Patient perspectives about multiple sclerosis: A metaphor study

AIM

Determining patients' perceptions of multiple sclerosis, a disease with varying symptoms and prognosis for each individual, can significantly contribute to directing care and treatment. Metaphors may be an opportunity to determine perceptions of this unique illness experience. The aim of this study was to reveal the perceptions of patients with multiple sclerosis about "multiple sclerosis" through metaphors.

METHODS

This study was conducted with metaphor analysis technique based on phenomenological method. The sample included 184 patients with multiple sclerosis. Data was collected face-to-face between July 2022 and January 2023. Each participant was interviewed individually and was asked to fill in the blanks in the sentence, "multiple sclerosis is like… because…". Content analysis was performed for metaphors.

RESULTS

The study revealed five main themes and twelve subthemes that provided insight into the participants' multiple sclerosis perceptions. The themes address (i) Manipulator multiple sclerosis; ambiguous multiple sclerosis, attritive multiple sclerosis, controller multiple sclerosis, demander multiple sclerosis, and conditional multiple sclerosis (ii) Temporal multiple sclerosis; cyclical multiple sclerosis and perpetual multiple sclerosis (iii) Follower multiple sclerosis; unaccepted multiple sclerosis, partner multiple sclerosis and ambusher multiple sclerosis (iv) Different multiple sclerosis; bittersweet multiple sclerosis and unique multiple sclerosis (v) Restorative multiple sclerosis.

CONCLUSION

This study demonstrated that patients with multiple sclerosis mostly had negative perceptions regarding their relationship with multiple sclerosis. The results place a responsibility on healthcare professionals to improve how patients adapt to multiple sclerosis. This study's results can bridge theoretical knowledge and practice.

'Am I fixed, am I better now?': undergoing MR-guided focused ultrasound for essential tremor: an interpretative phenomenological analysis

Introduction

Essential tremor (ET) is characterised by postural and intentional tremor typically affecting the upper limbs, which can negatively impact functionality and quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a novel and promising non-invasive treatment for ET which offers instantaneous results.

Methods

Using interpretative phenomenological analysis we explored the experience of undergoing MRgFUS in six ET patients as well as their experiences pre- and post-procedure.

Results

One-time, retrospective semi-structured interviews were conducted and six themes emerged: Life pre-treatment: "It's everyday tasks that get you down" and "Most people who understand, they are okay. Some people aren't"; MRgFUS: Treatment day: "Going into the unknown" and "There's no way I was going to press that button"; and Life post-treatment: "One is good. Two is better" and "Am I fixed, am I better now?."

Discussion

The findings point to a significant period of adjustment associated with living with ET and the effects of undergoing ET MRgFUS treatment. As ET progressed, participants struggled to cope with increasing symptoms and had to develop coping strategies to manage life with ET. The procedure itself was perceived as strange and extraordinary and despite some immediate adverse effects participants were determined to go through with it. Post procedure, all participants reported tremor suppression which was life changing. While some participants still felt burdened by ET, others expressed it took them a while to psychologically adjust to what essentially was their new body. This study has highlighted the need for patients to be supported at all stages of their ET journey.

Experience of hope in older people with chronic illness: A meta-synthesis

BACKGROUND

The increase in life expectancy has contributed to an increase in the number of older people, but this population has to learn to live with at least one chronic illness. Thus, hope has become an important resource for the older adult to face the repercussions of chronic illness.

OBJECTIVE

To synthesise qualitative evidence on the experience of hope in older people with chronic illness.

METHODS

This meta-synthesis included qualitative studies which present the experiences of hope in older people diagnosed with at least one chronic illness. The searches were made from six databases, guided by the SPIDER tool. The identified articles were then independently screened by two reviewers. The results were analysed according to the thematic synthesis approach.

RESULTS

Eighteen articles were included, and four analytical themes were constructed. The results allow us to understand that older people live with long-term conditions and hope for an ordinary life. To react to new changes and to maintain hope, they create goals that motivate them in daily life. The treatment is initially seen as a salvation, but the information acquired with the evolution of the illness modifies this perception. In addition, the uncertainty about the success of the treatment creates conflict in their hope. In the support and care of older people in the new context of illness, meaningful relationships strengthen hope most of the time. There is still the hope of being reconciled with death, but there are times when suffering overcomes the hope of living.

CONCLUSIONS

This meta-synthesis highlights that the experience of hope in older people is dynamic and influenced by the context of changes related to illness, treatment, significant relationships and proximity to death.

