Marcia Finlayson

Randomized controlled trial of an energy conservation course for persons with multiple sclerosis

Objective: To assess the short-term efficacy and effectiveness of a six-week energy conservation course on fatigue impact, quality of life and self-efficacy for persons with multiple sclerosis (MS). Methods: In this randomized controlled trial, we randomly assigned 169 persons with MS to an immediate intervention group or a delayed control group using a crossover design. The outcome measures: Fatigue Impact Scale, SF-36 Health Survey and Self-Efficacy for Performing Energy Conservation Strategies were measured before and after courses and no intervention control periods. We performed intent-to-treat analysis and compliers-only analyses using mixed effects analysis of variance models. Results: Taking the energy conservation course had significant effects on reducing the physical and social subscales of Fatigue Impact Scale and on increasing the Vitality subscale of the SF-36 scores compared with not taking the course. Additional subscales were significant depending on methods of analyses. Self-Efficacy for Performing Energy Conservation Strategies Assessment increased significantly (p<0.05) postcourse compared to precourse. Conclusions: Results support the efficacy and effectiveness of the energy conservation course to decrease fatigue impact, and to increase self-efficacy and some aspects of quality of life.

Injurious Falls Among Middle Aged and Older Adults With Multiple Sclerosis

OBJECTIVE To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS). DESIGN Survey. SETTING United States. PARTICIPANTS Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never). RESULTS More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27-2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62). CONCLUSIONS Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.

Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45—90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45—90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating. Multiple Sclerosis 2007; 13: 1168—1175. http://msj.sagepub.com

Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication.

Fatigue is a common symptom of multiple sclerosis (MS) with negative impacts extending from general functioning to quality of life. Both the cause and consequences of MS fatigue are considered multidimensional and necessitate multidisciplinary treatment for successful symptom management. Clinical practice guidelines suggest medication and rehabilitation for managing fatigue. This review summarized available research literature about three types of fatigue management interventions (exercise, education, and medication) to provide comprehensive perspective on treatment options and facilitate a comparison of their effectiveness. We researched PubMed, Embase, and CINAHL (August 2013). Search terms included multiple sclerosis, fatigue, energy conservation, Amantadine, Modafinil, and randomized controlled trial. The search identified 230 citations. After the full-text review, 18 rehabilitation and 7 pharmacological trials targeting fatigue were selected. Rehabilitation interventions appeared to have stronger and more significant effects on reducing the impact or severity of patient-reported fatigue compared to medication. Pharmacological agents, including fatigue medication, are important but often do not enable people with MS to cope with their existing disabilities. MS fatigue affects various components of ones health and wellbeing. People with MS experiencing fatigue and their healthcare providers should consider a full spectrum of effective fatigue management interventions, from exercise to educational strategies in conjunction with medication.

Falls, Aging, and Disability

Falls are a major public health problem, contributing to significant morbidity and mortality among older adults in the United States. This article summarizes and compares (1) fall prevalence rates, (2) fall risk factors, (3) consequences of falls, and (4) current knowledge about fall prevention interventions between community-dwelling older adults and people aging with physical disability. In this latter group, the article focuses on individuals with multiple sclerosis, late-effects of polio, muscular dystrophies, and spinal cord injuries.

Trauma Symptoms and Life Skill Needs of Domestic Violence Victims

This study identified the trauma symptoms and life skill needs of 84 domestic violence victims from three domestic violence programs. Women completed two self-report tools: Trauma Symptom Inventory (TSI) and Occupational Self Assessment (OSA). Staff members participated in focus groups regarding their perceptions of the women’s needs. Women scored within the clinical range on the Defensive Avoidance (39.8%), Intrusive Experiences (30.1%), and Tension Reduction Behavior (24.1%) clinical scales of the TSI. On the OSA, the groups’ priorities differed although all demonstrated a desire to function more independently. Their mental health functioning and prioritization of needs differed based on their level of involvement with the service delivery system. Staff members believe women lack skills in the areas of money management, seeking and obtaining employment, locating permanent housing, independently completing self-care and home management activities, managing stress, and parenting. The findings indicate that both mental health and life skills needs must be addressed.

Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis

Background: Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis (MS). Nevertheless, many people are unable to access these programs due to environmental barriers. Objectives: To test the efficacy and effectiveness of a group-based, teleconference-delivered fatigue management program for people with MS. Methods: A randomly allocated two-group time series design with a wait-list control group was used. In total 190 participants were allocated (94 intervention, 96 wait-list control). Primary outcomes (fatigue impact, fatigue severity, health-related quality of life (HRQOL)) were measured before, immediately after, at 6 weeks, 3 months, and 6 months post. Secondary outcome (self-efficacy) was measured at the same points. Effectiveness (intent-to-treat) and efficacy (per protocol) analyses were conducted. Results: The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity. Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact, fatigue severity, and 6 of 8 HRQOL dimensions. Changes were maintained for 6 months with small to moderate effect sizes. Conclusion: The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom.

The social experience of aging with a chronic illness: Perspectives of older adults with multiple sclerosis

Purpose. The purpose of this study was to explore the social experiences of older adults with multiple sclerosis (MS) in order to recognize the changes in social experience and social needs that may occur with aging with a chronic illness. Method. Analysis of qualitative data from an exploratory study utilizing a phenomenological approach with 27 older adults with MS, aged 55 – 81. Results. In-depth interviews revealed that the social experience was influenced by groups of factors including the persons social needs, experience of MS, values and expectations, characteristics of the social support system, the response of the support providers, and the accessibility of the social environment. The participants discussed concerns about the future adequacy of support. A process of negotiation was also described and was seen as an opportunity to change the social experience and social support received. Conclusion. This study provides an insiders view of the social changes that older adults living with MS experience. This study also identifies barriers to the acquisition of support and addresses the importance of appropriately responding to the changing needs of this population.

Educating Scholars of Practice: An Approach to Preparing Tomorrow's Researchers

SUMMARY Occupational therapys scholarship too often fails to result in a cumulative body of knowledge that is directly relevant to practice, and links theory and research to practice. This problem has its basis in how therapists are prepared to make scholarly contributions to the field. This article describes an educational strategy for preparing scholars of practice whose work will contribute to building a knowledge base that examines and enhances practice. The strategy is based upon social learning theory, employs principles of situated learning and cognitive apprenticeship, and involves students as members of an ongoing community of scholars. Steps to and benefits of creating this scholarly community and implementing this educational strategy are discussed.

Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life

Purpose. Cognitive changes occur in over 50% of persons diagnosed with multiple sclerosis (MS). Although previous research has provided information of the nature and severity of cognitive changes among persons with MS, it has offered relatively limited insight on the impact of these changes on levels of functioning and disability. The purpose of this study was to explore the impact of cognitive changes on the lives of four individuals with MS with different life roles (worker, parent, retired older adult). Method. Qualitative methodologies were used in the study and included multiple open-ended interviews with the study participants and the completion of Cognitive Experience Forms in between interviews. In addition, the Perceived Deficits Questionnaire and a demographics form were administered. Thematic analysis was used to analyse the study data. Results. Participants described the types of cognitive changes they are experiencing and how these changes affect their ability to participate and engage in desired activities and maintain their primary roles. Participants also talked about how cognitive changes affect their quality of life. Conclusions. This study points to the complexity of cognitive changes and highlight the importance of addressing these changes in rehabilitation.