1,721,098 research outputs found
Workers with disability: the case of multiple sclerosis
No full textThe impact of the multiple sclerosis (MS) on the individual's ability to work is important especially because the onset of the disease occurs mainly between 20 and 30 years of age. This study evaluated different factors associated with job maintenance using a questionnaire that defined what factors are considered obstacle or help in work management. A cross-sectional study of people with MS was carried out in Italy. A total of 1016 individuals with MS were enrolled in the study. Our results showed that negative item related to job maintenance as 'attitudes of other in the workplace' was associated with a lower likelihood of being employed (OR 0.65, 95 % CI 0.57-0.76), while 'your attitudes toward work' (OR 1.37, 95 % CI 1.19-1.59), 'attitudes of other in the workplace' (OR 1.41, 95 % CI 1.17-1.69) and 'personal considerations' (OR 1.54, 95 % CI 1.23-1.93), positive items related to job maintenance, were associated with a higher likelihood of being employed. In addition, a poor quality of life and severity disease as well same demographic characteristics (i.e. to be resident in South Italy or in the Islands, living in own original family, have lower educational level) inhibited significantly the job maintenance together with a heavy job and a fixed-term contract. In conclusion, a complex set of variables contribute to the barriers faced by PwMS who are employed suggesting that different stakeholders may play an important role in difficult management of the work for people with MS
Time-of-day influences resting-state functional cortical connectivity
Full text linkTime-of-day is rarely considered during experimental protocols investigating motor behavior and neural activity. The goal of this work was to investigate differences in functional cortical connectivity at rest linked to the time of the day using functional Near-Infrared Spectroscopy (fNIRS). Since resting-state brain is shown to be a succession of cognitive, emotional, perceptual, and motor processes that can be both conscious and nonconscious, we studied self-generated thought with the goal to help in understanding brain dynamics. We used the New-York Cognition Questionnaire (NYC-Q) for retrospective introspection to explore a possible relationship between the ongoing experience and the brain at resting-state to gather information about the overall ongoing experience of subjects. We found differences in resting-state functional connectivity in the inter-hemispheric parietal cortices, which was significantly greater in the morning than in the afternoon, whilst the intra-hemispheric fronto-parietal functional connectivity was significantly greater in the afternoon than in the morning. When we administered the NYC-Q we found that the score of the question 27 ("during RS acquisition my thoughts were like a television program or film") was significantly greater in the afternoon with respect to the morning. High scores in question 27 point to a form of thought based on imagery. It is conceivable to think that the unique relationship found between NYC-Q question 27 and the fronto-parietal functional connectivity might be related to a mental imagery process during resting-state in the afternoon
Tailored balance exercises on people with multiple sclerosis: A pilot randomized, controlled study
No full textBackground:
Altered integration of signals from visual (VIS), somatosensory (PROP) and vestibular system (VEST) lead to balance control impairments affecting the daily living activities of patients with multiple sclerosis (PwMS). As a consequence, tailored interventions could be crucial in improving efficacy of balance rehabilitation treatments.
Objective:
The objective of this paper is to assess the efficacy of tailored rehabilitation treatments for balance disorders based on visual, somatosensory and vestibular deficits versus traditional rehabilitation exercises.
Methods:
Thirty-two PwMS were assessed with the Berg Balance Scale (BBS), the composite score (CS) obtained by computerized dynamic posturography (CDP) test and the Modified Fatigue Impact Scale (MFIS). Based on CDP analysis, prevalent VIS, PROP or VEST deficits were identified and patients randomly allocated to a personalized (PRG) or traditional (TRG) rehabilitation group.
Results:
BBS score showed a significant difference between pre- and post-treatment scores of 6.3 and 2.0 points respectively for PRG and TRG. CS showed a significant difference between pre- and post-treatment scores of 16.6 and 7.6 points respectively for PRG and TRG. No interaction effect was found for MFIS score.
