MS Information Update no 44 - June 2009
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, 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. Barrett CL, Mann GE, Taylor PN, et al.
A randomized trial to investigate the effect of functional electrical stimulation (FES) and therapeutic exercise on walking performance for people with multiple sclerosis.
Mult Scler 2009;15(4);493-504. [Ref. 4735]
44 people with secondary progressive MS and unilateral dropped foot were allocated to receive FES or a physiotherapy home exercise program for 18 weeks. The exercise group showed statistically significant increase in 10m walking speed and distance relative to the FES group. Study concludes that exercise may provide greater training effect on walking speed than FES for people with secondary progressive multiple sclerosis.
2. Bogaardt H, van Dam D, Wever NM, et al.
Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis..
Ann Otol Rhinol Laryngol 2009;118(4):241-246. [Ref. 4736]
25 people with multiple sclerosis and swallowing problems were treated for three weeks with two sessions per week of neuromuscular electrostimulation. Results showed that the treatment of swallowing problems with neuromuscular electrostimulation in patients with multiple sclerosis in this sample was successful in the reduction of pooling of saliva and in the reduction of aspiration.
3. Brandes DW, Callender T, Lathi E, et al.
A review of disease modifying therapies for MS: maximizing adherence and minimizing adverse events.
Curr Med Res Opin 2009;25(1):77-92. [Ref. 4723]
Guidelines developed from extensive review of the literature conclude that effective management of MS as an ongoing dynamic process is required. Major factors influencing adherence included; managing treatment expectations; maintaining good health professional-patient communication, and sucessful management of adverse events.
4. Dalgas U, Ingemann-Hansen T, Stenager E.
Physical exercise and MS - recommendations.
In MS J 2009;16(1):5-11. [Ref. 4737]
Literature review considers available evidence base in wide variety of exercise regimes. Recommendations are made for; general exercise, resistance training, endurance training, and combined training. Recommendations are limited to people with EDSS <7 as insufficient evidence was available to consider those with greater impairment.
5. Fowler CJ, Panicker JN, Drake M, et al.
A UK consensus on the management of the bladder in multiple sclerosis.
J Neurol Neurosurg Psych 2009;80(5):470-477. [Ref. 4738]
Recommendations based on review of the literature and expert opinion using NICE criteria. Consensus highlighted that patients with MS who experience bladder symptoms should be assessed by an expert and encouraged to understand why they have developed poor bladder control. Successful management could be based on a simple algorithm including reagent sticks to test for urinary tract infections and post micturation residual volume measurement. The mainstay of treatment is antimuscaric medications in combination, where necessary, with clean intermittent self catheterisation.
6. Jensen MP, Barber J, Romano JM, et al.
A comparison of self-hypnosis (HYP) versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain.
Int J Clin Exp Hypn 2009;57(2):198-221. [Ref. 4698]
Of 22 individuals with MS and chronic pain 8 were assigned to self hypnosis training and 14 to either self hypnosis training or progressive muscle relaxation. Results found those who received self hypnosis training intervention reported more benefit than those assigned to progressive muscle relaxation in spite of similar treatment outcome expectations. Authors conclude that results support efficacy of self hypnosis training for management of chronic pain.
7. Johnson FR, Van Houtven G, Ozdemir S, et al.
Multiple sclerosis patients' benefit-risk preferences: serious adverse event risks versus treatment efficacy.
J Neurol 2009;256(4):554-562. [Ref. 4739]
Questionnaire survey of 651 people with MS reported delay in years to disability progression was the most important factor in treatment preferences. In return for decreases in relapse rates from 4 to 1 and increases in delay in progression from 3 to 5 years, patients were willing to accept a 0.38% annual risk of death or disability from PML, a 0.39% annual risk of death from liver failure or a 0.48% annual risk of death from leukemia. Study concludes that patient preferences for potential benefits and risks can assist in the decision making process.
8. Kehler MD, Hadjistavropoulos HD.
Is health anxiety a significant problem for individuals with multiple sclerosis?
J Behav Med 2009;32(2):150-159. [Ref. 4740]
Study of 246 people with MS found higher level of health anxiety compared to matched controls. Those with elevated health anxiety were less likely to score highly on problem focused coping but more highly on emotional preoccupation and social support suggesting preoccupation with the emotional impact of MS is at the expense of efforts to change or deal with the condition. Authors highlight the importance of assessing health anxiety over generalized anxiety in individuals with MS..
9. Kern S, Schrempf W, Schneider H, et al.
Neurological disability, psychological distress and health-related quality of life (HRQoL) in MS patients within the first three years after diagnosis.
Mult Scler 2009;15(6):752-758. [Ref. 4741]
Psychological distress and HRQoL was measured in 31 people with relapsing remitting MS within three years of diagnosis and 24 age and sex matched controls. Whilst associated with neurological disability, psychological distress was also present with minimal or no neurological disability and was independently associated with quality of life. Recommends psychological distress should be closely monitored and support structures be provided where necessary.
