosis (MS). Both negative and positive outcomes associated with the caregiving role have been reported. Psychological resilience may be an important factor influencing the MS caregiving experience, but an MS-specific model of care partner resilience has yet to be established. This study sought to explore an explicit model of MS care partner resilience. METHODS Cross-sectional data from 471 Canadian MS care partners were collected via an online survey. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to test measures within a hypothesized model of resilience. Resilience was measured using the 25-item Connor-Davidson Resilience Scale. RESULTS Following CFA, the hypothesized model was simplified due to the poor fit of several variables. The final model yielded a moderate SEM fit (χ2 = 6030.95, P < .01). Being a woman was associated with greater caregiving tasks (β = 0.53, P < .001) and poorer spiritual health (β = -0.35, P < .001). Spiritual health, but not caregiving tasks, had a positive impact on both positive (β = 0.48, P < .01) and negative coping (β = 0.49, P = .01). Quality of life and resilience did not have relationships with other variables in the model. However, quality of life had a positive, unidirectional influence on resilience (β = 0.83, P < .01). CONCLUSIONS Our findings indicate that spiritual health is an important predictor of coping and should be further explored in MS care partners. Quality of life may act as a precursor to resilience within MS care partners. Further research and exploration into MS care partner resilience is warranted to confirm this exploratory model.
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Affiliation(s)
- Katherine L. Cardwell
- From the Interdisciplinary School of Health Sciences (KLC, LAP), the Faculty of Medicine (OJM), and the Brain and Mind Research Institute (LAP), University of Ottawa, Ottawa, ON, Canada
| | - Laura Koch
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada (LK)
| | - Odessa J. McKenna
- From the Interdisciplinary School of Health Sciences (KLC, LAP), the Faculty of Medicine (OJM), and the Brain and Mind Research Institute (LAP), University of Ottawa, Ottawa, ON, Canada
| | - Lara A. Pilutti
- From the Interdisciplinary School of Health Sciences (KLC, LAP), the Faculty of Medicine (OJM), and the Brain and Mind Research Institute (LAP), University of Ottawa, Ottawa, ON, Canada
| | - Afolasade Fakolade
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada (AF)
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Benini S, Pellegrini E, Descovich C, Lugaresi A. Burden and resources in caregivers of people with multiple sclerosis: A qualitative study. PLoS One 2023; 18:e0265297. [PMID: 37068110 PMCID: PMC10109507 DOI: 10.1371/journal.pone.0265297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Caregivers of people with Multiple Sclerosis are required to provide ongoing assistance especially during the advanced stages of the disease. They have to manage interventions and assume responsibilities which significantly impact both their personal quality of life and family's dynamics. OBJECTIVE A qualitative phenomenological study was carried out to understand the experience of burden in caregivers and their resources to manage it. The study also explores how healthcare services involved in the Multiple Sclerosis Clinical Pathway respond to the needs of well-being of patients and family members. METHODS 17 caregivers were involved in focus groups and in semi-structured individual interviews. RESULTS Fatigue is experienced by all respondents and it starts when physical disabilities increase or when people become aware of them. Many caregivers declare that they refer to intrinsic (love towards their relatives, patience and dedication) or extrinsic (family members, hobbies) resources to cope with the burden of assistance. Patient associations and the Multiple Sclerosis Clinical Pathway play a significant role in supporting caregivers. CONCLUSIONS Fatigue, loneliness, and isolation are experienced by caregivers and strongly affect their quality of life and health status. The study highlights caregivers' need to reconcile working times with care times, to give more space to self-care and to have moments to share their experiences with someone else. These needs should be at the core of health policies in order to avoid physical and emotional breakdowns which could lead to the rupture of the relational balance on which home care is based.
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Affiliation(s)
| | | | | | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
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3
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Mcmullan J, Lohfeld L, McKnight AJ. Needs of informal caregivers of people with a rare disease: a rapid review of the literature. BMJ Open 2022; 12:e063263. [PMID: 36523233 PMCID: PMC9748923 DOI: 10.1136/bmjopen-2022-063263] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Many people living with a rare disease (RD) are cared for by a family member. Due to a frequent lack of individual RD knowledge from healthcare professionals, the patient and their informal caregiver are frequently obliged to become 'experts' in their specific condition. This puts a huge strain on family life and results in caregivers juggling multiple roles in addition to unique caring roles including as advocate, case manager and medical navigator. We conducted a rapid review of literature reporting on the unmet needs of informal caregivers for people living with an RD. All searches were conducted on 14 September 2021, followed by a manual searches of reference lists on 21 September 2021. SETTING Searches were conducted in Medline, Embase, Web of Science, GreyLit and OpenGrey. RESULTS Thirty-five papers were included in the final review and data extracted. This rapid review presents several unmet needs identified by informal caregivers of persons with an RD. The related literature was organised thematically: caregiver burden, support through the diagnosis process, social needs, financial needs, psychological needs, information and communication needs and acknowledgement from healthcare professionals. CONCLUSIONS This review provides evidence that increased meaningful support is required for caregivers. Active engagement should be encouraged from this cohort in future research and awareness raised of the support available to improve the quality of life for families living with an RD. The unmet needs identified through this review will benefit people living with an RD, caregivers, healthcare professionals and policy makers.
