Impact Scale Research Articles

Dynamics of choroid plexus volume is associated with the presence and development of fatigue in multiple sclerosis

BackgroundImmune-mediated processes are implicated in the pathogenesis of fatigue, a common symptom in multiple sclerosis (MS). The choroid plexus (CP) regulates central nervous system (CNS) immune homeostasis and undergoes volumetric...

Developing the Scale of the Social Health Impact of War.

Background/Aim: This study was conducted to develop the "Scale of the Effects of War on Social Health" to better understand the effects that news of have on individuals. Method: 389 adult individuals participated in the study. The scale was developed using exploratory and confirmatory factor analyses to test its structural validity.Results: As a result of exploratory and confirmatory factor analyses, the scale was found to consist of four dimensions: "worry and despair", "concentration", "shame and guilt" and "anger and control". The scale consists of a total of 16 statements. The calculated CR and AVE values show that the scale has a reliable structure. Conclusion: This study, conducted to determine the effect of war news on the social health of individuals, provides a scientific tool to identify and measure the potential effects of the frames reflected in mass media news during wartime on the social health status of individuals. The scale developed can contribute to a more comprehensive understanding of the effects of war news on the people who are not directly involved in the war but listen or read the news.

Co-rumination and intrapersonal cognitive processes predict distress: Longitudinal evidence from the COVID-19 pandemic.

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co-rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co-rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID-19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co-rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID-19 subscale. Co-rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co-rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co-rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing.

The Correlation Between Homesickness and Academic Achievement in Mathematics: Implications for Psychological Well-Being of Secondary School Students

This study examined the correlation between homesickness and academic achievement in mathematics among secondary school students, focusing on its implications for psychological well-being. A correlational research design was employed, involving a sample of 50 secondary school students from Awka South Local Government Area, Anambra State. Data were collected using Scale for Psychological Impact of Homesickness (SPIH) and the Mathematics Achievement Scale (MAS). Validity was ensured through expert consultations and Principal Component Analysis. Reliability was established with Kuder-Richardson formula 21 (K-R21) and Cronbach’s Alpha, yielding α = 0.89 for SPIH and α = 0.86 for MAS. Data were analyzed using SPSS, including non-parametric tests and normality assessments. The Spearman's rho correlation analysis revealed a significant, albeit weak, negative relationship between homesickness and academic achievement, indicating that higher levels of homesickness are associated with lower mathematics performance. Further analysis using the Mann-Whitney U test highlighted significant differences in homesickness levels and academic achievement between boarder and non-boarder students. These findings underscore the importance of addressing emotional challenges in educational settings. The study advocates for the implementation of comprehensive support systems, including counseling and resilience-building programs, to mitigate the impact of homesickness on academic performance. The results emphasize the need for schools to foster supportive environments that enhance students' psychological well-being and academic success. Future research should explore additional factors influencing this relationship to develop targeted interventions..

MyMS: An Interface for Patient-Reported Outcomes for Finnish Individuals With Multiple Sclerosis.

Patient-generated data are a cornerstone of individualized multiple sclerosis (MS) treatment. MyMS, an interface for patient-reported outcomes (PROs) was developed by the Finnish MS Register to enable systematic collection of PROs. MyMS collects data on demographics, lifestyle factors, disease-related factors, and validated questionnaires, including the Quality of Life Questionnaire (15D), the Multiple Sclerosis Impact Scale (MSIS-29), and the Fatigue Severity Scale (FSS). At the end of 2020, the patient-reported Expanded Disability Status Scale (PREDSS), the EuroQOL-5 Dimension (EQ-5D), the Fatigue Scale for Motor and Cognitive Functions (FSMC), and the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) were added. As of January 1, 2023, 1201 individuals with MS (79% female) have added data to MyMS. Of the validated PRO measures (PROMs), the 15D, MSIS-29, and FSS are the most used. The mean PREDSS score is 3.0 and median disease duration is 6.4 years. According to the existing PROMs, patients report mildly compromised quality of life and problems with fatigue and cognition. The patient interface of the Finnish MS Register consists of data from 17 of 21 counties with well-being services. The interface is used by 10% of Finnish individuals with MS. The addition of the PREDSS, EQ-5D, FSMC, and MSNQ to the interface has increased health care professional and patient interest in the use of PROMs. We suggest that PROs should be integrated into electronic health records to improve shared decision-making and diminish documentation burden.

Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services.

There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK. This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152). In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression. Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.