Conclusions:
BBS and CS showed changes in the PRG group that met clinical relevant difference, underlining that tailored rehabilitation interventions based on patient-specific sensory system impairment could improve balance and postural control in PwMS
Il costo sociale della sclerosi multipla in Italia: focus sulla riabilitazione
No full textIntroduzione La sclerosi multipla (SM) insorge tra la seconda e la terza decade di vita e determina
una progressiva disabilità, un significativo impatto sull’attività lavorativa e sulla qualità di vita e un
elevato costo sociale
Obiettivo dello studio Valutare l’impatto socio-economico della SM nel 2011 attraverso la stima dei
costi sanitari, non sanitari e relativi alla perdita di produttività, con un approfondimento per i costi
correlati alla riabilitazione.
Metodi È stato disegnato uno studio di tipo osservazionale, multicentrico e retrospettivo. Utilizzando
un approccio bottom up, le informazioni sono state raccolte direttamente su un campione di pazienti
attraverso un questionario anonimo. I soggetti sono stati arruolati, in modo consecutivo, attraverso i
Centri Clinici, le strutture di riabilitazione, o selezionati tramite una lista, tra i soci dell’Associazione.
Risultati Un totale di 1686 soggetti, rappresentativi dei vari livelli di disabilità (scala EDSS), sono
stati inclusi nell’analisi. Il costo medio annuo per paziente al 2011 è risultato pari a € 37.947,7, di
cui il 37% è rappresentato da costi non sanitari, seguono i costi sanitarie e la perdita di produttività
rispettivamente per il 34% e 29%. L’impatto economico della SM aumenta all’aumentare della
gravità della patologia da 22.749,7 € per gravità ‘lieve’ a 63.046,9 € per gravità ‘severa’ di malattia.
Considerando le singole voci di costo, la perdita di produttività incide per circa il 30% su tutti i costi,
segue (27%) l’assistenza informale e il costo dei farmaci DMD per il 16%. Circa il 26,7% (€ 3,418.4) dei
costi sanitari sono attribuibili alla riabilitazione, di questi circa il 6% sono stati pagati direttamente
dai pazienti. € 1.508,2 (44%) dei costi di riabilitazione si riferiscono a trattamenti erogati in regime
di ricovero. Infine, un’analisi multivariata ha evidenziato come alcune variabili socio-democrafiche e
cliniche siano correlate ai costi totali di malattia. In particolare si osservano per i soggetti che vivono
da soli e di età inferiore costi più bassi, mentre la presenza di ricadute è associata a costi più elevati
(+16%). Infine, una più elevata severità di malattia è correlata a costi più elevati con un incremento di
circa il 46% per ogni incremento unitario della scala EDSS, mentre si osserva un decremento (-16%)
dei costi per ogni punto della scala Eq-5D che misura la qualità della vita.
Conclusione Il costo medio annuo per paziente stimato nel nostro studio è coerente con le stime
riportate in altri paesi (1). Considerando che le quote dei costi che impattano maggiormente sia sulle
famiglie che sulla società sono attribuibili alla perdita di produttività e alle cure informali, risulta che
politiche e investimenti mirati a migliore la gestione del lavoro per le persone con SM e a supportare
la famiglia nella gestione quotidiana della malattia è di primaria importanza sia in termini di qualità
di vita che di impatto economico. Dal nostro studio emerge inoltre che una percentuale elevata
dei costi di riabilitazione dipendono dai ricoveri per riabilitazione, ne consegue che una maggiore
disponibilità e una migliore qualità dei servizi di riabilitazione sul territorio potrebbero ridurre tali
costi.