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Affiliation(s)
- Julie Mcmullan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Smyth P, Watson KE, Al Hamarneh YN, Tsuyuki RT. The effect of nurse practitioner (NP-led) care on health-related quality of life in people with multiple sclerosis - a randomized trial. BMC Neurol 2022; 22:275. [PMID: 35879701 PMCID: PMC9310450 DOI: 10.1186/s12883-022-02809-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Care for People with Multiple Sclerosis (PwMS) is increasingly complex, requiring innovations in care. Canada has high rates of MS; it is challenging for general neurologists to optimally care for PwMS with busy office practices. The aim of this study was to evaluate the effects of add-on Nurse Practitioner (NP)-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS), compared to usual care (community neurologist, family physician). Methods PwMS followed by community neurologists were randomized to add-on NP-led or Usual care for 6 months. Primary outcome was the change in HADS at 3 months. Secondary outcomes were HADS (6 months), EQ5D, MSIF, CAREQOL-MS, at 3 and 6 months, and Consultant Satisfaction Survey (6 months). Results We recruited 248 participants; 228 completed the trial (NP-led care arm n = 120, Usual care arm n = 108). There were no significant baseline differences between groups. Study subjects were highly educated (71.05%), working full-time (41.23%), living independently (68.86%), with mean age of 47.32 (11.09), mean EDSS 2.53 (SD 2.06), mean duration since MS diagnosis 12.18 years (SD 8.82) and 85% had relapsing remitting MS. Mean change in HADS depression (3 months) was: -0.41 (SD 2.81) NP-led care group vs 1.11 (2.98) Usual care group p = 0.001, sustained at 6 months; for anxiety, − 0.32 (2.73) NP-led care group vs 0.42 (2.82) Usual care group, p = 0.059. Other secondary outcomes were not significantly different. There was no difference in satisfaction of care in the NP-led care arm (63.83 (5.63)) vs Usual care (62.82 (5.45)), p = 0.194). Conclusion Add-on NP-led care improved depression compared to usual neurologist care and 3 and 6 months in PwMS, and there was no difference in satisfaction with care. Further research is needed to explore how NPs could enrich care provided for PwMS in healthcare settings. Trial registration Retrospectively registered on clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT04388592, 14/05/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02809-9.
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Affiliation(s)
- Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.
| | - Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Yazid N Al Hamarneh
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada
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5
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Rajachandrakumar R, Finlayson M. Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e874-e897. [PMID: 34935217 DOI: 10.1111/hsc.13687] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Unpaid caregivers, typically family and friends, provide significant amounts of support to people with multiple sclerosis (MS). Understanding their experiences, needs and challenges is necessary to ensure that caregivers receive the support that they require to continue in their role. Our aim was to map the current state of knowledge about unpaid caregivers of people with MS and identify gaps in knowledge to guide future research and practice. We used scoping review methodology with three major health-related databases (MEDLINE, CINAHL, APA Psychinfo), searching in September 2019, April and October 2020 and October 2021. We selected peer-reviewed scientific articles reporting on primary studies of unpaid caregivers of people with MS, regardless of topic or research design. We extracted information on study aim, participant characteristics, measures used and key findings to generate major themes and identify knowledge gaps. We identified 108 published studies between 1992 and 2021 that met our criteria. Studies of spousal caregivers were most common. Studies focused primarily on measurement of caregiver burden or other negative consequences of caregiving. Thirteen studies addressed positive consequences of caregiving. Sixteen studies reported actual tasks performed by caregivers and seven reported outcomes of caregiver support interventions. Attention to diversity issues that may influence caregiving experiences and outcomes was rare. Overall, knowledge of MS caregiving is limited, particularly with respect to tasks performed by caregivers that may contribute to negative outcomes, diversity issues and effective approaches to remediate caregiver burden. Without this knowledge, finding ways to better support MS caregivers will be difficult.
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Affiliation(s)
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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6
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Smyth P, Watson KE, Tsuyuki RT. Measuring the effects of nurse practitioner (NP)-led care on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial. Trials 2021; 22:785. [PMID: 34749784 PMCID: PMC8577034 DOI: 10.1186/s13063-021-05726-3] [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: 04/09/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background Canada has one of the highest rates of multiple sclerosis (MS) in the world. Treatments and supports for people with MS (PwMS) have become increasingly complex, requiring individualized and adaptive care. Specialized NPs provide advanced skills to those with complex medical conditions, with potential to enhance the health, functioning, and quality of life for PwMS. This study aims to determine the effect of a Nurse Practitioner (NP) on depression and anxiety levels in PwMS. Methods We will perform a parallel randomized controlled trial. PwMS who are followed by general private-practice neurologists will be randomly assigned to the intervention group (NP-led care) or the ‘usual care’ control group (general neurologist or family physician and registered nurse support). In the intervention group, the NP will assess and provide care to the MS patient and their caregiver at a baseline visit, with 3-month and 6-month follow-up visits. PwMS in the control group will receive usual care provided by their community neurologists or family physicians with the standard assistance provided by registered nurses experienced in MS care. The primary outcome will be the difference in change in the patient’s anxiety and depression scores as measured by the validated Hospital Anxiety and Depression Scale (HADS) questionnaire at 3 months. Secondary outcomes will include difference in change in HADS at 6 months; Modified Fatigue Impact Scale scores (MSIF) at 3 and 6 months; EQ-5D scores at 3 and 6 months; caregiver health-related quality of life in MS measures (CAREQOL-MS) at 3 and 6 months; number of visits and phone calls to healthcare professionals recorded by patient, and satisfaction with NP-led care vs usual care measured by the validated Consultant Satisfaction Questionnaire. Discussion Findings from this study will contribute to exploring benefits of advanced nursing practitioner interventions for PwMS followed by general neurologists and family physicians in a community setting. It will provide evidence of the benefits of NP-led care for PwMS and offer an alternative healthcare resource for management of MS. Trial registration ClinicalTrials.govPro00069595. Retrospectively registered on June 26, 2020. Protocol version: January 2017, version 1. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05726-3.
