Factors affecting employment among informal caregivers assisting people with multiple sclerosis

Comparison of trunk mechanics and spatiotemporal outcomes in caregivers using a robotic assisted transfer device and a mobile floor lift

OBJECTIVE

The purpose of this study was to compare trunk mechanics, distance covered, and average instantaneous velocity and acceleration recorded with caregivers performing transfer tasks using a research mannequin with both a prototype robotic assisted transfer device (RATD) and a mobile floor lift.

DESIGN

Cross-Sectional.

SETTING

Biomechanics Lab and Human Engineering Research Laboratories.

PARTICIPANTS

Caregivers (N = 21).

INTERVENTION

Robotic Assisted Transfer Device.

OUTCOME MEASURES

Range of flexion-extension, lateral bend, and axial rotation; distance covered; average instantaneous velocity and acceleration.

RESULTS

Caregivers performing transfers using the RATD as compared to when using the moble floor lift reported significantly smaller range of trunk flexion-extension, lateral bending, and axial rotation, and reported lower pelvic based distance covered and slower average instantaneous velocity and acceleration (P < 0.001).

CONCLUSION

The design and usability of a RATD indicates design driven mobility advantages over clinical standard mobile floor lifts due to its ability to expand the workspace while further reducing risk factors for low back pain. While the concept is promising, further testing is required to address limitations and confirm the concept for clinical applications.

Profiles of resilience in multiple sclerosis family care-partners: A Canadian cross-sectional study

BACKGROUND

Psychological resilience may play an important role in protecting multiple sclerosis care-partners from the negative effects of their support role. However, predictors of resilience in this population have yet to be identified.

OBJECTIVES

To identify characteristics predictive of psychological resilience in multiple sclerosis care-partners as informed by the Ecological Model of Resilience.

METHODS

Informal multiple sclerosis care-partners (n = 540) completed an online survey. Psychological resilience was measured using the 25-item Connor-Davidson Resilience Scale. Sociodemographic and care-context predictors of resilience were analyzed using hierarchical regression.

RESULTS

The mean resilience score was 59.0 (SD = 7.6) out of a possible 100. Sociodemographic variables accounted for 31% of the variance in resilience scores in multiple sclerosis care-partners. When care-context variables were incorporated into the model, 55% of variance was explained (F[7,320] = 26.824, p < 0.001). Each group of variables remained significant in both low disability and high disability models. Social support was the only individual variable that remained significant across all models (p < 0.05).

CONCLUSIONS

Multiple sclerosis care-partners differ strikingly from other caregiving populations. Both sociodemographic and care-context variables were found to promote or hinder resilience in multiple sclerosis care-partners. Social support, in particular, may be an important target for promoting resilience in multiple sclerosis care-partners and could be leveraged in future initiatives.

Exploring the Needs of Spousal, Adult Child, and Adult Sibling Informal Caregivers: A Mixed-Method Systematic Review

Informal caregivers (ICGs) provide care to their family or friends in case of an illness, disability, or frailty. The caregiving situation of informal caregivers may vary based on the relationship they have with the care recipient (CR), e.g., being a spouse or being an adult child. It might be that these different ICGs also have different needs. This study aims to explore and compare the needs of different groups of ICGs based on the relationship they have with their CR. We conducted a systematic review, performing a search in the databases PubMed, CINAHL, and PsycINFO. We included studies with qualitative, quantitative, or mixed-method study designs. We analyzed the data using the thematic analysis method. We included 22 articles (18 qualitative; 4 quantitative). The included articles reported the needs of ICGs taking care of a spouse (spousal ICGs), parent (adult child ICG), or sibling aged 18 years or above (adult sibling ICGs). We did not include other relationships due to the limited number of articles on these relationships. The most prominent needs reported by the spousal, adult child, and adult sibling ICGs were the need for information and need for support. The three groups differed in their needs as well. Adult child and adult sibling ICGs indicated a need to be acknowledged by the people around them for their role of carer, while they also needed to be seen as an individual having their own personal needs. Moreover, spousal ICGs indicated a unique need of redefining their role and relationship with their CR. Overall, the findings indicate that along with experiencing common needs, the investigated groups have unique needs as well. Knowing the needs of different groups of ICGs can help develop tailored solutions to improve the quality of life of the ICGs and their CR.

Systematic Review Registration: [www.crd.york.ac.uk/prospero/], identifier [CRD42020188560].