Rehabilitation Transition Program to Improve Community Participation Among Stroke Survivors

Interventions are needed to support the long-term needs of stroke survivors when they transition from inpatient rehabilitation to home, where they face new home and community environmental barriers. To compare the efficacy of a novel, enhanced rehabilitation transition program with attentional control to improve community participation and activity of daily living (ADL) performance and to reduce environmental barriers in the home and community after stroke. This phase 2b, parallel randomized clinical trial assessed patients 50 years or older who had experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in ADLs before stroke, and planned to be discharged home. Patients were assessed at an inpatient rehabilitation facility in St Louis, Missouri, and their homes from January 9, 2018, to December 20, 2023. Community Participation Transition after Stroke (COMPASS), including home modifications and strategy training. The primary outcome was community participation (Reintegration to Normal Living Index). Secondary outcomes were daily activity performance (Stroke Impact Scale ADL domain and the In-Home Occupational Performance Evaluation [I-HOPE] activity, performance, and satisfaction scores) and environmental barriers in the home (I-HOPE environmental barriers score). A total of 185 participants (mean [SD] age, 66.3 [9.0] years; 105 [56.8%] male) were randomized (85 to the COMPASS group and 100 to the control group). The COMPASS and control participants experienced similar improvements in community participation by 12 months, with no significant group (mean difference, 0.3; 95% CI, -4.6 to 5.2; P = .91) or group × time interaction (between-group differences in changes over time, 1.3; 95% CI, -7.1 to 9.6; P = .76) effects. Improvements in I-HOPE performance and satisfaction scores were greater for COMPASS participants than control participants at 12 months (between-group differences in changes for performance: 0.39; 95% CI, 0.01-0.77; P = .046; satisfaction: 0.52; 95% CI, 0.08-0.96; P = .02). The COMPASS participants had greater improvements for I-HOPE environmental barriers than the control participants (P = .003 for interaction), with the largest differences at 6 months (between-group differences in changes: -15.3; 95% CI -24.4 to -6.2). In this randomized clinical trial of stroke survivors, participants in both groups experienced improvements in community participation. COMPASS participants had greater improvements in self-rated performance and satisfaction with performing daily activities as well as a greater reduction in environmental barriers than control participants. COMPASS reduced environmental barriers and improved performance of daily activities for stroke survivors as they transitioned from inpatient rehabilitation to home. ClinicalTrials.gov Identifier: NCT03485820.

Spectrum of Cognitive Impairment in Patients with Multiple Sclerosis

Introduction. Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS), which significantly affects patients’ daily life and professional activity. Despite the development of methods to screen MS patients for CI, data on its prevalence in the Russian population are still lacking. Aim: to comprehensively assess cognitive functions in patients with different types of MS. Materials and methods. The study included MS patients who did not have any other possible causes of CI and no diseases or conditions that confounded this assessment. CI was determined using the Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) test battery and the Stroop test as a decrease in the scores below the mean by at least 1.5 standard deviations. CI was subjectively assessed using the Perceived Deficit Questionnaire; fatigue was subjectively assessed using the Modified Fatigue Impact Scale (MFIS). The Mann–Whitney test and Fisher’s exact test were used for comparison, and the Spearman test was used to evaluate correlations. Results. We evaluated 77 MS patients (30 men; age 40 [30; 48] years; 47 with relapsing-remitting MS, 30 with progressive MS). CI incidence was 23.4% in patients with relapsing-remitting MS and 77% in patients with progressive MS, while multi-domain CI was statistically significantly more common in patients with progressive MS. Impairment of processing speed was the most common. Patients with relapsing-remitting MS and CI were statistically significantly older and had longer disease duration than those without CI. There was a statistically significant correlation of subjective CI severity with MFIS scores but not with testing results. Conclusion. CI incidence in MS patients was relatively high with greater severity and involvement of more domains in patients with progressive MS. No correlation was found between subjective and objective CI assessment results, which may suggest that patients underestimated their deficit.

Effects of a plank-based strength training programme on muscle activation in patients with long COVID: a case series.