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Affiliation(s)
- Penelope Smyth
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada.
| | - Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
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Topcu G, Buchanan H, Aubeeluck A, Ülsever H. Informal carers' experiences of caring for someone with Multiple Sclerosis: A photovoice investigation. Br J Health Psychol 2020; 26:360-384. [PMID: 33128428 DOI: 10.1111/bjhp.12482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/23/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study explores the lived experiences of carers of people with Multiple Sclerosis (MS), specifically in relation to their quality of life (QoL), through the use of images and narratives, with the aim of gaining a nuanced insight into the complex nature of QoL in the MS caregiving context. DESIGN Real-time qualitative design using the photovoice method. METHODS Twelve MS carers (aged 30-73 years) took photographs of objects/places/events that represented enhancement or compromise to their QoL and composed written narratives for each photograph based on their experiences of caregiving. In total, 126 photographs and their corresponding narratives were analysed using content analysis. RESULTS Seven inter-related themes were identified. MS caregiving-related challenges, sense of loss (e.g., loss of activities), emotional impact (e.g., feeling lonely), urge to escape, and sense of anxiety over the unpredictability of MS carer role were discussed in relation to the negative experiences that compromised their QoL. The themes precious moments (e.g., time spent with loved ones or hobbies) and helpful support (e.g., family and pets) encompassed participants' positive experiences that enhanced their QoL. CONCLUSIONS Findings demonstrated the multi-faceted and complex nature of MS caregiver's QoL and highlighted that although the experiences of MS carers were mostly negative, there were also some positive aspects to caregiving, that helped enhance carers' QoL by ameliorating these negative experiences. These findings can be used to inform support programmes and enhance service provision for MS carers.
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Affiliation(s)
- Gogem Topcu
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Heather Buchanan
- Division of Rehabilitation, Ageing and Well-being, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aimee Aubeeluck
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Hatice Ülsever
- Department of Psychology, Cyprus International University, Nicosia, North Cyprus
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8
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Follow-Ups with callers of a palliative and hospice care hotline for severely affected multiple sclerosis patients: Evaluation of its impact. Mult Scler Relat Disord 2020; 42:102079. [PMID: 32315978 DOI: 10.1016/j.msard.2020.102079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Palliative and Hospice Care (PHC) focuses on improving quality of life for anyone who has a serious illness. Multiple Sclerosis (MS) patients have significant PHC needs, yet PHC still mostly attends to cancer patients. The implemented and evaluated nationwide PHC-MS hotline (Strupp et al., 2017) appeared to provide a useful service to patients. OBJECTIVES Prospective follow-up study to evaluate the impact of the hotline and analyse challenges and possible barriers to integrating PHC services. METHODS Information on implementing PHC services was gathered through follow-up hotline consultations utilising a standardised documentary sheet. Data was analysed descriptively and several individual cases are presented. RESULTS Of 303 calls to the hotline (54.5% female, mean age 51 years, 87.7% chronic progressive MS, mean duration of illness 17 years, median EDSS 8), for 84 (27.7%) PHC services were indicated. Of these 84 patients, 32 agreed to follow-up calls which were conducted at least once. For 6 (19%) patients, PHC service integration was successful. For 5 (16%) PHC was refused. For 5 (16%) PHC did not fit current patient needs, and for 7 (22%) PHC has not yet been contacted by patients (or caregivers). For a further 9 (28%) follow-ups revealed that no more consultation was possible (e.g., caller lost to follow-up). CONCLUSION The PHC approach and its services as well as legislation are still highly focused on cancer care, although patients with long-term neurological conditions would likely benefit greatly from them.
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9
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Racial differences in retinal neurodegeneration as a surrogate marker for cortical atrophy in multiple sclerosis. Mult Scler Relat Disord 2019; 31:141-147. [DOI: 10.1016/j.msard.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
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10
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Petrikis P, Baldouma A, Katsanos AH, Konitsiotis S, Giannopoulos S. Quality of Life and Emotional Strain in Caregivers of Patients with Multiple Sclerosis. J Clin Neurol 2019; 15:77-83. [PMID: 30618220 PMCID: PMC6325374 DOI: 10.3988/jcn.2019.15.1.77] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose This study aimed was to measure the quality of life, fatigue, stress, and depression in a consecutive sample of caregivers of multiple sclerosis (MS) patients. Methods We included data from 131 consecutive caregivers of MS patients [age=51.2±12.8 years (mean±SD), males=53.4%, duration of caregiving=10.0±6.3 years]. We assessed the quality of life, fatigue, stress, and depression of the caregivers using the 36-item Short Form Health Survey, Krupp Fatigue Severity Scale, Kingston Caregiver Stress Scale, and Hamilton Scale for Depression, respectively. The disability status of the patients was assessed using the Kurtzke Expanded Disability Status Scale. We used linear regression models to identify possible correlations between all of the aforementioned scales, while multivariable logistic regression models were employed to assess the correlations of caregiver fatigue with caregiver characteristics and patient disability. Results The linear regression analyses revealed that caregiver fatigue was positively associated with stress and negatively correlated with both physical health status and mental health status. Caregiver stress was positively associated with depression and negatively correlated with both physical health status and mental health status. Depression was negatively correlated with both caregiver physical health status and mental health status. In multivariable logistic regression analysis, caregiver fatigue was found to be independently associated with education status [odds ratio (OR)=0.61, 95% CI=0.37 to 0.99], history of chronic disease (OR=5.52, 95% CI=1.48 to 20.55), other chronic diseases in the family (OR=7.48, 95% CI=1.49 to 37.47), and the disability status of the patient (OR=1.36, 95% CI=1.03 to 1.80). Conclusions Fatigue, stress, and depression in caregivers of MS patients are negatively correlated with their physical health status and mental health status. Caregiver fatigue is independently associated with education status, history of chronic disease, other chronic disease in the family, and patient disability.