IMPLICATIONS FOR PRACTICE

A better understanding of the role and characteristics of hope in older people with chronic illness may help to develop more effective interventions to promote and maintain hope.

Barriers to and Facilitators of Adjustment Among Iranian Multiple Sclerosis Patients: A Qualitative Study

Patients with multiple sclerosis (MS) experience various physical symptoms and psychosocial problems that disrupt their normal life, and adapting to these conditions is vital for them. Many factors that serve as facilitators of and barriers to achieving adjustment should be identified to be able to help the patients. This study was conducted to explain the experiences of patients with MS regarding the facilitators of and barriers to adjustment using conventional content analysis. The participants consisted of 18 patients, one nurse, one physician, and one patient companion, who were selected from the Multiple Sclerosis Clinic of BouAli, northern Iran, through purposive sampling. Data were collected through individual, in-depth, and semi-structured interviews and analyzed using the method recommended by Elo and Kyngäs (2008). The data analysis generated five subcategories as facilitators and five subcategories as barriers. The subcategories of facilitators included family's appropriate behavior with the patient, occupation, studying and information gathering, religious beliefs, and turning attitude into disease simplification and optimism. The subcategories of barriers were concerns about the uncertain future of the disease, physicians' poor communication and behavior, society's poor attitude, economic problems, and unsatisfactory support by the government and insurance companies. The results showed that a set of individual, environmental, and social factors serves as facilitators of or barriers to the process of adjustment to MS in patients. Gaining knowledge about these factors in congruence with the sociocultural context of the society, as derived from people's real experiences, can help healthcare staff and the family of these patients provide more efficient assistance to the patients for achieving adjustment earlier.

Pain Perceptions, Suffering and Pain Behaviours of Professional and Pre-Professional Dancers towards Pain and Injury: A Qualitative Review

Limited data exist that describe the experiences of pain and injury in dancers. The purpose of the current study was to understand pain perceptions, suffering and pain behaviours associated with pre-professional and professional dancers and to consider the psychosocial factors that influence suffering, behaviour and perceptions of pain. A thematic synthesis review was undertaken in three stages: (1) A systematic search using pre-defined search terms was conducted until 17 November 2022. Qualitative studies were included if they captured dancers’ perceptions, experiences, or the behaviour of dancers towards pain and injury. (2) Quality appraisal and certainty assessments was performed. (3) A five-phase synthesis generated themes that included a certainty assessment score. Twelve studies with 290 dancers met the inclusion criteria. The aggregated mean age was identified as 28.5 years. No studies were excluded following the quality appraisal stage. Nine studies included professional ballet dancers. Three themes were developed: (1) developing positive and adapted perceptions and behaviours towards pain, (2) the impact and danger of embracing pain and the risk of injury and (3) factors that influenced the response to injury and the ability to perform. This review has highlighted the experiences of pre-professional and professional dancers towards pain and injury. Practical implications for healthcare professionals, employers, choreographers and dancers are provided. Further research is required given the limited evidence base.

Experiences of receiving a diagnosis of multiple sclerosis: a meta-synthesis of qualitative studies

PURPOSE

This meta-synthesis aimed to synthesise qualitative evidence on experiences of people with Multiple Sclerosis (MS) in receiving a diagnosis, to derive a conceptual understanding of adjustment to MS diagnosis.

METHODS

Five electronic databases were systematically searched to identify qualitative studies that explored views and experiences around MS diagnosis. Papers were quality-appraised using a standardised checklist. Data synthesis was guided by principles of meta-ethnography, a well-established interpretive method for synthesising qualitative evidence.

RESULTS

Thirty-seven papers were selected (with 874 people with MS). Synthesis demonstrated that around the point of MS diagnosis people experienced considerable emotional upheaval (e.g., shock, denial, anger, fear) and difficulties (e.g., lengthy diagnosis process) that limited their ability to make sense of their diagnosis, leading to adjustment difficulties. However, support resources (e.g., support from clinicians) and adaptive coping strategies (e.g., acceptance) facilitated the adjustment process. Additionally, several unmet emotional and informational support needs (e.g., need for personalised information and tailored emotional support) were identified that, if addressed, could improve adjustment to diagnosis.

CONCLUSIONS

Our synthesis highlights the need for providing person-centred support and advice at the time of diagnosis and presents a conceptual map of adjustment for designing interventions to improve adjustment following MS diagnosis.Implications for RehabilitationThe period surrounding Multiple Sclerosis diagnosis can be stressful and psychologically demanding.Challenges and disruptions at diagnosis can threaten sense of self, resulting in negative emotions.Adaptive coping skills and support resources could contribute to better adjustment following diagnosis.Support interventions should be tailored to the needs of newly diagnosed people.