This study aimed to analyse the effects of a plank-based strength training programme on muscle activation in patients with long COVID. Case series study that included patients with long COVID who participated in a 12-week trunk and pelvic muscle strength training programme. Clinical variables and the modified fatigue impact scale (MFIS) were used to assess fatigue levels. Percentage of muscle activation during a core muscle plank was measured via surface electromyography. Pre- and post-intervention results were compared using the Wilcoxon signed-rank test and evaluated with Cohen's D effect size (ES). Twenty-one subjects participated in the study; 81% female, mean age 47.5 years (range: 28-55 years), and median duration of symptoms 21 months (range: 5-24 months); 90.5% of the participants experienced fatigue (MFIS score = 38). Muscle activation during plank exercises improved across all muscles after the intervention, with significant increases in the left (p = 0.011, medium ES) and right external oblique (p =0.039, small ES) muscles and the right latissimus dorsi muscle (p = 0.039, small ES). Additionally, significant reductions in fatigue were observed in the total MFIS score (p = 0.004, medium ES) and in the physical (p < 0.001, large ES) and psychosocial subscales (p = 0.033, small ES). Results suggest that a plank-based strength training programme may be effective in enhancing trunk and pelvic muscle activation in individuals with long COVID.

Psychosocial Impact of the COVID-19 Pandemic on Older Adults With and Without Cognitive Impairment: A Cross-Sectional Study

Objectives1) To develop and test the validity of the Psychosocial Pandemic Impact Scale (PPIS); 2) test associations between PPIS scores and demographics/cognitive performance in older adults; 3) answer whether the PPIS scores would differ between cognitively healthy (HOA) or mildly impaired older adults (MCI), and between those assessed before and after vaccines were available in Brazil. DesignCross-sectional study. SettingCommunity-dwelling older adults registered to participate in a remote randomized clinical trial of computerized cognitive training were assessed online during the COVID-19 pandemic in Brazil. ParticipantsA sample of 181 older adults (>60 years) was used for the PPIS psychometric analysis, from which 120 who completed baseline cognitive, quality of life, and mood assessments were included in the group comparisons and correlational analysis. MeasurementsThe psychosocial pandemic impact scale (PPIS); The Montreal Cognitive Assessment (MoCA; used as a brief screening tool); The verbal fluency test (to assess executive function) and the Verbal memory and learning with the Portuguese version of the rey auditory verbal learning test (RAVLT); The geriatric anxiety inventory (GAI); The Geriatric Depression Scale - Short Form (GDS); The WHOQOL-BREF and WHOQOL-OLD quality of life questionnaires; The Katz and Lawton scales and the Activities of Daily Living Questionnaire (ADLQ) to measure daily function. ResultsThe PPIS demonstrated good internal consistency (α = .84) and sampling adequacy (MSA= .85) and was significantly associated with validated measures of anxiety and depression (GAI: ρ = 0.49, p< 0.001; GDS: ρ = 0.48, p = 0.006) and quality of life (WHOQOL-Bref: ρ = -0.46, p< 0.001; WHOQOL-Old: ρ = -0.24, p = 0.03), confirming construct validity and scale reliability. HOA who were female and had more years of education and those with MCI who were younger and had better memory reported higher PPIS scores. One-way ANOVAs including age and education as covariates revealed that people with MCI reported higher PPIS scores than HOA before vaccination (p = 0.01), but not after. While HOA assessed before and after vaccines were available showed similar PPIS scores, those with MCI assessed after had a trend towards lower scores than those assessed before (p = 0.06). ConclusionsOur study provides a reliable instrument for assessing older adults' psychosocial pandemic impact and shows that people with MCI might be more vulnerable to such effects—which are mediated by memory performance, age, education, and gender. This data can help clinicians to identify and propose interventions targeting vulnerable populations during public health emergencies.

Recovery in patients undergoing ablative fractional carbon dioxide laser for adult hypertrophic burn scars: a longitudinal cohort study

IntroductionAblative fractional carbon dioxide laser (AFCO2L) is widely used as a treatment for hypertrophic burn scars. This study aimed to evaluate clinician and patient-reported outcomes after AFCO2L treatment, safety, and identify factors influencing outcomes. MethodsThis longitudinal study recruited adult patients with hypertrophic burn scars treated with AFCO2L at a single Australian burn unit. Patients received up to four AFCO2L treatments over approximately 12 months. Outcomes were ultrasound scar thickness, the Patient and Observer Scar Assessment Scale (POSAS), and the Brisbane Burn Scar Impact Scale (BBSIP), measured at baseline and 3, 6, and 12-months post first AFCO2L treatment. Analysis used mixed effects linear models. Results47 patients were included with median age 32 years (IQR:24,53) and median burn TBSA of 35% (IQR:7.5%,48%). Statistically significant improvements between baseline and 12-month follow-up occurred in scar thickness, all POSAS and BBSIP subscores. Most improvements remained when accounting for TBSA, Fitzpatrick skin type, scar maturity, and body area treated. Patients reported transient symptoms after 61 of 89 (69%) AFCO2L treatments, but infection or delayed wound healing occurred after only 4 of 89 (4%) treatments. ConclusionThis study supports safety and improved clinician and patient-reported outcomes in patients undergoing AFCO2L for hypertrophic burn scars.