Multiple Sclerosis Adult Day Programs and Health-Related Quality of Life of Persons with Multiple Sclerosis and Informal Caregivers

Background

Multiple sclerosis adult day programs (MSADPs) offer life-enhancing services for individuals and informal caregivers affected by multiple sclerosis (MS), including medical care, rehabilitation therapies, nutrition therapy, cognitive training, tailored education, exercise programs, and social interaction. The purpose of this study was to examine the effects of MSADPs on health-related quality of life (HRQOL) and health care utilization of persons with MS and HRQOL and well-being of informal caregivers.

Methods

Using a quasi-experimental design, outcomes between baseline and 1-year follow-up in persons with MS and informal caregivers who used MSADP services and a comparison group of similar persons with MS and caregivers who did not use MSADP services were compared. For persons with MS, outcomes included standardized measures of physical and mental HRQOL and health care utilization. For caregivers, outcomes included physical and mental HRQOL and well-being. Changes in outcomes between baseline and follow-up were examined using propensity score-weighted difference-in-differences regression analysis.

Results

For persons with MS, MSADP use had a significant positive effect on 12-Item Short Form Health Survey physical component scores, although the difference was not clinically meaningful. Use of MSADPs did not have effects on any other outcomes for persons with MS or caregivers.

Conclusions

Use of MSADPs did not show a clinically meaningful effect on HRQOL for persons with MS or informal caregivers. The MSADPs do not seem to offer sustained benefits to persons with MS or caregivers, but the possibility of initial short-term benefits cannot be ruled out.

Association of Unemployment and Informal Care with Stigma in Multiple Sclerosis: Evidence from the Survey on Living with Neurological Conditions in Canada

Background

Multiple sclerosis (MS) typically affects young adults during their primary productive years. We assessed the magnitude of, and factors associated with, employment status and informal care in people with MS in Canada.

Methods

Data were compiled from the nationally representative cross-sectional Survey on Living with Neurological Conditions in Canada (SLNCC), which included adolescents and adults (age ≥15 years). Employment status was categorized as currently working or not working. The frequency of informal care that people with MS received was categorized as none, less than daily, or daily. Logistic regression analyses were undertaken to identify factors associated with employment status and informal care requirements in people with MS.

Results

Of 4409 SLNCC respondents, 631 had MS, of whom 530 were included in the analysis. Of 358 respondents aged 18 to 65 years, 47.8% were not working because of MS; 44.0% reported receiving informal care, with more than half requiring daily care. For caregivers' employment, 15.5% reduced work and 8.2% stopped working because of caregiving. Greater feelings of stigmatization were associated with not working (adjusted odds ratio, 7.42 [95% CI, 2.59-21.28]) and greater informal care (adjusted odds ratio, 3.83 [95% CI, 1.84-7.96]), adjusting for sex, age, education, health-related quality of life, time since MS diagnosis, and comorbidity.

Conclusions

People who feel stigmatized because of their MS are more likely to be unemployed and to require more informal care. Further research is needed to understand the temporal nature of the association between stigma and employment, productivity loss, and informal care.

Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts

INTRODUCTION

The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031).

METHODS

Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions.

RESULTS

The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period.

CONCLUSION

MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts.

EVASEP: A Noninterventional Study Describing the Perception of Neurologists, Patients, and Caregivers on Caregivers' Role in the Support of Patients Suffering from Multiple Sclerosis Treated with Subcutaneous Interferon Beta 1a

Background. The perception of the role of caregivers for people with multiple sclerosis (MS) is important but poorly studied, particularly in patients with low levels of disability. Objectives. To describe the perceptions of the role of caregivers from the perspective of the caregiver, the patient, and neurologists. Methods. This observational study was conducted in France on patients with relapsing remitting MS treated with subcutaneous (SC) interferon-β-1a (IFN-β-1a) for more than 24 months. Results. Caregiver, patients, and neurologists all considered providing moral support and fighting against the disease as the most important role of the care provider. Moral support was considered significantly more important by caregivers than the patients and neurologists (p = 0.002) and caregivers considered their role in helping patients to fight disease more important than did the neurologists (p = 0.006). Knowledge of disease and available treatments were less important among support providers than patients (p = 0.007 and p = 0.001). Conclusion. There are many unmet needs in the perception of the role of caregivers for people with MS which need to be addressed to deliver the most effective care package for patients and to support the needs of the support provider.

