MS Information Update no 40 - June 2008
The criteria for inclusion of papers in MS Information Update are relevance to MS management issues, currency and references appearing in publications to which nurses and other health professionals may not have ready access.
If you would like copies of any of these papers, please contact info@mstrust.org.uk, ring us on 01462 476700 or write to us at MS Trust, Spirella Building, Letchworth Garden City, Herts SG6 4ET quoting the Information Update number (above), the item number(s) and your postal address.
We can only accept requests from within the United Kingdom.
We ask for a donation of £1.00 per paper ordered to help cover the costs of the Information Service.
1. Barnes F.
Care of people with multiple sclerosis in the community setting.
Br J Community Nurs 2007;12(12):552-557. [Ref. 4411]
Article contains an overview of MS with an emphasis on supporting self management and includes a table of the most common symptoms and management options. The importance of preventing complications secondary to MS including urinary tract infections, pressure sores and aspiration pneumonia is highlighted and consideration given to the role of the palliative care team in advanced MS in the community.
2. Beiske AG, Svensson E, Sandanger I, et al.
Depression and anxiety amongst multiple sclerosis patients.
Eur J Neurol 2008;15(3):239-245. [Ref. 4490]
Cross sectional population based study where 140 people with MS, describing a wide range of disease duration and disability level, were found to experience twice as many symptoms of depression and three times as many of anxiety compared with the general population. 16% of those with depression and 11% with anxiety were receiving treatment whilst 18% of untreated patients expressed the need to be treated.
3. Betts L.
Exercise and multiple sclerosis: Have we come full circle?
Br J Neurosci Nurs 2008;4(4):166-169. [Ref. 4489]
Review of studies demonstrating the benefit of exercise in MS and examination of current health promotion strategies for people with MS. Considers how an understanding of self efficacy might be relevant to self management and the need for health professionals to be aware of the resources and information currently available to support exercising.
4. Borkoles E, Nicholls AR, Bell K, et al.
The lived experiences of people diagnosed with multiple sclerosis in relation to exercise.
Psychol Health 2008;23(4):427-441. [Ref 4472]
Seven active exercisers (with scores 4-6 on Kurtzke scale) took part in semi structured interviews relating to exercise experience since diagnosis of MS. Loss of spontaneous opportunities to exercise because of actual or perceived barriers was highlighted and the impact of environmental and social barriers at leisure facilities (particularly swimming pools), transport, avoidance of stigmatisation, discrimination, and stereotyping examined. Concludes that promoting exercise in this population should be a joint initiative between the different agencies involved in the individuals care, and should include personal assistants and gym staff.
5. Clerico M, Faggiano F, Palace J, et al.
Recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis (Review).
Cochrane Database of Systematic Reviews 2008, Issue 2 CD005278. [Ref. 4535]
Review considered three trials testing the efficacy of interferon beta (including a total of 639 people on treatment and 521 on placebo), no trials tested efficacy of glatiramer acetate. Authors conclude that efficacy of interferon beta on preventing conversion from clinically isolated syndrome (CIS) to clinically definite MS was confirmed over two years.
6. Coyle PK.
Switching algorithms: from one immunomodulatory agent to another.
J Neurol 2008;255 (Suppl 1):44-50 [Ref. 4530]
Considers the difficulties in defining what might constitute a suboptimal response to disease modifying treatment including unacceptable side effects, disability progression and an increase in relapse rate when treatment initiation may have followed the first event. Examines the available studies on treatment switching, and proposes criteria for switching between first line treatments for relapsing remitting MS.
7. Debouverie M, Pittion-Vouyovitch S, Brissart H, et al.
Physical dimension of fatigue correlated with disability change over time in patients with multiple sclerosis.
J Neurol 2008;255(5):633-636. [Ref. 4529]
Study of 196 MS patients where baseline data on fatigue (MFIS), health related quality of life (SF-36) and disability status (EDSS) were collected. After 3 years 54% had unchanged or improved disability status and 46% showed worsening. A high level of fatigue was associated with increased EDSS. Suggests fatigue can be a predictor of objective outcomes such as changes in disability status at three years.