A qualitative study of illness narratives: ‘overcoming the monster’ master plot for patients with stroke

Background/Aims

Research that considers illness narrative ‘master plots’ (common and recognisable story plots related to the experience of illness), as expressed by individuals who have had a stroke, is needed Thus far, the literature has focused on identifying pre-established illness narrative master plots: the restitution, the chaos and the quest narrative. However, these narrative plots represent extreme psychological responses to the experience of illness; other narratives need to be understood in order to most effectively support individuals with stroke. Further research must identify if other master plots exist, and consider the implication of such plots.

Methods

A narrative methodology was undertaken, contextualised within a social constructivist worldview. A purposive sample of individuals with stroke undertook a single online semi-structured interview. A categorical-form narrative analysis was undertaken in five stages.

Results

A total of eight individuals were interviewed. Following analysis, six individuals were identified as illustrating experiences related to a master plot termed ‘overcoming the monster’. The ‘monster’ was represented in several ways, which included: a mental health problem or an expression relating to internal feelings; a sense of being isolated from others; a threat to the individual's independence; and a negative interaction or experience related to health care. Individuals identified clear strategies for ‘overcoming the monster’. These included: adopting a different way of viewing life; identifying and attaining both big and small goals; persistence and determination in the face of adversity; and giving support to others through activities and receiving support.

Conclusions

Allied health professionals need to understand the importance of this narrativisation of stroke because research has shown that allied health professionals can stereotype interactions by plots and seek to correct them. Implications of these findings ilustate the importance of understanding the individuals experience, not immediately reacting to a narrative type that may seem to fit, understanding the plot of overcoming the monster varies and may need time to be observed.

Key demographics and psychological skills associated with adjustment to progressive Multiple Sclerosis early in the diagnosis

Background/purpose

Being diagnosed with a progressive type of multiple sclerosis (MS) has been associated with worse psychological outcomes compared to relapsing-remitting type. Previous studies of adjustment to MS have primarily focused on relapsing-remitting type MS. The present study aims to examine psychological adjustment for people newly diagnosed with progressive multiple sclerosis.

Methods

This was a multicenter cross-sectional survey of 189 people newly diagnosed with progressive MS. A composite measure of psychological adjustment was created from questionnaires measuring psychological distress, positive affect, perceived-stress, life satisfaction and self-concept. Predictor variables included coping strategies, social support, relationship with partner, psychological vulnerability, MS-related beliefs, and responses to symptoms. Data were analysed using a regularised regression model to indicate which group of all variables are associated with adjustment.

Results

People who were older (b = 0.17(0.07), p = 0.02), in employment (b = 0.40 (0.17), p = 0.01), and with lower illness severity (b = −0.24 (0.08), p = 0.001) showed better adjustment. Based on a Lasso regression, the most important psychological and demographic variables associated with lower adjustment (out-of-sample cross-validation R²= 62.6%) were lower MS self-efficacy and higher avoidance, cognitive vulnerability, embarrassment avoidance, conflict, helplessness, and secondary progressive MS type.

Conclusions and implications

Helping newly diagnosed people to find ways to tolerate anxiety-causing situations by encouraging acceptance may help people adjust to progressive MS by lowering their avoidance. Further, building confidence in managing the illness and addressing relationship issues are key focus areas in psychological interventions for people with progressive multiple sclerosis.

Comparison between attention and experiences of chronic complex patients: A multicentric study

The aim of this research is to explore and analyse the functional status and experiences of complex patients located at levels 3-4 of the risk pyramid of the chronic care model in primary care, within the hospital system of two regions in Spain. The design was a mixed design (COREQ). The participants were enrolled in programs for chronic complex patients and their caregivers. Sociodemographic variables were gathered, together with the following measures: the Barthel test, the Mini mental test, the Zarit questionnaire, the IEXPAC scale and the Braden scale. A semi-structured interview was conducted individually with patients in order to explore their experiences and narrative on the process of their illness and the support they had received. The sample comprised 206 chronic pluripathological patients, of whom 103 were from Cantabria and a further 103 were from Mallorca. The patient profile in both regions was very similar. There was an equal distribution across both gender and the patients were over 78 years old. They all had a basic (primary) education, an average income and required moderate physical dependence, receiving assistance primarily from their children. The qualitative analysis highlighted patients' awareness of the illness and their concern for the future, noting that, overall, patients were satisfied with the care provided by their caregivers and the health system. We can conclude that is the first multicentric study of these characteristics conducted in Spain, despite it being the country with the second largest ageing population in the world. It is important to test new organisational models with differentiating areas of advanced clinical practice in primary care, whereby both patients and their caregivers can be co-responsible within the care process.

