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Wills O, Probst Y. Towards new perspectives: A scoping review and meta-synthesis to redefine brain health for multiple sclerosis. Eur J Neurol 2024; 31:e16210. [PMID: 38226556 DOI: 10.1111/ene.16210] [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: 10/20/2023] [Revised: 12/03/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND PURPOSE Research promoting the health of the brain has increased exponentially over the last decade. The importance of 'brain health' for multiple sclerosis (MS), as one example, is a high priority. However, as research into the concept increases, so does varied use of the term. METHODS A scoping review, guided by the methodological framework of the Joanna Briggs Institute, was conducted to collate the evidence relating to brain health for MS. A comprehensive literature search incorporated six search strategies to retrieve both scientific and grey literature sources. All evidence sources were qualitatively charted and synthesized (meta-synthesis) according to their definition of brain health used, outcome measures and brain-healthy lifestyle elements. RESULTS Seventy evidence sources (34 peer reviewed, 36 grey literature) were eligible for inclusion. Of these, just over half (n = 40, 57%) provided a definition of brain health. The most common definition alluded to the biomedical model of neurological reserve (n = 22, 55%), a self-remodelling theory described to retain optimal brain function. Twenty-nine outcome measures of brain health were identified, the most frequent being magnetic resonance imaging metrics (n = 25, 83%). Physical activity was the most prevalent brain-healthy lifestyle element (n = 44), followed by avoidance of smoking (n = 26) and diet (n = 24). CONCLUSIONS Brain health should be considered a primary target for optimal disease and lifestyle management across the MS disease course. A working definition reflecting a shift from a medical lens towards broader biopsychosocial contexts that may influence brain health for people living with MS is proposed.
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Affiliation(s)
- Olivia Wills
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Wills O, Wright B, Greenwood LM, Solowij N, Schira M, Maller JJ, Gupta A, Magnussen J, Probst Y. Lifestyle management and brain MRI metrics in female Australian adults living with multiple sclerosis: a feasibility and acceptability study. Pilot Feasibility Stud 2024; 10:71. [PMID: 38698454 PMCID: PMC11064336 DOI: 10.1186/s40814-024-01495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Limited studies of multiple sclerosis (MS) exist whereby magnetic resonance imaging (MRI) of the brain with consistent imaging protocols occurs at the same time points as collection of healthy lifestyle measures. The aim of this study was to test the feasibility, acceptability and preliminary efficacy of acquiring MRI data as an objective, diagnostic and prognostic marker of MS, at the same time point as brain-healthy lifestyle measures including diet. METHODS Participants living with relapsing remitting MS partook in one structural MRI scanning session of the brain, completed two online 24-hour dietary recalls and demographic and self-reported lifestyle questionnaires (e.g. self-reported disability, comorbidities, physical activity, smoking status, body mass index (BMI), stress). Measures of central tenancy and level of dispersion were calculated for feasibility and acceptability of the research protocols. Lesion count was determined by one radiologist and volumetric analyses by a data analysis pipeline based on FreeSurfer software suite. Correlations between white matter lesion count, whole brain volume analyses and lifestyle measures were assessed using Spearman's rank-order correlation coefficient. RESULTS Thirteen female participants were included in the study: eligibility rate 90.6% (29/32), recruitment rate 46.9% (15/32) and compliance rate 87% (13/15). The mean time to complete all required tasks, including MRI acquisition was 115.86 minutes ( ± 23.04), over 4 days. Conversion to usual dietary intake was limited by the small sample. There was one strong, negative correlation between BMI and brain volume (rs = -0.643, p = 0.018) and one strong, positive correlation between physical activity and brain volume (rs = 0.670, p = 0.012) that were both statistically significant. CONCLUSIONS Acquiring MRI brain scans at the same time point as lifestyle profiles in adults with MS is both feasible and accepted among adult females living with MS. Quantification of volumetric MRI data support further investigations using semi-automated pipelines among people living with MS, with pre-processing steps identified to increase automated feasibility. This protocol may be used to determine relationships between elements of a brain-healthy lifestyle, including dietary intake, and measures of disease burden and brain health, as assessed by T1-weighted and T2-weighted lesion count and whole brain volume, in an adequately powered sample. TRIAL REGISTRATION The study protocol was retrospectively registered in the Australia New Zealand Clinical Trials Registry (ACTRN12624000296538).