Analysis of the center of pressure variables in women with migraine does not reflect differences in balance: A cross-sectional study

IntroductionMigraine is a neurological disease that affects proportionally more women. It has been documented that migraineurs often experience balance disturbances. ObjectiveTo evaluate the balance between migraineur patients (MG) and healthy volunteers classified as control group (CG). MethodA cross-sectional study. Seventy-four women were evaluated: 37 MG and 37 CG. The evaluation of the center of pressure (COP) variables was carried out using a balance platform in three postures, bipodal eyes closed (BEC), right monopodal with eyes open (RMEO), and left monopodal with eyes open (LMEO). Self-report questionnaires (dizziness handicap inventory (DHI), fall risk efficacy scale (FES I), the functional impact scale (HIT 6) and the timed up and go test (TUG test) were used. The U-Mann Whitney test was used to verify differences in the COP between MG and CG. The Kruskal-Wallis one-way ANOVA was used to analyze the differences between migraine groups (MGs) with postures, self-report questionnaires, and TUG test. A p < 0.05 was considered statistically significant. ResultsNo statistically significant changes were found in the balance variables, except the medial-lateral excursion variable in the BEC (p < 0.02) and LMEO (p = 0.04) postures. No significant differences were found between the MGs with HIT 6 (p = 0.48) or FES I (p = 0.49). Significant differences were found between the MGs with DHI (p = 0.003). The TUG test showed statistically significant changes between groups (p < 0.01). ConclusionThe women with migraine in this sample did not show differences in postural balance, however, dizziness and functional differences are shown compared to healthy women.

Value of the central sensitisation inventory in patients with axial spondyloarthritis.

In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors. Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40. 201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5-24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSI<40 (p<0.004). No significant differences in CPM were observed. In multivariable linear regression, sex, PCS, IPQ-R Identity, MFIS and HADS anxiety were independently associated with CSI (78% explained variance). In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.

Relationship between fatigue and quantitative electromyography findings in patients with myasthenia gravis

BackgroundFatigue is a common complaint among patients with myasthenia gravis (MG). In this study, we investigated the alterations in muscle morphology in patients with MG experiencing fatigue using quantitative electromyography (QEMG), and explored the relationship between electrophysiological findings and the severity of both fatigue and disease. MethodsWe performed QEMG of the biceps brachii muscle using the peak ratio method and multi-motor unit potential (MUP) analysis across three groups: 18 MG patients with fatigue, 34 MG patients without fatigue, and 33 healthy subjects. Stimulated single-fiber EMG was performed on the frontalis muscle. The severity of perceived fatigue and disease was subsequently assessed using the quantitative myasthenia gravis (QMG) score, the MG-activities of daily living (MG-ADL) profile, self-reported fatigue questionnaires, and handgrip strength measurements. ResultsThe QEMG study revealed a reduced mean MUP duration and size index (SI), in addition to an increased peak ratio in patients with MG (p < 0.05), which tended to be more pronounced in those experiencing fatigue. Compared to healthy subjects, MG patients with fatigue displayed a myopathic pattern characterised by a high peak ratio, short duration, and small-amplitude MUPs, without any increase in the number of phases or small time intervals. The mean peak ratio was positively correlated with the QMG, MG-ADL, and Fatigue Impact Scale total and physical subscores (p < 0.05). Further, MG patients with fatigue exhibited reduced maximum grip strength, which was positively correlated with the mean MUP duration, amplitude, SI, and thickness, and negatively correlated with the mean peak ratio (p < 0.05). No significant differences were observed in the jitter or block measurements (p > 0.05). ConclusionsThe present study investigated electrophysiological findings that were not considered or theorised in prior studies on patients with MG experiencing fatigue. The results of this study suggest that myopathic changes may be a critical pathophysiological component underlying the fatigue associated with MG.