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Affiliation(s)
- Petros Petrikis
- Psychiatric Clinic, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Anastasia Baldouma
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece.,Neurosurgical Research Institute, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece.,Neurosurgical Research Institute, School of Medicine, University of Ioannina, Ioannina, Greece
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Sadigh M, Nawagi F, Sadigh M. The Economic and Social Impact of Informal Caregivers at Mulago National Referral Hospital, Kampala, Uganda. Ann Glob Health 2018; 82:866-874. [PMID: 28283141 DOI: 10.1016/j.aogh.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The severe deficit of health care workers in Uganda necessitates hospitalized patients to be cared for by a relative. These informal caregivers constitute a crucial component of patient care. Mulago Hospital in Kampala, Uganda, is one of the nation's national referral hospitals, receiving very sick patients. Although studies have been conducted on challenges facing informal caregivers in the home setting, no study has addressed the caregiver burden in the hospital setting. METHODS A survey of 100 randomly selected informal caregivers was conducted in Mulago Hospital's internal medicine wards to evaluate informal caregivers' demographics, impact on patient care, and challenges. RESULTS Challenges include emotional burdens, lack of sanitation, accommodation, sufficient health workers, finances, and recognition. Recommendations were given to ensure improve informal caregivers' situations. CONCLUSIONS Despite hardships, informal caregivers recognize the importance of familial presence, thereby setting a new standard for patient care by recreating the comfort of home care in the hospital. Studying the characteristics of these care givers and more fully delineating the sacrifices they make and the challenges they faced provides the basis for a series of recommendations to hospital management aimed both at improved patient care and care of the informal caregiver.
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Affiliation(s)
- Mitra Sadigh
- Post Baccalaureate Premedical Program, University of Vermont College of Medicine, Burlington, VT.
| | - Faith Nawagi
- Nursing School, Makerere University College of Health Sciences, Kampala, Uganda
| | - Majid Sadigh
- Western Connecticut Health Network/University of Vermont College of Medicine, Danbury, CT
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12
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Lee EJ, Pieczynski J, DeDios-Stern S, Simonetti C, Lee GK. Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis. Work 2016; 52:777-87. [PMID: 26599674 DOI: 10.3233/wor-152205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. However, gender differences in psychosocial adjustment among caregivers have not been fully explored. OBJECTIVE The purpose of this study was to explore gender differences in the need for various supports and type of social support needed, caregiver strain, and quality of life among caregivers for individuals with MS. METHODS 106 caregivers participated in this study. Independent sample t-tests and multiple regression analyses were conducted to examine gender differences in strain, need for supports, social support, and quality of life. RESULTS Analyses revealed gender difference among important psychosocial variables. Specifically, women reported higher levels of caregiver strain, higher needs for emotional support, and higher perceived social support. Additionally, multiple regression analyses revealed an inverse relationship between expressed emotional needs and quality of life for men, but not for women. CONCLUSIONS MS caregivers experience significant strain that diminishes quality of life. Social support and needs fulfillment can act to buffer this stress; however, results indicate that this varies by gender, with gender differences observed in strain, perceived support, and expressed needs among MS caregivers. The study implications for rehabilitation research are discussed.
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Affiliation(s)
- Eun-Jeong Lee
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Jessica Pieczynski
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | | | - Gloria K Lee
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, East Lansing, MI, USA
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13
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Meca-Lallana J, Mendibe M, Hernández-Clares R, Caminero AB, Mallada-Frechin J, Dávila-Gonzalez P, Garcés-Redondo M, Gómez M, Millán-Pascual J, Soriano-Hernández G, Amigo-Jorrín MDC. Predictors of burden and depression among caregivers of relapsing-remitting MS patients in Spain: MS Feeling study. Neurodegener Dis Manag 2016; 6:277-87. [PMID: 27480482 DOI: 10.2217/nmt-2016-0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To assess potential predictors for burden and depression among caregivers of relapsing-remitting multiple sclerosis patients in Spain. Family functioning and social support were also assessed. PATIENTS & METHODS Multicenter and cross-sectional study in relapsing-remitting multiple sclerosis adult patients and their respective informal caregivers (n = 180). Assessment performed: Zarit Scale (Burden), Center for Epidemiologic Studies Depression-7 Scale (depression), Family APGAR (Adaptation, Partnership, Growth, Affection, Resolve) Questionnaire (family functioning) and Duke UNC-11 Functional Social Support Questionnaire (social support). Multivariate logistic regression analysis assessed burden and depression predictors among caregivers. RESULTS Caregivers suffered burden (19.4%) and depression (20.6%) and perceived poor social support (9.4%) and family dysfunction (10.6%). Burden predictors were patient's degree of disability, caregiver time and number of medications administered to patient. Depression predictors were patient's age and daily caregiving time. CONCLUSION The factors reported here could help clinicians to identify caregiver groups particularly at risk of burden and depression for timely intervention.