8. Edwards RG, Barlow JH, Turner AP.
Experiences of diagnosis and treatment among people with multiple sclerosis.
J Eval Clin Pract 2008;14(3):460-464. [Ref.4526]
Semi structured telephone interviews with 24 people with MS where disease duration ranged from one to 37 years. Highlights the distress that may be experienced in the period between symptom onset and diagnosis and suggests the effect of delay in diagnosis on psychosocial adaptation should be studied further. Highlights satisfactory information provision and support during and after diagnosis is imperative.
9. Gentry T.
PDAs (personal digital assistants) as cognitive aids for people with multiple sclerosis.
Am J Occup Ther 2008;62(1):18-27. [Ref. 4532]
20 participants with MS who rated cognitive difficulty as their most, or second most, troubling MS symptom and who achieved low scores on the CHART-R and RBMT-E scales were trained in use of PDA over eight weeks. Participants experienced improvement in everyday function which was maintained at eight week follow up. Concludes that people with cognitive impairment related to MS could benefit from the use of PDA as a compensatory assistive technology.
10. Hirst C, Ingram G, Pearson O, et al.
Contribution of relapses to disability in multiple sclerosis.
J Neurol 2008;255(2):280-287. [Ref. 4528]
279 relapses in 182 patients were assessed before, during, and after relapse using EDSS. Mean EDSS prior to relapse was 3.73, during relapse 5.18 and post relapses 4.23. 49% of patients had residual increase post relapse of at least 0.5 EDSS points and 32.7% an increase of one point. No influence of sex, site of relapse or age at relapse was found. Suggests that acute relapses are commonly associated with objective worsening of disability and recovery is incomplete.
11. Johansson S, Ytterberg C, Hillert J, et al.
A longitudinal study of variations in and predictors of fatigue in multiple sclerosis.
J Neurol Neurosurg Psychiatry 2008;79(4):454-457. [Ref. 4525]
Study of 200 people with MS attending outpatient clinic over two years found that depressive symptoms, weak or moderate sense of coherence, living with a partner and not working were independent predictors of fatigue. Levels of fatigue were found to vary over the two year period. Suggest that health and related services should be aware of both disease and social variables when assessing fatigue.
12. Johnson SL.
The concept of fatigue in MS.
J Neurosci Nurs 2008;40(2):72-77. [Ref 4523]
Overview of fatigue that considers environmental risk factors, personal and developmental factors, and pathological processes involved. Considers the different manifestations of fatigue and the difficulties of measurement, limitations of Fatigue Impact Scale and Fatigue Severity Scale are considered. Clinical management strategies are discussed and the importance for health professionals of recognising fatigue as primary or secondary highlighted.
13. Leone MA, Bonissoni S, Collimedaglia L, et al.
Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study.
Mult Scler 2008;14(4):485-493. [Ref. 4547]
72 patients were evaluated every six months or until the first relapse for three years. Over the study 209 attacks where experienced of which 21% left mild sequelae, and 13% severe. Sphincteric symptoms were most likely to be associated with sequelae. Factors predicting incomplete recovery were found to be more closely linked to the characteristic of a single relapse (extension and duration of tissue damage) than to any genetic or environmental factors.
14. McClurg D, Ashe RG, Lowe-Strong AS.
Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis - a double blind, placebo controlled randomised clinical trial.
Neurourol Urodyn 2008;27(3):231-237. [Ref. 4527]
74 people with MS presenting with lower urinary tract dysfunction were randomly allocated to receive either pelvic floor muscle training electromyography biofeedback and placebo neuromuscular electrical stimulation (group 1) or similar treatment with active neuromuscular electrical stimulation (group 2). Incontinence episodes were reduced in group 1 by 47% and group 2 by 85%. Suggests addition of active neuromuscular electrical stimulation should be considered as a first line treatment option in alleviating symptoms of lower urinary tract dysfunction in MS.
15. Martinelli Boneschi F, Colombo B, Annovazzi P, et al.
Lifetime and actual prevalence of pain and headache in multiple sclerosis.