10. Lode K, Bru E, Klevan G, et al.
Depressive symptoms and coping in newly diagnosed patients with multiple sclerosis.
Mult Scler 2009;15(5):638-643. [Ref. 4742]
Questionnaire study of 86 people newly diagnosed with MS and 93 healthy controls found people with MS used less problem focussed strategies of coping and less emotion focused strategy. Depressive symptoms were related to focusing on and venting emotion and, avoidance strategies of disengagement. Supports newly diagnosed patients being offered interventions to support coping focussed strategies
11. McClurg D, Lowe-Strong A, Ashe R.
Pelvic floor training for lower urinary tract dysfunction in MS. Does pelvic floor muscle training (PFMT) improve lower urinary tract function in MS?
Nurs Times 2009;105(7):45-47. [Ref. 4744]
36 people with MS took part in a nine week intervention, attending clinic once a week and performing PFM exercises at home. Digital assessment of PFM, bladder diary, and 24 hour pad test and uroflowmetry were used for assessment. Nine week PFMT program improved function in pelvic floor; reduced symptoms associated with lower urinary tract dysfunction and increased quality of life in people with MS.
12. Mallam E, Scolding N.
The diagnosis of MS.
Int MS J 2009;16:19-25. [Ref. 4743]
Considers the challenges of making a diagnosis of MS. The evolution of current diagnostic criteria is examined and common presenting symptoms discussed. The possibility of multifarious differential diagnoses is highlighted and recommendation made that diagnostic uncertainty is discussed openly with patients.
13. Mackereth PA, Booth K, Hillier VF, et al.
Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial.
Complement Ther Clini Pract 2009;15(1):14-21. [Ref. 4751]
Fifty people with MS received six week courses of either reflexology or progressive muscle relaxation to measure their effects on stress, anxiety, blood pressure and heart rate. Positive results were seen for both therapies in reducing measures of stress and anxiety.
14. Marrie RA, Horowitz R, Cutter G, et al.
The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed and undertreated.
Mult Scler 2009;15(3):385-392. [Ref. 4745]
8983 responders from the NARCOMS registry completed questionnaires where 48% reported a mental comorbidity, most frequently depression. Concludes that mental comorbidity remains under diagnosed and undertreated in MS and highlights that people of lower socioeconomic status experience a greater incidence of depression.
15. Poder K, Ghatavi K, Fisk JD, et al.
Social anxiety in a multiple sclerosis clinic population.
Mult Scler 2009;15(3)393-398. [Ref. 4746]
245 people with multiple sclerosis completed self report scales of anxiety and depression. Severity of social anxiety symptoms was associated with reduced health related quality of life but not related to neurological disability. Concludes that greater awareness and routine systematic enquiry of social anxiety symptoms are an important component of comprehensive care for people with MS.
16. Rantell A.
Lower urinary tract symptoms (LUTS) in women with multiple sclerosis: part 1.
Br J Nurs 2009;18(7):S14-18. [Ref.4747]
Examines how MS affects bladder function, defines symptoms associated with storage and voiding dysfunction. Considers medication that may exacerbate or lead to urinary incontinence and works through stages of assessment of LUTS. Part 2 will consider pharmacological and surgical interventions.
17. Rudick RA, Polman CH.
Current approaches to the identification and management of breakthrough disease in patients with multiple sclerosis.
Lancet Neurol 2009:8(6):545-559 [Ref. 4748]
Literature review suggests monitoring strategies including regular follow-up visits, planned regular assessment of treatment compliance, discussion and management of adverse events, and monitoring of relapses, disability, and MRI measures are key in identification of breakthrough disease in MS. The role of neutralizing antibodies and biological markers is considered.
18. Snook EM, Motl W.
Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis.
Neurorehabil Neural Repair 2009;23(2):108-116. [Ref. 4749]
Literature review concludes that exercise training is associated with a small improvement in walking mobility in individuals with multiple sclerosis. Larger effects were associated with supervised training, exercise programmes of >3 months and mixed samples of relapsing remitting and progressive MS.
19. Treadaway K, Cutter G, Salter A, et al.
Factors that influence adherence with disease-modifying therapy in MS.
J Neurol 2009;256(4):568-576. [Ref. 4750]
Multicentre observational study using online questionnaires of 800 participants who had maintained DMD therapy for >6 months. The most common reason for none adherence was forgetting to take medication. Injection procedure and unrealistic treatment expectations were also factors. Suggests further exploration of impact on cognitive symptoms on adherence and development of relevant interventions could improve adherence.
20. Wiendl H, Holfeld R.
Multiple sclerosis therapeutics: unexpected outcomes clouding undisputed successes.
Neurology 2009;72(11);1008-1015. [Ref. 4714]
Considers the problems of head to head trials; the impact of serious adverse reactions, the challenges encountered in therapy for progressive MS and a need for more sensitive outcome measures in this arena. The difficulty of carrying out placebo controlled trials and the value of frequently used endpoints are also raised.
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.
