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Larsson BJ, Nordin K, Nygren I. Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory. J Neurol Sci 2023; 455:122780. [PMID: 37976792 DOI: 10.1016/j.jns.2023.122780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTS The aim of this study was to describe the presence of anxiety and depression among patients with Amyotrophic Lateral Sclerosis (ALS) and their relatives from diagnosis and during the disease progression. An additional aim was to explore if the patient's physical function correlated with the patients' or relatives' anxiety and depression. METHODS A prospective and longitudinal study, including 33 patients with ALS and their relatives who filled out the Hospital Anxiety and Depression Scale (HADS) at the time of diagnosis and over a period of two years. The patient's physical function was measured with the revised Amyotrophic Lateral Sclerosis Functional and Rating Scale (ALS FRS-R). RESULTS The results showed that many patients (45%) and relatives (58%) had symptoms of anxiety and that 13% of the patients and 29% of the relatives had symptoms of depression soon after the patient had been diagnosed with ALS. The prevalence of anxiety decreased over time in the group of patients but remained stable in the group of relatives. Relatives had more symptoms of anxiety compared to patients. There was a correlation between the patient's physical function and HADS in the group of relatives; however, no correlation was found in the group of patients. CONCLUSION The results showed that many patients and relatives suffered from symptoms of anxiety quite soon after their diagnosis, and that many relatives had symptoms of anxiety during the disease trajectory. This highlights the need to continuously measure patients' anxiety/depression level but also to pay attention to symptoms among relatives.
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Affiliation(s)
- Birgitta Jakobsson Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Spörndly-Nees S, Jakobsson Larsson B, Zetterberg L, Åkerblom Y, Nyholm D, Åsenlöf P. Pain in patients with motor neuron disease: Variation of pain and association with disease severity, health-related quality of life and depression - A longitudinal study. Palliat Support Care 2023:1-8. [PMID: 37955056 DOI: 10.1017/s1478951523001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
OBJECTIVES To describe levels of pain over time during disease progression in individual patients and for a total sample of patients with motor neuron disease (MND), respectively, and to examine associations between pain, disease severity, health-related quality of life (HRQOL), and depression. METHODS A prospective cohort study was conducted on 68 patients with MND, including data collected on five occasions over a period of 2 years. Pain was assessed using the Brief Pain Inventory - Short Form. Depression was assessed using the Amyotrophic Lateral Sclerosis (ALS)-Depression-Inventory (ADI-12). Disability progression was measured using the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version (ALSFRS-R). HRQOL was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5). RESULTS Participants reported great individual variation over time. The median level of pain was 4 (min 0 and max 10). Higher levels of pain during the last 24 h were associated with higher depression scores (ADI-12), poorer quality of life (ALSAQ-5), and lower reporting of fine and gross motor skills (ALSFRS-R). Baseline pain levels did not predict future values of depression and function. Individuals reporting average pain >3 experienced more hopelessness toward the future and reported higher depression scores compared with participants reporting average pain <3. SIGNIFICANCE OF RESULTS Great within-individual variation of pain intensity was reported. Pain intensity was associated with depression, function and HRQOL cross-sectionally, but it did not have a strong prognostic value for future depression, function, or HRQOL. Patients with MND should be offered frequent assessment of pain and depressive symptoms in person-centered care, allowing for individualization of treatment.
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Affiliation(s)
- Sören Spörndly-Nees
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | | | - Lena Zetterberg
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | - Ylva Åkerblom
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
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Malmström N, Jakobsson Larsson B, Nilsson S, Öhlén J, Nygren I, Andersen PM, Ozanne A. Living with a parent with ALS - adolescents' need for professional support from the adolescents' and the parents' perspectives. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-9. [PMID: 37486108 DOI: 10.1080/21678421.2023.2228348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
AIM The aim of the study was to qualitatively investigate the adolescents' need for professional support when a parent has amyotrophic lateral sclerosis (ALS) - from the adolescents' and the parents' perspectives. METHODS A total of 37 individual semi-structured single interviews with 18 families were conducted, including 11 adolescents aged 8-25 and 26 parents, 13 with ALS and 13 co-parents. Data was analysed using qualitative content analysis. RESULTS Both adolescents and parents described the adolescents as needing professional support but found it difficult to articulate this need. However, the results indicate that the adolescents needed help in bringing manageability into their lives due to the uncertainty of living with the illness in the family. It was therefore essential to ensure that the adolescents were not forgotten in the disease context and that their needs for being involved as well as for obtaining information and understanding, was addressed. The importance of offering the adolescents support early was emphasized, but also of actively helping the families to master challenges in their everyday life. Support adapted to each family's unique situation and preferences was desired, as the adolescents' need for support seemed to be individual, disease-dependent and varied during different phases. CONCLUSION Given the adolescents' need for information and understanding, healthcare professionals must actively work to reach the adolescents as early as possible. It is crucial to ensure that the adolescents are given the opportunity to be involved based on their own conditions, as well as to support the families to strengthen their communication.