Mult Scler 2008;14(4):514-521. [Ref. 4548]
Cross sectional sample of 428 consecutive MS patients (74% with relapsing remitting MS) attending Italian MS Centre outpatient clinic over a 3 month period was examined using semi structured interview. Mean disease duration was 9.6 years and mean EDSS 2.0. Contains table of actual and lifetime risk of prevalence of different types of pain in this MS population across different disease courses. Lifetime prevalence of at least one type of neuropathic or somatic pain was found to be 39.4%, and 58.5% when headache was included. Progressive MS was found to increase risk of dysaesthesic pain and greater disability carried a higher risk of back pain.
16. White CP, White MB, Russell CS.
Invisible or visible symptoms of MS: which are more predictive of health distress?
J Neurosci Nurs 2008 40(2):85-95,102. [Ref. 4522]
In a sample of 145 adults with MS pain and depression were found to be the most predictive of health distress whilst for those who had MS for 11 years or longer fatigue, pain and depression were most significant. Visible symptoms considered were use of assistive devices, balance and speech problems. Suggests that to minimize health distress, health professionals should assess and aggressively treat pain.
17. Peterson EW, Cho CC, von Kock L, et al.
Injurious falls among middle aged and older adults with multiple sclerosis.
Phys Med 2008; 89(6):1031-1037. [Ref. 4521]
Questionnaire study of 354 people with MS aged 55-94 years found more than 50% reported injurious falls, 12% in the six months prior to the survey. Suggests that management of fear of falling and osteoporosis are important components of comprehensive fall injury prevention programmes for people aging with MS.
18. Prunty MC, Sharpe L, Butow P, et al.
The motherhood choice: a decision aid for women with multiple sclerosis.
Educ Couns 2008;71(1):108-115. [Ref. 4533]
Randomised controlled trial of 194 women with MS deciding whether to start or enlarge a family. Participants were randomised to receive the decision aid (DA) or not and answered a questionnaire measuring decisional conflict, self efficacy, knowledge, depression and anxiety as well as views regarding having children pre and post intervention. Women who received the DA showed greater knowledge about pregnancy and MS, self efficacy and decreased decisional conflict. The DA was found to be free from adverse psychological impacts.
19. van Kessel K, Moss-Morris R, Willoughby E, et al.
A randomised controlled trial of cognitive behaviour therapy (CBT) for multiple sclerosis.
Psychosom Med 2008;70(2):205-213. [Ref. 4536]
72 people with MS were assigned either weekly CBT or relaxation therapy (RT) for eight weeks. Fatigue was assessed before and after treatment and at three and six months post treatment. The CBT group reported a significantly greater reduction in fatigue compared with the RT group; however both groups showed clinically significant decreases in fatigue. Whilst this study has limitations authors suggest that both CBT and RT are acceptable treatment options for fatigue in MS.
20. Townsend G.
Supporting people with multiple sclerosis in employment: a United Kingdom survey of current practice and experience.
Br J Occ Ther 2008;71(3):103-111. [Ref. 4487]
80 health professionals (32 OTs, 26 MS specialist nurses, 4 MS specialist physiotherapist and 8 DEAs) took part in the questionnaire survey. The most common disease factor identified for loss of employment was fatigue followed by loss of mobility. Physical barriers were most commonly highlighted as a work factor, but social factors were less identified. Concludes that professionals' awareness of the impact of personal and social issues is minimal and highlights a lack of connection between interventions offered and reports of issues raised by people with MS
21. Yorkston KM, Kuehn CM, Johnson KL, et al.
Measuring participation in people living with MS: a comparison.
Disabil Rehabil 2008;30(2):88-97. [Ref. 4524]
Highlights the importance of reflecting the perspective of the person with MS when considering participation, how important an activity might be, rather than only the frequency the activity is carried out. Suggests further study to understand the role that self efficacy and environmental barriers may play in participation would be of value.
If you would like copies of any of these papers, please contact info@mstrust.org.uk, ring us on 01462 476700 or write to us at MS Trust, Spirella Building, Letchworth Garden City, Herts SG6 4ET.