Understanding quality of life across different clinical subtypes of multiple sclerosis: a thematic analysis

PURPOSE

Multiple sclerosis (MS) is a neurological disease that has different clinical presentations and illness trajectories. The aim of this study was to explore factors that are important for quality of life (QoL) of people with MS (pwMS), and to understand how they may differ across three subtypes.

METHODS

Both convenience and purposive sampling were employed. Semi-structured interviews were conducted with people with relapsing-remitting MS (n = 16), secondary progressive MS (n = 14), and primary progressive MS (n = 13). All interviews were audio recorded and then transcribed verbatim for thematic analysis involving both inductive and deductive processes. A separate analysis for each subtype was made during the inductive process before examining for similarities and differences across the three subtypes in the deductive process.

FINDINGS

Four factors were identified to have an important influence on QoL of pwMS: restricted and disrupted enjoyment, disturbed future, challenged sense of self, and well-being of significant others. The themes reflect how pwMS commonly perceived enjoyment as a purpose of life, while also illustrating how their QoL may be questioned because of new perspectives going forward with MS, challenges to their sense of self, and increased concerns for their significant others as a result of MS. Subtype differences were attributed to different illness trajectories: relapsing or progressive.

CONCLUSIONS

There are subtype differences in the negative impact of MS on QoL. Clinicians are encouraged to understand the challenges of different illness trajectories, in particular the traumatic nature of relapses and steady worsening of symptoms among those with progressive subtypes of MS.

The psychological adjustment needs of individuals following an acquired brain injury: A systematic review

This systematic review explored the psychological adjustment needs of individuals following an acquired brain injury (ABI). Whilst the landscape of rehabilitation in ABI has changed rapidly over the last decade, there is still a lack of emphasis on psychological processes in this area. An electronic search of PsycArticles, PsycINFO, PubMed, JSTOR, and Cochrane Library databases was conducted for records between January 2009 and December 2019 detailing the psychological adjustment needs of individuals in a general ABI population. A total of 17 studies with varying methodologies were initially extracted. Methodological quality was then independently assessed by the three authors, with 14 articles meeting the quality threshold. Across methodologies, key themes emerged in relation to: difficulties adjusting to a new sense of self, the critical nature of social support, and the multifaceted nature of the adjustment process which incorporates many internal and external factors. These results illustrate the importance of psychological factors in ABI rehabilitation and as such highlight that the emphasis on functional outcomes in ABI may be an obstacle to the facilitation of the process of psychological adjustment. This provides justification for a more psychologically informed, holistic approach and inspires further debate as to the fundamental importance of psychological adjustment for individual's post-ABI.

An Integrative Review Considering the Impact of Storytelling and Sharing Interventions in Stroke

Background: Review-based research is needed which can establish the psychosocial outcomes and mechanisms of “storytelling and sharing” interventions for people with stroke. This information will act to inform the value and development of such interventions. Methods: An integrative review was conducted in three stages: (a) a systematic search strategy was undertaken to focus on articles between 2009 until January 2020 to locate articles the considered storytelling and sharing interventions for people diagnosed with stroke; (b) critical appraisal was undertaken to assess study quality; and (c) synthesis within three stages including data reduction, data display and conclusion. Results: Fourteen articles (including 727 participants) were identified that met the eligibility criteria. Five themes were identified that represented the outcome and mechanisms that appeared to be associated with a stroke intervention. These included introducing the concept of hope and learning to be positive, the enhanced ability to cope, the impact of loneliness and social interaction, impact on emotions, depression and related emotions such as fear. Conclusions: Storytelling interventions appear to impact loneliness, introduce positivity and hope and enable coping through knowledge exchange. The main mechanisms which appeared to influence these outcomes were social comparisons and social control.

Perceived social support, loneliness, and hope during the COVID-19 Pandemic: Testing a mediating model in the UK, USA, and Israel

Objectives

The COVID‐19 epidemic is affecting the entire world and hence provides an opportunity examine how people from different countries engage in hopeful thinking. The aim of this study was to examine the potentially facilitating role of perceived social support vis‐à‐vis hope as well as the mediating role of loneliness between perceived social support and hope. This mediating model was tested concurrently in the UK, the USA, and Israel.