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Affiliation(s)
- Nina Malmström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Jakobsson Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- Palliative Centre at the Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter M Andersen
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden, and
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Åkerblom Y, Zetterberg L, Larsson BJ, Nyholm D, Nygren I, Åsenlöf P. Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases. BMC Palliat Care 2021; 20:154. [PMID: 34641829 PMCID: PMC8507097 DOI: 10.1186/s12904-021-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Up to 85% of people with motor neuron disease (MND) report pain, but whether pain has negative impact on quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQOL) in patients with MND. Methods In this cross sectional study, 61 patients were recruited from four multidisciplinary teams in Sweden, whereof 55 responded to the pain measure (The Brief Pain Inventory – Short form) and were included in the main analyses. Disease severity was measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version, and individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting. Results Forty-one (74%) of the participants who answered BPI-SF (n = 55) reported pain. Thirty-nine (71%) of those reported pain during the past 24 h. The severity of pain was on average moderate, with eight participants (14%) reporting severe pain (PSI ≥ 7). Satisfaction with IQOL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQOL between those reporting pain/not reporting pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U = 249, p = 0.452). There was neither any correlation between pain severity and satisfaction with IQOL, nor between disease severity and satisfaction with IQOL. Conclusions The results add to the hypothesis that associations between non-motor symptoms such as pain prevalence and pain severity and IQOL in MND are weak. Pain prevalence was high and the results pointed to that some participants experienced high pain severity, which indicate that pain assessments and pain treatments tailored to the specific needs of the MND population should be developed and scientifically evaluated.
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Affiliation(s)
- Ylva Åkerblom
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | - Lena Zetterberg
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | | | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, 75185, Uppsala, Sweden
| | - Ingela Nygren
- Department of Neuroscience, Neurology, Uppsala University, 75185, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden.
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Åkerblom Y, Jakobsson Larsson B, Zetterberg L, Åsenlöf P. The multiple faces of pain in motor neuron disease: a qualitative study to inform pain assessment and pain management. Disabil Rehabil 2019; 42:2123-2132. [PMID: 31014130 DOI: 10.1080/09638288.2018.1555615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: The aim was to explore personal experiences of pain in people with motor neuron disease.Materials and methods: Sixteen participants were individually interviewed on one occasion concerning their experiences of presentation, consequences, and management of pain. Qualitative content analysis with researcher triangulation was used to synthesize and interpret data.Results: Four themes emerged as the result of the analysis: (1) The multiple faces of pain, (2) The thin line between experience of pain and no pain, (3) The negative effects of pain on role functioning (4) Successful coping with pain requiring personal effort and competent engagement. The important findings were the experiences of unpredictability of pain breakthroughs, the efforts required to manage pain, consequences for activity and quality of life, and the suffering induced by diminishment and neglect of pain from both patients and staff.Conclusions: Pain in motor neuron disease seems to have certain and multiple characteristics, which is why there is a need to develop and implement pain assessment methods adapted to this population. Such methods may help make pain more predictable, and increase the possibilities to provide effective and individually tailored pain treatment.IMPLICATIONS FOR REHABILITATIONPain is a common, but often neglected, ailment in motor neuro disease, which deserves more attention from health care.Staff should provide information about the pain being possible to treat successfully with medication, by contrast to the possibility of curing the disease itself.Pain assessments should be implemented during the entire course of the disease, covering a time frame long enough to cover characteristic fluctuations of pain.Whenever possible, facilitate the performance of painful activities of daily living as much as possible to make room for engagement in other personally valued activities of importance for individual quality of life.
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Affiliation(s)
- Ylva Åkerblom
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Lena Zetterberg
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Jakobsson Larsson B, Nordin K, Nygren I. Coping with amyotrophic lateral sclerosis; from diagnosis and during disease progression. J Neurol Sci 2016; 361:235-42. [DOI: 10.1016/j.jns.2015.12.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
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Jakobsson Larsson B, Nordin K, Askmark H, Nygren I. Coping strategies among patients with newly diagnosed amyotrophic lateral sclerosis. J Clin Nurs 2014; 23:3148-55. [DOI: 10.1111/jocn.12557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - Karin Nordin
- Department of Public Health and Caring Science; University of Uppsala; Uppsala Sweden
- Department of Global Health and Primary Care; University of Bergen; Norway
| | - Håkan Askmark
- Department of Neuroscience, Neurology; Uppsala University Hospital; Uppsala Sweden
| | - Ingela Nygren
- Department of Neuroscience, Neurology; Uppsala University Hospital; Uppsala Sweden
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