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Affiliation(s)
- Olivia Wills
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Brooklyn Wright
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Lisa-Marie Greenwood
- Illawara Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Nadia Solowij
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawara Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Mark Schira
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Jerome J Maller
- General Electric Healthcare, Richmond, Melbourne, Australia
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Alok Gupta
- Illawara Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
- Wollongong Diagnostic Imaging Group, Wollongong, NSW, Australia
| | - John Magnussen
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawara Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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Wills O, Probst Y, Haartsen J, McMahon A. The role of multidisciplinary MS care teams in supporting lifestyle behaviour changes to optimise brain health among people living with MS: A qualitative exploration of clinician perspectives. Health Expect 2024; 27:e14042. [PMID: 38576113 PMCID: PMC10995448 DOI: 10.1111/hex.14042] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Healthcare professionals have an important role in advocating for the adoption of a brain-healthy lifestyle for optimal multiple sclerosis (MS) care. Nonetheless, studies to date have mainly focussed on the consumer perspective. Herein, we aimed to explore the current practices of how healthcare professionals support protective, lifestyle-related behaviour changes to optimise brain health among people living with MS (plwMS), and their perspectives of professional roles. METHODS Australian healthcare professionals were recruited via study advertisements, purposive and snowball sampling, to participate in an online, semi-structured and audio-recorded interview. Clinicians were eligible if they had a minimum of a tertiary Bachelor's degree and 12-months experience working with plwMS, access to the Internet and sufficient time to participant. An inductive, data-driven form of reflexive thematic analysis was undertaken before thematic categorisation of the quotes from transcripts. Data analysis was guided by the methods of Braun and Clark and the study's underpinnings drew on the constructs of the Social Cognitive Theory (SCT). RESULTS Six physicians, 10 MS nurses, 18 allied health professionals, one exercise therapist and one alternative therapist were interviewed. Three primary themes encompassing the perceived role of healthcare professionals in supporting a brain-healthy lifestyle were identified: (1) the empowering role, (2) collaborative role and (3) communicative role. External factors/forces including time constraints, professional expertise, training and skill set, power dynamics, consumer readiness, health literacy, self-efficacy and motivation are at play, and affect how/when healthcare professionals may support behaviour change to optimise lifelong brain health for plwMS. CONCLUSION Healthcare professionals recognise their critical role in encouraging and supporting the adoption of a brain-healthy lifestyle to optimise lifelong brain health for plwMS. However, discord is evident when they underestimate the complexity of translating knowledge of lifestyle-related behaviour change(s) into action. Greater awareness must be made in recognising and addressing the bidirectionality of external factors such as those in the SCT, that may influence how behaviour change occurs. PUBLIC CONTRIBUTION Healthcare professionals volunteered to be interviewed as part of the data collection phase of this study.
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Affiliation(s)
- Olivia Wills
- School of Medical, Indigenous and Health SciencesUniversity of WollongongWollongongNew South WalesAustralia
| | - Yasmine Probst
- School of Medical, Indigenous and Health SciencesUniversity of WollongongWollongongNew South WalesAustralia
| | | | - Anne‐Therese McMahon
- School of Medical, Indigenous and Health SciencesUniversity of WollongongWollongongNew South WalesAustralia
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Powell PA, Wills O, Reynolds G, Puustinen-Hopper K, Roberts J. The effects of exposure to images of others' suffering and vulnerability on altruistic, trust-based, and reciprocated economic decision-making. PLoS One 2018; 13:e0194569. [PMID: 29561883 PMCID: PMC5862494 DOI: 10.1371/journal.pone.0194569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
In this paper we explored the effects of exposure to images of the suffering and vulnerability of others on altruistic, trust-based, and reciprocated incentivized economic decisions, accounting for differences in participants' dispositional empathy and reported in-group trust for their recipient(s). This was done using a pictorial priming task, framed as a memory test, and a triadic economic game design. Using the largest experimental sample to date to explore this issue, our integrated analysis of two online experiments (total N = 519), found statistically consistent evidence that exposure to images of suffering and vulnerability (vs. neutral images) increased altruistic in-group giving as measured by the "triple dictator game", and that the manipulation was significantly more effective in those who reported lower trust for their recipients. The experimental manipulation also significantly increased altruistic giving in the standard "dictator game" and trust-based giving in the "investment game", but only in those who were lower in in-group trust and also high in affective or cognitive empathy. Complementary qualitative evidence revealed the strongest motivations associated with increased giving in the experimental condition were greater assumed reciprocation and a lower aversion to risk. However, no consistent effects of the experimental manipulation on participants' reciprocated decisions were observed. These findings suggest that, as well as altruistic decision-making in the "triple dictator game", collaboratively witnessing the suffering of others may heighten trust-based in-group giving in the "investment game" for some people, but the effects are heterogeneous and sensitive to context.
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Affiliation(s)
- Philip A. Powell
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Olivia Wills
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
| | - Gemma Reynolds
- Department of Psychology, Middlesex University, London, United Kingdom
| | - Kaisa Puustinen-Hopper
- Centre for Advanced Spatial Analysis, University College London, London, United Kingdom
- Impossible Labs, London, United Kingdom
| | - Jennifer Roberts
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
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