Methods

In April 2020, as the first wave of the virus struck the three aforementioned countries, we assessed perceived social support, loneliness, and hope in 400 adults per country (N = 1,200). Assessments in the UK/USA were conducted via the Prolific platform, whereas in Israel they were conducted via Facebook/WhatsApp.

Results

In all three countries, perceived social support predicted elevated hope, although the effect was smallest in the UK. Loneliness mediated this effect in all three countries, although full mediation was attained only in the UK.

Conclusions

Perceived social support may facilitate hope in dire times, possibly through the reduction of loneliness.

Practitioner Points

Findings are consistent with respect to the potentially protective role of perceived social support vis‐à‐vis hope.

Perceived social support may increase hope through decreasing loneliness.

In the UK, the above‐noted mediating effect of loneliness appears to be stronger than in Israel and the USA.

Elevated levels of perceived social support should serve as a desired outcome in individual and group psychotherapy, as well as in community based interventions.

Screening and supporting the mental health of student physiotherapists during the COVID-19 pandemic

Background/Aims

The purpose of this study was to use the Model of Emotions, Adaptation and Hope as a way to screen and support physiotherapy students and understand the impact of the COVID-19 pandemic on their health by focusing on the stories (narrative) they tell.

Methods

This pilot mixed methods study included a convenience sample of BSc and MSc level student physiotherapists. A single screening online interview was conducted via Zoom or Skype. Students' narratives underwent qualitative analysis and quantitative analysis using the Model of Emotions, Adaptation and Hope.

Results

A total of 19 students took part in this study. Students identified four master plot narratives as a response to the interview: future control; lost productivity; isolation; and opportunity. Significant pre-interview to follow-up change was found in acceptance, pleasantness and energy.

Conclusions

It is possible to support the mental health of physiotherapy students by screening for difficulties and listening to and exploring their responses.

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self-managing rheumatoid arthritis

Background

As chronic illnesses, such as rheumatoid arthritis (RA), place an increased burden on health‐care systems, the ability of individuals to self‐manage these diseases is crucial.

Objective

To identify and synthesize the lived experience of self‐management described by adults living with RA.

Design

A systematic search of five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and ASSIA) was undertaken to identify relevant studies. Data were extracted and quality‐assessed using CASP guidelines. A meta‐synthesis was conducted based on Thomas and Harden's thematic synthesis approach.

Results

The search identified 8423 publications. After removing duplicates, 6527 records remained of which 32 studies met the inclusion criteria. Quality of studies was moderate to high, yet a considerable lack of reflection on researcher bias was evident. Our analysis identified 28 dimensions of self‐management RA across six domains: (a) cognitive‐emotional, (b) behavioural, (c) social, (d) environmental, (e) physical and (f) technological. Cognitive‐emotional experiences dominated the analysis. Renegotiating ‘the self’ (self‐concept, self‐esteem, self‐efficacy) was a key focus of self‐management among individuals with RA.

Conclusion

Our findings highlight the focus of ‘the self’ as a central concern in the self‐management of RA. Standardized self‐management programmes may primarily focus on disease management and daily functioning. However, we suggest that personal biographies and circumstances should move to the fore of self‐management support.

Registration

PROSPERO International Prospective Register of Systematic Reviews 2018: CRD42018100450.

Patient or Public Contribution

Patient and public involvement was not explicit in this review. However, three authors provided a patient perspective on the self‐management of arthritis and autoimmune disease.

The Experience of Post-Stroke Pain and The Impact on Quality of Life: An Integrative Review

Background: Many people experience post-stroke pain (PSP). It is a long-term consequence of stroke that commonly goes unrecognised and untreated. As a result, an integrative review is needed to identify the primary factors that affect PSP and determine the impact on quality of life (QOL). Methods: An integrative review using a quantitatively led data synthesis, supported by qualitative evidence, was conducted. Results: Fourteen studies were identified and 2415 (968 females, 1447 males) people were included. Five primary themes were identified as effecting the experience of PSP; anxiety, depression, fatigue, cognitive function and physical function. Anxiety, depression and fatigue increase PSP. Pain, depression, fatigue and reduced physical function lower QOL. Conclusions: It is essential that clinicians recognise PSP in order to optimize QOL and function post-stroke. Further research is needed to employ a strategy to identify and objectively quantify PSP and its impact on QOL.

