MS research update - 9 October 2009
- Informal or unpaid care givers surveyed
- Impact of disability on mental well-being greater for men
- Bone health investigated in people with MS
- Predicting response to disease modifying drugs
- Individual rehab versus group classes - which is best?
Informal or unpaid care givers surveyed
About 30% of people with MS require some form of home care assistance and 80% of that assistance is provided by informal or unpaid care givers. This American study gathered statistics on the care givers of 530 more disabled people with MS. Almost half of these care givers reported that they provided more than 20 hours of care per week to the person with MS, with more than 9 in 10 shopping for groceries, doing indoor housework, preparing meals or providing transportation for the person with MS. More than 4 in 10 employed care givers reduced the amount of time worked in the previous 12 months because of their care giving responsibilities. Although more than half of the MS care givers in the study reported that care giving was demanding, time consuming or challenging, about 90% of these MS care givers were happy that they could help. About two in three of these MS care givers found that care giving was rewarding, with more than 8 in 10 proud of the care they provided. More than a quarter of the informal care givers to people with MS thought they would benefit from treatment or counselling provided by mental health professionals. The researchers concluded that it is important to ensure that informal care givers have access to appropriate mental health care, given the scope of their care giving responsibilities.
Buchanan RJ, Radin D, Chakravorty BJ et al.
Informal care giving to more disabled people with multiple sclerosis.
Disabil Rehabil. 2009;31(15):1244-56.
Medline abstract
Impact of disability on mental well-being greater for men
Women have more than twice the risk of developing multiple sclerosis (MS) compared with men, a ratio that seems to be increasing. A total of 370 people with MS (105 men and 265 women) in Ferrara, Italy completed a questionnaire designed to provide information about their quality of life and the results compared between the two genders.
Taken together, the group had a lower quality of life compared to the general population. Quality of life decreased as disability (measured with the EDSS scale) increased. The impact of disability on quality of life was higher for men than women and this was particularly marked at higher levels of disability for quality of life measures relating to mental health, suggesting that women were better able to cope. The investigators conclude that the impact of disability seems to be greater on men, in particular for mental well-being and suggest that interventions should to be gender specific in order to better meet needs.
Casetta I, Riise T, Nortvedt MW et al.
Gender differences in health-related quality of life in multiple sclerosis.
Mult Scler. 2009 Oct 1. [Epub ahead of print]
Medline abstract
Bone health investigated in people with MS
Increasing age and increasing disability, leading to reduced physical activity, are known to cause decreases in bone mineral density and an increased risk of osteoporosis. However, little is known about the effects of MS on bone health in younger and fully mobile people. This study investigated 80 people with MS who were younger than 50 and fully mobile in order to identify potential predictors of reduced bone mass and determine the prevalence of low bone mineral density in this group. Bone mineral density was measured at three points - hips, lumbar (lower back) spine and wrists and information gathered on past and present vitamin D and calcium intake and a variety of lifestyle habits. A number of MS-related variables as well as past life-style habits differentially affected bone mineral density at the three clinically important skeletal sites. Low bone mineral density was found in 19 members of the group. This study suggests that bone health should receive greater attention in care for persons with MS.
Steffensen LH, Mellgren SI, Kampman MT.
Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis.
J Neurol. 2009 Oct 1. [Epub ahead of print]
Medline abstract
Predicting response to disease modifying drugs
In this review, the authors discuss different approaches for monitoring and predicting treatment responses to disease-modifying agents in people with relapsing remitting MS.
Disease modifying drugs are only partially effective, and, in most people receiving such treatment, clinical activity persists. Accurately assessing the treatment response to disease-modifying agents enables non-responders to be identified at an early stage so that they can be switched to another, potentially more effective, therapy. Several criteria based on relapses, disability progression or both have been proposed for evaluating the treatment response to disease-modifying agents. These criteria have not been independently validated, however, and no consensus over which are the best to use currently exists among investigators. MRI could also be employed to detect asymptomatic disease activity in people treated with disease-modifying agents. Pharmacogenomic approaches, looking for the role of an individual's genetic makeup in responses to disease modifying drugs, are in the early stages of development for MS, but hold great promise for the eventual development of individually tailored therapies.
Río J, Comabella M, Montalban X.
Predicting responders to therapies for multiple sclerosis
Nature Reviews Neurology 2009 Oct;5(10):553-60
Medline abstract
Individual rehab versus group classes - which is best?
This study compared group health education with an individualised physical rehabilitation programme. 50 volunteers were divided between the two groups: group health education consisted of seven classes while individualised physical rehabilitation consisted of four physical therapy sessions plus three telephone calls. Participants completed questionnaires and were assessed for physical fitness and activity before and after the study.
Both group classes and individualised therapy were effective in improving health and physical activity. The results also show that participants may benefit more physically from individualized physical rehabilitation and more mentally from group health education. The authors conclude that interventions combining both approaches might be most effective for people with multiple sclerosis.
Plow MA, Mathiowetz V, Lowe DA.
Comparing individualized rehabilitation to a group wellness intervention for persons with multiple sclerosis.
Am J Health Promot. 2009 Sep-Oct;24(1):23-6.
Medline abstract