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Affiliation(s)
- José Meca-Lallana
- Multiple Sclerosis Unit, Department of Neurology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Cathedra of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, España
| | - Mar Mendibe
- Department of Neurology, Hospital Universitario de Cruces, Vizcaya, Spain
| | - Rocío Hernández-Clares
- Multiple Sclerosis Unit, Department of Neurology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Cathedra of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, España
| | - Ana Belén Caminero
- Department of Neurology, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | | | | | - Moisés Garcés-Redondo
- Department of Neurology, Hospital de Tortosa Vergede la Cinta, Tortosa, Tarragona, Spain
| | - Montserrat Gómez
- Department of Neurology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Jorge Millán-Pascual
- Section of Neurology, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
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Mutch K, Methley A, Hamid S, Moore P, Jacob A. If they are OK, we are OK: the experience of partners living with neuromyelitis optica. Disabil Rehabil 2016; 39:1279-1286. [PMID: 27374494 DOI: 10.1080/09638288.2016.1193233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Neuromyelitis optica (NMO) is a rare neuro-inflammatory condition characterized by acute relapses causing severe visual or physical disability. The impact on family members and their experiences have not been studied. The study aims were to explore the lived experience of partners of people with NMO and to investigate potential carer burden in this population. METHOD A mixed-method design was used; 11 partners of people with NMO completed semi-structured interviews; 54 partners completed Zarit Burden Interview and Hospital Anxiety and Depression Scale. RESULTS Three qualitative themes influenced partners' quality of life (QoL): role/relationship; it's all about them; and the impact of NMO. Life changed dramatically for participants after the first NMO attack, necessitating responsibility for physical, financial, social, and emotional support. As NMO symptoms improved and stabilized, freedom and QoL for spouses also improved, albeit with on-going worries regarding the impact of potential devastating future relapses. Quantitative findings showed mild/moderate carer burden (46%), mild/moderate anxiety (59%), and mild/moderate depression (24%). No partner indicated severe carer burden, anxiety, or depression. CONCLUSION Participants regarded themselves as partners rather than carers whom require assessment and support for their emotional and health well-being. Health-care professionals need to acknowledge the important role partners play in the dynamics of the family unit, through greater discussion and inclusion. Implications for Rehabilitation NMO has a strong impact on couples, resulting in both physical caregiving needs and anxiety regarding the unpredictability of potential devastating relapses. Partners do not necessarily experience clinically significant "burden", anxiety or depression, and tools which screen for this may not capture the nature of their experiences. Health-care professionals need to acknowledge, consult, and respect the experience of partners during assessment and implementation of action plans. Partners should be individually assessed based upon the physical and emotional dependency created by NMO to improve their health and well-being.
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Affiliation(s)
- Kerry Mutch
- a Walton Centre Foundation Trust , Liverpool , UK
| | - Abigail Methley
- b Section for Clinical and Health Psychology, School of Psychological Sciences , University of Manchester , Manchester , UK
| | - Shahd Hamid
- a Walton Centre Foundation Trust , Liverpool , UK
| | - Perry Moore
- a Walton Centre Foundation Trust , Liverpool , UK
| | - Anu Jacob
- a Walton Centre Foundation Trust , Liverpool , UK
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Leibach GG, Stern M, Arelis AA, Islas MAM, Barajas BVR. Mental Health and Health-Related Quality of Life in Multiple Sclerosis Caregivers in Mexico. Int J MS Care 2016; 18:19-26. [PMID: 26917994 DOI: 10.7224/1537-2073.2014-094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) rates are increasing in Latin America, and caregiving for an individual with MS is associated with poorer mental and physical health outcomes. No existing research has examined the relation between mental health and health-related quality of life (HRQOL) in MS caregivers in Latin America. METHODS The present study examined the association between mental health (Patient Health Questionnaire-9, Satisfaction with Life Scale, Rosenberg Self-esteem Scale, State-Trait Anxiety Inventory) and HRQOL (36-item Short Form Health Status Survey) in 81 Mexican MS caregivers. RESULTS A canonical correlation analysis uncovered a large, significant overall association between mental health and HRQOL, with 52.7% of the variance shared between the two sets of constructs. When individual canonical loadings were examined in this analysis, the most substantial pattern that emerged was between depression and general health. Four regressions controlling for demographic variables found that HRQOL uniquely accounted for 19.0% of the variance in caregiver anxiety, 32.5% in depression, 13.5% in satisfaction with life, and 14.3% in self-esteem. CONCLUSIONS These findings demonstrated a strong association between HRQOL and mental health, which points to directions for future studies on interventions for MS caregivers, particularly in Mexican and other Latino populations.
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Affiliation(s)
- Gillian G Leibach
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA (GGL); Department of Child & Family Studies, Rehabilitation & Mental Health Counseling Program, University of South Florida, Tampa, FL, USA (MS); Department of Neuroscience, University of Guadalajara, Guadalajara, Mexico (MAMI); Department of Research, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (AAA); and Department of Psychology, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (BVRB)
| | - Marilyn Stern
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA (GGL); Department of Child & Family Studies, Rehabilitation & Mental Health Counseling Program, University of South Florida, Tampa, FL, USA (MS); Department of Neuroscience, University of Guadalajara, Guadalajara, Mexico (MAMI); Department of Research, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (AAA); and Department of Psychology, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (BVRB)
| | - Adriana Aguayo Arelis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA (GGL); Department of Child & Family Studies, Rehabilitation & Mental Health Counseling Program, University of South Florida, Tampa, FL, USA (MS); Department of Neuroscience, University of Guadalajara, Guadalajara, Mexico (MAMI); Department of Research, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (AAA); and Department of Psychology, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (BVRB)
| | - Miguel Angel Macias Islas
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA (GGL); Department of Child & Family Studies, Rehabilitation & Mental Health Counseling Program, University of South Florida, Tampa, FL, USA (MS); Department of Neuroscience, University of Guadalajara, Guadalajara, Mexico (MAMI); Department of Research, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (AAA); and Department of Psychology, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (BVRB)
| | - Brenda Viridiana Rábago Barajas
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA (GGL); Department of Child & Family Studies, Rehabilitation & Mental Health Counseling Program, University of South Florida, Tampa, FL, USA (MS); Department of Neuroscience, University of Guadalajara, Guadalajara, Mexico (MAMI); Department of Research, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (AAA); and Department of Psychology, Universidad Enrique Diaz de Leon, Guadalajara, Mexico (BVRB)
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Penwell-Waines L, Goodworth MCR, Casillas RS, Rahn R, Stepleman L. Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers. HEALTH COMMUNICATION 2015; 31:478-484. [PMID: 26400038 DOI: 10.1080/10410236.2014.967909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study applied the Stress/Health Model to examine a novel approach for promoting stress management among 67 caregivers of persons with multiple sclerosis, who often face unique caregiving challenges. Hierarchical regressions indicated that caregiver distress (i.e., emotional burden) and engagement in other health-promoting activities (i.e., controlling alcohol use) were the best predictors of caregiver stress management. Communication with the MS care recipient's health provider about caregiver engagement in health-promoting activities was associated with caregiver stress management, but not significantly more so than explained by the other factors (i.e., caregiver distress and engagement in health-promoting behaviors). A more controlled study would be indicated to further explain how to encourage, within the medical setting, caregiver engagement in self-care activities.