The effects of storytelling in the promotion of physical activity for chronically ill patients: an integrative review

Background/Aims

Physical activity is regarded as an essential component of self-management for people with chronic illness. Storytelling is an approach that successfully uses a group environment to influence change in physical activity intentions and behaviours. The aim of this study was to develop an understanding of what a storytelling intervention entails, its main effects and how this leads to the promotion of physical activity in chronically ill patients.

Methods

An integrative review was undertaken in three stages: search, appraisal and synthesis. Studies were included if they represented participants with a chronic illness, used a storytelling approach for the intervention and had physical activity as a component of the intervention.

Results

A total of 14 articles were identified that included a total of 818 participants (191 male, 348 female, 279 unknown). No articles were identified as flawed and all were included in the synthesis. Four themes were identified: ideal processes within interventions; psychosocial factors that influenced storytelling; perceived outcomes relating to storytelling; and perceived benefits of physical activity.

Conclusions

This review develops a deeper understanding of the required processes, associated factors and outcomes of storytelling interventions for people with chronic illness. It provides evidence of how storytelling can be used to promote physical activity. Further research into storytelling interventions is required.

Fear, fight, familiarize: the experiences of people living with relapsing-remitting multiple sclerosis and taking oral medication

Purpose: In addition to becoming familiar with the life changing event of having a chronic illness and exploring its meaning in daily life, people with relapsing-remitting Multiple Sclerosis (RRMS) are faced with important decisions about immunomodulating treatment. Biomedical research on the use of Disease Modifying Therapies (DMTs) mostly focuses on adherence, conceptualized and understood as a behavioral act leading to a desired outcome. Less attention has been paid to the meaning for a person with RRMS of starting and continuing the use of DMTs. Studies on the experiences of people with RRMS taking orally administered DMTs are lacking. The aim of this phenomenological study was to examine the experiences of people with RRMS taking oral medication. Methods: The study was guided by Interpretative Phenomenological Analysis (IPA) and Phenomenology of Practice. 25 persons with RRMS participated in in-depth interviews. Results: In general, participants of this study find themselves in alternating phases that vary by degree of experienced unfamiliarity or familiarity with concern to one's illness, one's changing body, and one's new life. The meaning of taking medication is closely related to these phases. Conclusions: Adherence serves a purpose in the lifeworlds of participants. Medication is the embodiment of this purpose. The pill has inherent meaning.

Factors which Influence Risk Taking and the Evolution of Social-Identity in Stroke Narratives: A Thematic Synthesis

Background: The disruption of a stroke can impact an individual’s sense of social identity. A comprehensive review is required to understand the factors and processes that influence changes in social identity following a stroke. Aims: To undertake a review of literature to discover a process of social identity evolution for people with stroke and identify the factors which influence it. Methods: A meta-ethnographic approach to review was undertaken and a subtle realist viewpoint was assumed. Studies were included if they documented experiences and perceptions relating to stroke. Eight electronic databases were searched from January 2009 until January 2019. Quality assessment and synthesis techniques were applied. Findings: Out of the 18 papers included, a total of 251 (141/251, 56% male, 109/251, 43% female, 1/251, 0.4% undisclosed) individuals were included within the synthesis. The evolution of social-identity model was developed and identified with five key stages to represent a process that individuals with stroke can experience. Factors which influence the process were identified and direct implications for clinical practice are given. Conclusion: This review has highlighted the major themes within the evolution of social identity and management strategies for risk taking to achieve a desired future. Further research is required to consider how these findings may be tested in clinical practice.

Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke

Background

Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke.

Objectives

To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke.

Methods

The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis.

Results

All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop ‘new’ hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future.

Conclusions

Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope‐fostering environments which support people to develop hope for their future.

Adapting to Multiple Sclerosis Stigma Across the Life Span

BACKGROUND

Most people with multiple sclerosis (MS) experience social stigma at mild-to-moderate levels, with potential implications for their health. However, little is known about how adults adapt to social stigma across their lives, or with respect to MS stigma in particular. Using a large national database and controlling for confounding demographic and health-related variables, this study examined whether longer MS duration was associated with reports of stigma in people with MS.

METHODS

Data were available from 6771 participants enrolled in the semiannual survey conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS). Participants completed measures of MS stigma and reported on demographic and health-related covariates.

RESULTS

With disability level, age, and other demographic and health-related covariates taken into account, the longer respondents had lived with MS, the less stigma they felt. Results were similar for people's anticipation of stigma and their feelings of isolation because of stigma.

CONCLUSIONS

As people gain experience living with MS, their adaptations to the social aspects of their illness may allow them to structure their lives so that they can mitigate the impact of stigma. Doctors, therapists, and other health care personnel should consider that patients with MS might be especially concerned and distressed by stigma earlier in the course of their illness.