Quantifying the relationship between increased disability and health care resource utilization, quality of life, work productivity, health care costs in patients with multiple sclerosis in the US

BACKGROUND

Multiple sclerosis (MS) is a chronic progressive condition affecting the central nervous system. Progression of MS results in increased level of disability and most patients will eventually experience some degree of functional impairment and impaired mobility. Costs and burdens escalate as MS disability increases. However, there is a lack of recent data on the impact of MS disability on the cost and burden among patients in the US.

METHODS

Data for this study were drawn from a real world, cross-sectional survey undertaken between 2013 and 2014. Neurologists completed detailed patient report forms (PRF) for the most recent consulting patients with MS (age >18 years). Patient's perceptions of their diagnosis and health-related quality of life (HRQoL) were collected through a patient self-completion questionnaire (PSC). Regression analysis was used to evaluate the relationship between disability (determined by latest Expanded Disability Status Scale [EDSS] score) and current relapse and health care resource utilization, health care costs, HRQoL and work productivity.

RESULTS

PRF data were collected for 715 patients (335 also completed a PSC). Patients with higher disability scores (EDSS 3-5 and >5 vs <3 points) and current relapse (vs no current relapse) reported significantly greater health resource utilization for physician visits (p < 0.05) and hospitalizations (p < 0.05) in the preceding 12 months. In addition, they had poorer HRQoL (p < 0.05), were significantly more likely to be unemployed (p < 0.05) and to have had to stop working due to MS (p < 0.05). They also incurred significantly higher health care related costs, including costs for physician consultations, hospitalizations and therapy (p < 0.05). The total costs of care were $51,825, $57,889 and $67,116 for EDSS < 3, EDSS 3-5 and EDSS > 5 groups, respectively; $51,692 and $58,648 for non-relapse and relapse groups, respectively.

CONCLUSIONS

For MS patients in the US, health resource utilization and healthcare care costs increase with progression of disability. As the disability worsens, patients also exhibit diminished HRQoL and lower work productivity. There is a need for treatments that slow down or delay disability progression among MS patients.

Care Partners and Multiple Sclerosis: Differential Effect on Men and Women

BACKGROUND

Caring for someone with multiple sclerosis (MS) can be a stressful experience that requires clinical attention. We investigated the impact of caregiver stress on the emotional well-being and physical health of the MS care partner using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry.

METHODS

Care partners of NARCOMS participants were invited to complete an online questionnaire that captured demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact of caregiving on employment.

RESULTS

Of 1446 care partners who agreed to participate, 1333 had complete data. Most were men (n = 825, 61.9%), with a mean (SD) age of 51.1 (11.2) years. The mean (SD) Zarit total score was 24.6 (15.1), placing the overall group in the mild caregiver burden range. Compared with male care partners, female care partners reported higher levels of burden and stress and more medication use for stress/anxiety and mood disorders. Male care partners were more likely to report physical concerns. Care partners of people with primary progressive MS reported greater perceived burden than did partners of people with secondary progressive MS and relapsing-remitting MS. More than 40% of care partners (559 of 1288) had missed work during the past year owing to caregiving responsibilities.

CONCLUSIONS

Care partners of people with MS have substantial physical and psychological health concerns and experience an adverse impact on employment. Future research should evaluate how to mitigate the adverse effects of caregiving and evaluate positive aspects of the role.

Patterns of Objective and Subjective Burden of Informal Caregivers in Multiple Sclerosis

Background. Home care for patients with Multiple Sclerosis (MS) relies largely on informal caregivers (ICs). Methods. We assessed ICs objective burden (Resource Utilization in Dementia measuring informal care time (ICT)) and ICs subjective burden (Zarit Burden Inventory (ZBI)). Results. ICs (N = 99) were spouses (70%), mean age 52 years, assisting disabled patients with a mean EDSS (Expanded Disability Status Scale) of 5.5, with executive dysfunction (mean DEX (Dysexecutive questionnaire) of 25) and a duration of MS ranging from 1 to 44 years. Objective burden was high (mean ICT = 6.5 hours/day), mostly consisting of supervision time. Subjective burden was moderate (mean ZBI = 27.3). Multivariate analyses showed that both burdens were positively correlated with higher levels of EDSS and DEX, whereas coresidency and IC's female gender correlated with objective burden only and IC's poor mental health status with subjective burden only. When considering MS aggressiveness, it appeared that both burdens were not correlated with a higher duration of MS but rather increased for patients with severe and early dysexecutive function and for patients classified as fast progressors according to the Multiple Sclerosis Severity Score. Conclusion. Evaluation of MS disability course and IC's personal situation is crucial to understand the burden process and to implement adequate interventions in MS.