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Affiliation(s)
- Lauren Penwell-Waines
- a Department of Psychiatry and Health Behavior , Medical College of Georgia at Georgia Regents University
| | | | | | | | - Lara Stepleman
- a Department of Psychiatry and Health Behavior , Medical College of Georgia at Georgia Regents University
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Unmet needs of caregivers of severely affected multiple sclerosis patients: A qualitative study. Palliat Support Care 2015; 13:1685-93. [PMID: 26081132 DOI: 10.1017/s1478951515000607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) patients' caregivers are sometimes considered as "hidden patients." How much more this might be true for caregivers of severely affected MS patients has so far been scarcely studied. Palliative care also addressing relatives' needs might therefore be very relevant for these caregivers. However, we do not yet know which unmet needs they have and how these could be met. Our aim was to gain an insight into the subjectively unmet needs of caregivers of severely affected MS patients in Germany. METHOD The study employed a qualitative cross-sectional approach for assessing unmet needs. Twelve caregivers of severely affected MS patients were recruited using a convenience sampling approach. Face-to-face interviews were conducted, audiotaped, and transcribed verbatim, followed by qualitative content analysis. RESULTS Unmet needs were sorted into the following categories: "relationship to physician," "individual support by the healthcare system," "relationship to the individual severely affected by MS," "end-of-life issues," "self-care," and "higher awareness of MS." Caregivers tended to group the unmet needs of their care recipients with their own and rarely focused on their own wishes and restrictions. SIGNIFICANCE OF RESULTS A close patient-caregiver dyad makes it difficult to differentiate unmet caregiver needs. However, the palliative care approach might help caregivers of severely affected MS patients by answering questions on disease progress and end-of-life issues, as well as by offering respite care, support for self-care, and help in preserving one's identity, and also anticipating the time to come after the death.
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18
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Khan O, Williams MJ, Amezcua L, Javed A, Larsen KE, Smrtka JM. Multiple sclerosis in US minority populations: Clinical practice insights. Neurol Clin Pract 2015; 5:132-142. [PMID: 26137421 DOI: 10.1212/cpj.0000000000000112] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The heterogeneity of multiple sclerosis (MS) characteristics among various ethnic minority populations is a topic of recent interest. However, these populations are consistently underrepresented in clinical trials, leading to limited data on the effectiveness of treatments in these groups of patients and lack of an evidence-based approach to treatment. In order to achieve optimal disease management in the ethnic minority MS populations, a better understanding of the regional, socioeconomic, and cultural influences that result in underrepresentation of these groups in clinical trials is needed. Furthermore, it would be beneficial to identify the genetic factors that influence disease disparity in these minority populations. Suggestions for the identification and implementation of best practices for fostering the trust of ethnic minority patients with MS and enhancing their participation in clinical trials are offered.
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Affiliation(s)
- Omar Khan
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
| | - Mitzi J Williams
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
| | - Lilyana Amezcua
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
| | - Adil Javed
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
| | - Kristin E Larsen
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
| | - Jennifer M Smrtka
- Department of Neurology (OK), Wayne State University School of Medicine, Detroit, MI; Multiple Sclerosis Center of Atlanta (MJW), GA; Department of Neurology (LA), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (AJ), University of Chicago School of Medicine, IL; ProEd Communications (KEL), Beachwood, OH; and South Florida Neurology Associates (JMS), Boca Raton
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Uccelli MM. The impact of multiple sclerosis on family members: a review of the literature. Neurodegener Dis Manag 2014; 4:177-85. [PMID: 24832035 DOI: 10.2217/nmt.14.6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most common neurological diseases in young adults and involves inflammatory demyelination of the CNS. MS typically manifests between 20 and 40 years of age, and can lead to significant disability in some cases. The disease course is unpredictable. MS has a significant impact on families, influencing their wellbeing and quality of life, often creating psychological stress in each family member as well as on family functioning in general. Common themes include the impact of the emotional state of the person with MS on family members, the role of the healthy parent on how children cope, the effect of a lack of information about MS, communication within the family and with healthcare professionals, and the importance of assessing and treating families as a dynamic unit in order to assure comprehensive intervention plans. The current literature review is based on 30 full research articles meeting inclusion criteria related to partners/couples, family caregivers, children with a parent with MS and parents of young children with MS.