A Thematic Synthesis Considering the Factors which Influence Multiple Sclerosis Related Fatigue during Physical Activity

The purpose of this study is to consider the factors that influence fatigue related to physical activity in patients with multiple sclerosis (PwMS) and to identify the necessary adaptations undertaken by patients to remain active. A review using a thematic synthesis methodology situated within a subtle realist paradigm was undertaken. The review was completed in three stages: 1) search of relevant studies; 2) critical appraisal of literature; and 3) thematic synthesis. Nineteen studies met the inclusion criteria. This included a total of 263 participants of whom 243 were PwMS (159 females, 70 males and 14 unknown). The aggregated mean age was 53.3 years and aggregated mean time living with MS post diagnosis 11.3 years. Following critical appraisal, no articles were excluded. Three major themes were identified: (1) fatigue-related consequences, (2) exercise related barriers affecting fatigue, and (3) factors that make fatigue bearable for MS individuals. The thematic synthesis identified the cycle of activity and inactivity as a result of fatigue perception. Exercise experience, professional and social support, as well as the necessary adaptation of a training programme empower PwMS to adopt a more active coping strategy and enjoy the benefits of exercise. Clinicians could consider the implementation of a suitable, individualised exercise programme to reduce PwMS's stress during physical activities.

Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies

BACKGROUND

Patients with psoriasis face numerous treatment and self-management decisions. Shared decision making is a novel approach where patients' preferences and values are considered in cooperation with healthcare professionals before making treatment decisions.

OBJECTIVE

The objective of this systematic review was to explore what is illuminated in psoriasis research regarding shared decision making, and to estimate the effects of shared decision-making interventions in this context.

METHODS

Qualitative, quantitative, and mixed-methods studies were eligible for inclusion. We searched six electronic databases up to January 2018. Two reviewers independently applied inclusion and quality criteria. The SPIDER framework was used to identify eligibility criteria for study inclusion. Narrative and thematic syntheses were utilized to identify prominent themes emerging from the data.

RESULTS

A total of 23 studies were included in the review. Of these, we included 18 studies (19 papers) to describe what was illuminated with regard to shared decision making in psoriasis research. Four major themes emerged: interpersonal communication; exchange of competence and knowledge; different world view; and involvement and preference, organized under two analytical themes; "Co-creation of decisions" and "Organization of treatment and treatment needs". For shared decision-making effects, we included four controlled studies. These varied in scope and interventional length and showed limited use of shared decision making-specific outcome measures, reflecting the early stage of the literature. Because of study heterogeneity, a meta-synthesis was not justified.

CONCLUSIONS

There appears to be a need to strengthen the relationship between medical doctors and patients with psoriasis. The evident lack of knowledge about each other's competence and the lack of self-efficacy for both patients and providers challenges the basic principles of shared decision making. The effects of shared decision making in psoriasis are inconclusive, and more research appears necessary to determine the possible benefits of shared decision-making interventions.

The Mindful Body: A Phenomenology of the Body With Multiple Sclerosis

For people living with multiple sclerosis (MS), one's own body may no longer be taken for granted but may become instead an insistent presence. In this article, we describe how the body experience of people with MS can reflect an ongoing oscillation between four experiential dimensions: bodily uncertainty, having a precious body, being a different body, and the mindful body. People with MS can become engaged in a mode of permanent bodily alertness and may demonstrate adaptive responses to their ill body. In contrast to many studies on health and illness, our study shows that the presence of the body may not necessarily result in alienation or discomfort. By focusing the attention on the body, a sense of well-being can be cultivated and the negative effects of MS only temporarily dominate experience. Rather than aiming at bodily dis-appearance, health care professionals should therefore consider ways to support bodily eu-appearance.

Psycho-emotional content of illness narrative master plots for people with chronic illness: Implications for assessment

Illness narratives are stories of illness told by patients with chronic illness. One way of studying illness narratives is by considering illness narrative master plots. An examination of illness narrative master plots has revealed the importance of psycho-emotional information contained within the story that is told. There is a need for research to capture this information in order to better understand how common stories and experiences of illness can be understood and used to aid the mental well-being of individuals with chronic illness. The current editorial provides a suggestion of how this is possible. This editorial identifies that stories can be “mapped” graphically by combining emotional responses to the illness experience with psychological responses of the illness experience relating to hope and psychological adaptation. Clinicians and researchers should consider the evidence presented within this editorial as: (1) A possible solution for documenting the mental well-being of individuals with chronic illness; and (2) As a tool that can be used to consider changes in mental well-being following an intervention. Further research using this tool will likely provide insights into how illness narrative master plots are associated together and change across the course of a chronic illness. This is particularly important for illness narrative master plots that are difficult to tell or that are illustrative of a decline in mental well-being.