1. MSIF Multiple Sclerosis International Federation. Global Economist Impact of Multiple Sclerosis. 2010; Accessed
02/2013; Available from: http://www.msif.org/docs/Global_economic_impact_of_MS.pd
Mind wandering in people with Multiple Sclerosis: A psychometric study
Full text linkBackground: Although mind wandering (MW) is associated with various psychological aspects frequently affected in people with Multiple Sclerosis (PwMS), there is lack of validated tools to assess MW in this clinical population.Objective: This psychometric study aimed to assess structural and construct validity and reliability of a brief Italian version of Mind Wandering (MW) Scale that measures two different dimensions of MW, i.e., spontaneous (MW-S) and deliberate (MW-D).Methods: Structural validity of the MW Scale was assessed by explorative factor analysis (EFA). To investigate construct validity, mood (Hospital Anxiety Depression Scale) and personality (10-items Big Five Inventory Test) were correlated with MW constructs. Reliability was assessed by Cronbach's alpha for internal consistency and intraclass correlation coefficients.Results: EFA confirmed two distinct constructs of MW, i.e., MW-S and MW-D, also in PwMS. This tool appropriately fits the graded response model, supporting validity (about 79% of hypotheses for convergent and discriminant constructs confirmed) and internal consistency (MW-S: Cronbach's alpha = 0.84; MW-D: Cronbach's alpha = 0.88).Conclusion: MW Scale could be a useful tool to measure MW also in PwMS. As MW seems to be connected to clinical manifestations of MS, a detailed assessment of MW should be encouraged in clinical practice
Improving disease course detection in multiple sclerosis: an alternative patient-reported outcomes-based strategy
No full textSelf-assessment reliability in multiple sclerosis: the role of socio-demographic, clinical and quality of life aspects
No full textIntroduction: Several multiple sclerosis studies matching self- and physician assessment of disease course and disability show moderate and high agreement respectively. However, the role played by socio-demographic, clinical, and quality of life (QoL) factors was not much investigated. The study aims at exploring how self-/physician agreement could depend on these variables. Materials and methods: Participants were asked to report own disease course and disability according to preset categories. Kappa-value and confidence interval (CI) for disease course and two-way random interclass correlation coefficient (ICC) and CI for disability were calculated to evaluate self-/physician agreement. Χ2 was applied to examine whether other factors (gender, age, education, civil status, disease duration, fatigue, quality of life) had systematic effects. Results: Data analysis on 203 participants indicated fair agreement (Kappa-value = 0.30; 95% CI 0.23–0.38) and no dependency on the categories of each variable for disease course. Satisfactory correlation was found for disability (ICC = 0.74; 95% IC 0.67–0.80), good agreement was found for almost all variable categories, and significant differences were observed for education (better agreement for higher levels), disease duration, fatigue and QoL (better agreement for worse conditions). Discussion: Results seem to suggest that higher education and worse clinical and QoL conditions could engage the patient in developing more disease awareness and realistic self-perception and self-evaluation
The effect of Nintendo(R) Wii(R) on balance in people with multiple sclerosis: a pilot randomized control study
No full textImprovement of sensory strategies is a relevant part of balance rehabilitation in multiple sclerosis (MS). This study aimed to Assess the effectiveness of visual-feedback exercises in improving balance in MS. We divided 36 patients into Wii and control-treated groups that underwent balance rehabilitation. Outcomes were obtained for Berg Balance Scale (BBS), Modified Fatigue Impact Scale, and sway area under conditions of opened and closed eyes. BBS showed a statistically significant improvement (from 49.6 to 54.6 points, p < 0.05) in the Wii group. Interactive visual-feedback exercises such as Wii could be more effective than the current standard protocol in improving balance disorders in MS
Profile and burden of the family caregiver: the caring experience in multiple sclerosis. An observational study
Full text linkBackground The broad implications of caring for a family member with a chronic medical condition, such as MS, can lead caregivers to experience a high burden of care. The aim of the study was to describe profile of MS caregivers and their burden and to explore potential factors influencing this burden. Methods 200 family caregivers of a person with MS completed survey questionnaires across a cross-sectional study. Many information were collected: caregiver socio-demographic and health-related data, caregiving activities, knowledge of MS, coping strategies, mood, social support received and care recipient information. Caregiving burden was measured by the ZBI (Zarit Burden Interview). The extent to which the variables explained caregiver burden was analyzed using a hierarchical approach. Results 68% of the caregivers reported a perceived burden of care (ZBI score > 20). Our results show that physical and mental related-health variables are important predictive factors of the care burden, explaining much of the observed variance (40.9%). Conclusion Family caregivers in MS continue to make up the shortfall produce by national health and welfare systems. We highlighted the importance of good physical and mental health in decreasing perceived burden. Working to alleviate psychological distress through mechanisms focus on reducing worries and perceived burden may be a valid approach
Exploring cortical activation patterns during linear vs. curvilinear walking in people with multiple sclerosis using a walking aid
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