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Affiliation(s)
- Michele Messmer Uccelli
- * Italian Multiple Sclerosis Society, Healthcare Professional & Client Programs, Via Operai 40, Genoa 16149, Italy;
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20
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Jahromi SR, Sahraian MA, Ashtari F, Ayromlou H, Etemadifar M, Ghaffarpour M, Mohammadianinejad E, Nafissi S, Nickseresht A, Shaygannejad V, Togha M, Torabi HR, Ziaie S. Islamic fasting and multiple sclerosis. BMC Neurol 2014; 14:56. [PMID: 24655543 PMCID: PMC3994348 DOI: 10.1186/1471-2377-14-56] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Month-long daytime Ramadan fasting pose s major challenges to multiple sclerosis (MS) patients in Muslim countries. Physicians should have practical knowledge on the implications of fasting on MS. We present a summary of database searches (Cochrane Database of Systematic Reviews, PubMed) and a mini-symposium on Ramadan fasting and MS. In this symposium, we aimed to review the effect of fasting on MS and suggest practical guidelines on management. Discussion In general, fasting is possible for most stable patients. Appropriate amendment of drug regimens, careful monitoring of symptoms, as well as providing patients with available evidence on fasting and MS are important parts of management. Evidence from experimental studies suggests that calorie restriction before disease induction reduces inflammation and subsequent demyelination and attenuates disease severity. Fasting does not appear to have unfavorable effects on disease course in patients with mild disability (Expanded Disability Status Scale (EDSS) score ≤3). Most experts believed that during fasting (especially in summer), some MS symptoms (fatigue, fatigue perception, dizziness, spasticity, cognitive problems, weakness, vision, balance, gait) might worsen but return to normal levels during feasting. There was a general consensus that fasting is not safe for patients: on high doses of anti-convulsants, anti-spastics, and corticosteroids; with coagulopathy or active disease; during attacks; with EDSS score ≥7. Summary These data suggest that MS patients should have tailored care. Fasting in MS patients is a challenge that is directly associated with the spiritual belief of the patient.
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Affiliation(s)
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Acaster S, Perard R, Chauhan D, Lloyd AJ. A forgotten aspect of the NICE reference case: an observational study of the health related quality of life impact on caregivers of people with multiple sclerosis. BMC Health Serv Res 2013; 13:346. [PMID: 24016141 PMCID: PMC3847194 DOI: 10.1186/1472-6963-13-346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/21/2013] [Indexed: 11/21/2022] Open
Abstract
Background There are few published health technology assessments that have included the impact of a disease or treatment on caregivers’ health related quality of life (HRQL). The objectives of this study were to explore the overall HRQL of caregivers of people with Multiple Sclerosis compared to matched controls, and more specifically explore the impact of different levels of functioning in people with MS on caregivers’ HRQL scores. Methods A cross sectional observational study conducted as an online survey was undertaken in the UK. 200 caregivers of people with MS and 200 matched controls completed the EQ-5D, SF-36, HADS and a socio-demographic questionnaire. Caregivers also completed the Patient Determined Disease Steps questionnaire as a measure of MS severity. Differences in HRQL between caregivers and controls were assessed using t-tests and chi square analyses as appropriate. Ordinary Least Squares regression was also used to evaluate the disutility of being a caregiver compared to controls stratified by MS severity. Results Caregivers reported significantly lower HRQL, as measured by the SF-36, HADS and EQ-5D, compared to matched controls. A lower level of functioning in people with MS was mirrored by lower levels of caregivers’ HRQL. At the point at which mobility problems required wheelchair use caregivers reported better HRQL. Conclusions The potential impact of caregiving on HRQL is an important consideration for economic evaluations. In relation to MS, the results suggest that caregiver’s HRQL deteriorates as the people with MS lose functioning; thus treatments that delay loss of function may have a benefit for caregivers as well as patients.
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Affiliation(s)
- Sarah Acaster
- Oxford Outcomes Ltd, Seacourt Tower, West Way, Oxford, UK.
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Bergvall N, Tambour M, Henriksson F, Fredrikson S. Cost-minimization analysis of fingolimod compared with natalizumab for the treatment of relapsing-remitting multiple sclerosis in Sweden. J Med Econ 2013; 16:349-57. [PMID: 23211038 DOI: 10.3111/13696998.2012.755537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fingolimod and natalizumab have the same European Union licence for the treatment of relapsing multiple sclerosis, and are considered by the Committee for Medicinal Products for Human Use (CHMP) to have broadly similar efficacy. OBJECTIVE A cost-minimization analysis was performed to compare differences in treatment costs between fingolimod and natalizumab from a societal perspective in Sweden. METHODS This analysis included costs associated with initiating and following treatment (physician visits and monitoring), continuing therapy (drugs and administration), and lost patient productivity and leisure time. Unit costs (in Swedish krona [SEK]) were based on regional data (median prices for physician visits and monitoring sessions). Natalizumab infusion costs were obtained from the national cost-per-patient database. Drug costs for both therapies were 15,651 SEK/28 days. RESULTS After 3 years, fingolimod use was associated with savings of 124,823 SEK/patient compared with natalizumab (total cost/patient: 566,718 SEK vs 691,542 SEK). Cost savings with fingolimod were 40,402 SEK/patient after 1 year and 301,730 SEK/patient after 10 years. Treatment with natalizumab was 18% more expensive than fingolimod therapy after 1 year and 23% more expensive after 10 years. LIMITATIONS Based on the CHMP assessment, it was assumed that fingolimod and natalizumab have similar efficacy. The analysis was conducted for Sweden, and caution is needed in extrapolating the results to other countries. CONCLUSION Fingolimod is cost-saving compared with natalizumab for the treatment of relapsing-remitting multiple sclerosis in Sweden.