The experience of informal caregivers of patients with motor neurone disease: A thematic synthesis

ABSTRACTObjective:Research is required in order to illustrate and detail the experiences of informal caregivers of patients with motor neurone disease (pwMND) to further advance the research base and to inform the development of future support structures and services. Due to the heterogeneous nature of caregiving for pwMND, one way in which this can be achieved is through a qualitative review. A qualitative thematic analysis of existing qualitative studies has not, to the best of the authors' knowledge, been previously undertaken. Thus, the present synthesis aims to identify caregivers' experiences and to suggest factors that contribute to these experiences in order to fulfill the required research needs.

METHOD

A thematic synthesis of qualitative literature was conducted. AMED, Medline, SPORTDiscus, CINAHL, and PubMed were electronically searched from inception until September of 2015. Studies were eligible if they included qualitative literature reporting on firsthand experience of informal caregivers of patients with MND, were published in English, and contained verbatim quotations. Critical appraisal was undertaken using a 13-item consolidated criteria for reporting qualitative studies (COREQ) checklist.

RESULTS

A total of 10 studies met the inclusion criteria, with 148 (50 male) current or previous informal caregivers of pwMND identified. Critical appraisal demonstrated that study design and reflexivity were underreported. The synthesis derived three themes: (1) loss of control, (2) inability to choose, and (3) isolation.

SIGNIFICANCE OF RESULTS

The synthesis highlighted the factors that contribute to both positive and negative caregiving experiences. Through these experiences, such suggestions for service provision as improving communication with healthcare professionals and having a single point of contact emerged. However, the outcome of such suggestions on the experience of caregivers is beyond the scope of our synthesis, so that further research is required.

Shared decision making within goal setting in rehabilitation settings: A systematic review

OBJECTIVE

To map out and synthesise literature that considers the extent of shared decision-making (SDM) within goal-setting in rehabilitation settings and explore participants' views of this approach within goal-setting.

METHODS

Four databases were systematically searched between January 2005-September 2015. All articles addressing SDM within goal-setting involving adult rehabilitation patients were included. The literature was critically appraised followed by a thematic synthesis.

RESULTS

The search output identified 3129 studies and 15 articles met the inclusion criteria. Themes that emerged related to methods of SDM within goal-setting, participants' views on SDM, perceived benefits of SDM, barriers and facilitators to using SDM and suggestions to improve involvement of patients resulting in a better process of goal-setting.

CONCLUSIONS

The literature showed various levels of patient involvement existing within goal-setting however few teams adopted an entirely patient-centred approach. However, since the review has identified clear value to consider SDM within goal-setting for rehabilitation, further research is required and practice should consider educating both clinicians and patients about this approach.

PRACTICE IMPLICATIONS

To enhance the use of SDM within goal-setting in rehabilitation it is likely clinicians and patients will require further education on this approach. For clinicians this could commence during their training at undergraduate level.

The experience of fatigue in neurological patients with Multiple Sclerosis: a thematic synthesis

OBJECTIVES

To identify the experiences that result from MS-related fatigue (MSRF) through a systematic review and thematic synthesis of qualitative literature.

DESIGN

The thematic synthesis was undertaken in three stages: (1) a systematic review of the literature, searching relevant databases from their inception to March 2016. (2) A critical appraisal of included studies, and (3) a double blind 2-phase synthesis of results was undertaken.

SETTING

Participants were included from articles using primary and secondary care settings.

PARTICIPANTS

The synthesis included nine articles that incorporated a total of one hundred and fifty two participants (103 females and 49 males) in the review.

RESULTS

No articles were excluded following critical appraisal. Two major themes were synthesised: (1) biopsychosocial experiences of fatigue, which illustrated the physical, cognitive and social challenges patients experience and (2) experiences that alter the impact of fatigue including the strategies individual employ to help manage fatigue. These major themes were further split into five subthemes.

LIMITATIONS

Only the most common experiences of MSRF were identified. Findings did not break down results by key demographics e.g. disease type. Only English language studies were included.

CONCLUSION

Physiotherapists are able to support the management by: (a) having a greater understanding of MSRF and (b) being able to help patients manage the factors that influence it.