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Pike J, Jones E, Rajagopalan K, Piercy J, Anderson P. Social and economic burden of walking and mobility problems in multiple sclerosis. BMC Neurol 2012; 12:94. [PMID: 22989365 PMCID: PMC3517776 DOI: 10.1186/1471-2377-12-94] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic progressive neurological disease and the majority of patients will experience some degree of impaired mobility. We evaluated the prevalence, severity and burden of walking and mobility problems (WMPs) in 5 European countries. METHODS This was a cross-sectional, patient record-based study involving 340 neurologists who completed detailed patient record forms (PRF) for patients (>18 years) attending their clinic with MS. Patients were also invited to complete a questionnaire (PSC). Information collected included demographics, disease characteristics, work productivity, quality of life (QoL; EuroQol-5D and Hamburg Quality of Life Questionnaire Multiple Sclerosis [HAQUAMS]) and mobility (subjective patient-reported and objectively measured using the timed 25 foot walk test [T25FW]). Relationships between WMPs and disease and other characteristics were examined using Chi square tests. Analysis of variance was used to examine relationships between mobility measures and work productivity. RESULTS Records were available for 3572 patients of whom 2171 also completed a PSC. WMPs were regarded as the most bothersome symptom by almost half of patients who responded (43%; 291/683). There was a clear, independent and strong directional relationship between severity of WMPs (subjective and objective) and healthcare resource utilisation. Patients with longer T25FW times (indicating greater walking impairment) were significantly more likely to require additional caregiver support (p < 0.0001), visit a variety of healthcare professionals including their primary care physicians (p = 0.0044) and require more long-term non-disease modifying drugs (p = 0.0001). A similar pattern was observed when subjective reporting of the severity of WMPs was considered. Work productivity was also markedly impacted by the presence of WMPs with fewer patients working full time and a reduction in weekly working hours as T25FW times and the subjective severity of WMPs increased. CONCLUSIONS In Europe, WMPs in MS represent a considerable personal and social burden both financially and in terms of quality of life. Interventions to improve mobility could have significant benefits for patients and society as a whole.
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Henney HR, Blight AR. Walking impairment in patients with multiple sclerosis - a new therapeutic approach and clinical potential of dalfampridine extended release tablets. Degener Neurol Neuromuscul Dis 2012; 2:53-64. [PMID: 30890878 DOI: 10.2147/dnnd.s19839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Walking impairment is a clinical hallmark of multiple sclerosis (MS) that has been under-recognized as a therapeutic target for pharmacologic intervention. The development and approval of dalfampridine extended release tablets (dalfampridine-ER; known as prolonged-, modified, or sustained-release fampridine outside the USA), 10 mg taken twice daily, to improve walking in patients with MS, fills a previously unmet need. In three randomized, double-blind, placebo-controlled trials, dalfampridine-ER improved walking speed in approximately one-third (37%) of treated patients, and average walking speed on therapy among these responders improved by approximately 25% relative to baseline. Walking-speed improvement among responders was clinically significant, as determined by a statistically significant improvement in the patient-reported 12-item Multiple Sclerosis Walking Scale. Long-term extension studies indicate that responders were able to maintain benefits, compared with nonresponders over prolonged periods of treatment. Dalfampridine-ER was generally well tolerated. Dizziness, insomnia, balance disorder, headache, nausea, urinary tract infection, and asthenia were the most common adverse events. Although the incidence of seizures appeared to be dose related, among patients treated with dalfampridine-ER in the three trials, the rate of seizures was 0.25%. These efficacy and safety data suggest that dalfampridine-ER can be a useful and clinically relevant addition to the pharmacologic armamentarium for the management of MS symptoms and disabilities. Because of its narrow therapeutic index and potential for seizures, it is especially important in the clinical setting to adhere to the dosing recommended in the approved labels.
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Giordano A, Ferrari G, Radice D, Randi G, Bisanti L, Solari A. Health-related quality of life and depressive symptoms in significant others of people with multiple sclerosis: a community study. Eur J Neurol 2012; 19:847-54. [PMID: 22233289 DOI: 10.1111/j.1468-1331.2011.03638.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Uncertain prognosis and modest treatment efficacy make multiple sclerosis (MS) a particularly difficult disease to adjust to for both patients and their significant others (SOs). Few studies have assessed health-related quality of life (HRQOL) and depressive symptoms in SOs of people with MS in the community. We assessed, and identified predictors of, HRQOL and depression in SOs of adults with MS. METHODS POSMOS (postal survey of self-assessed health in MS adults and SOs) is a longitudinal survey on a random sample of 251 people with MS in the Milan area. In 2010, SOs and contemporaneous controls completed the SF-36 and Chicago Multiscale Depression Inventory (CMDI). RESULTS Overall, 142 SOs (mean age 53.1 years; 50% women, 65% partners) and 120 controls (similar to SOs for sex and education, but older) participated. By multivariable modeling of the SO plus control population, SF-36 vitality was lower in SOs (proportional odds ratio 0.45; 95% confidence interval 0.28-0.70), women (0.41; 0.27-0.64), and older subjects (0.98; 0.97-0.99). SF-36 mental health was also lower in SOs (0.62; 0.40-0.96) and women (0.43; 0.28-0.67). Regarding MS characteristics associated with HRQOL and depression in SOs, severe disability [Expanded Disability Status Scale (EDSS > 6.5)] had no effect, whilst depressive symptoms (pathologic CMDI) negatively influenced most SF-36 and all CMDI scores in SOs. CONCLUSIONS SOs had significantly lower vitality and psychological well-being than controls, identifying a burden in being the companion of a person with MS. This burden was unrelated to physical compromise but associated with depressive symptoms in MS.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
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Pangalila RF, van den Bos GA, Stam HJ, van Exel NJA, Brouwer WB, Roebroeck ME. Subjective caregiver burden of parents of adults with Duchenne muscular dystrophy. Disabil Rehabil 2011; 34:988-96. [DOI: 10.3109/09638288.2011.628738] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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