Impact of patient death on physicians’ mental health

IntroductionPhysicians often encounter stressful situations that can impact their mental well-being. The death of a patient represents one of the most difficult situations in routine medical practice. Literature notably lacks comprehensive studies into physicians’ personal experiences with patients’ deaths. However, it does underscore heightened levels of sorrow, guilt, and stress stemming from the passing of terminally ill patients. As a majority of studies in this realm adopt qualitative methodologies, there is merit in supplementing existing research with a quantitative approach that employs validated psychometric scales. Furthermore, the study of phenomena associated with stress, particularly the perceived professional support by physicians in stressful events, can contribute to the implementation of preventive measures to help physicians cope. ObjectiveOur study aims to measure the traumatic impact on resident and intern physicians at national university hospitals following the death of patients, as well as to assess the perceived level of professional support among these physicians. Materials and methodsWe conducted a nationwide cross-sectional, descriptive, and analytical study. Participants included interns and residents from various specialties (medical, surgical and laboratory) at national university hospitals in Morocco. Assessing the traumatic impact of patients’ death on doctors was conducted using two psychometric scales: the Peri-Traumatic Distress Inventory (PDI) and the Revised Impact of Event Scale (IES-R). Additionally, we used the Perceived Professional Social Support Scale (QSSP-P) to evaluate how supportive the professional environment was towards these doctors. All scales utilized in the study are validated in the French language. ResultsThe study included 96 participants, with 67.7% being female. The average age was 26.8 years, ranging from 23 to 39 years. The majority of participants managed more than nine patients simultaneously (58.3%) while 41.7% were scheduled for more than six 24h shifts per month. During their training, over 64.6% of interns and residents faced more than ten patients’ death incidents, and 68.8% considered their first patient death as the most traumatizing. Half of the physicians evaluated the patients’ care as moderately appropriate, with 46.9% believing that the incident could have been prevented. Notably, 70.8% of interns and residents involved in patient care experienced self-blame and attributed a share of responsibility to themselves for the patient's demise. The majority of participants, 82.3%, exhibited peri-traumatic distress with a PDI score exceeding 15. Among the studied factors, only the perceived responsibility and a management system centered on a single physician (rather than a team) demonstrated a noteworthy correlation with PDI scores. The mean score on the IES-R scale was 25.6, with almost half of the sample (54.2%) reporting moderate to severe PTSD symptoms. The severity of these symptoms was significantly correlated with higher age, high number of patient's deaths experienced and the physician's perceived sense of responsibility. Participants in our study were more satisfied with support from colleagues compared to support functions (paramedical staff, administrative officials) or superiors. Moreover, only colleagues’ support was statistically significantly associated with low scores on the traumatic impact scales. ConclusionPhysicians maintain a unique relationship and therapeutic alliance with their patients. Therefore, the death of a patient can have a significant psychological impact on the physician. This study allowed us to objectively measure this psychological impact and evaluate professional support. The results of these studies encourage further exploration of the issue and the implementation of measures to reduce this psychological impact.

Allied rehabilitation using caregiver-mediated exercises combined with telerehabilitation for stroke (ARMed4Stroke): A randomised controlled trial

Objective To assess the added value of caregiver-mediated exercises combined with telerehabilitation in addition to usual care compared to usual care alone on the self-reported mobility outcome after subacute stroke. Design Multicentre, observer-blinded, parallel randomised controlled trial. An off-site researcher allocated treatments using minimisation. Setting Four rehabilitation centres in the Netherlands. Participants Forty-one patient–caregiver dyads within 3 months poststroke. Intervention Eight-week blended care program with caregiver-mediated mobility exercises for 2.5 h per week supported by telerehabilitation and four face-to-face sessions in addition to usual care. Main measures Self-reported mobility domain of the Stroke Impact Scale postintervention. Secondary outcomes were functional outcome, dyads’ psychosocial wellbeing, care transition to the community postintervention and after 6 months. Results Forty-one dyads (21 intervention, 20 control) were randomised, and 37 (N = 18; N = 19) were analysed following intention-to-treat. The Stroke Impact Scale mobility was not significantly different between groups postintervention (B 0.8, 95% CI –6.8–8.5, p = 0.826). The secondary outcomes, namely, (a) caregivers’ quality of life postintervention (p = 0.013), (b) caregivers’ symptoms of depression postintervention (p = 0.025), and (c) independence in leisurely activities at 6 months (p = 0.024), showed significant benefits in favour of caregiver-mediated exercises with telerehabilitation. A significant difference favouring controls was found in self-reported muscle strength at 6 months (p = 0.002). Conclusions Caregiver-mediated exercises combined with telerehabilitation yielded no differential effect on our primary outcome self-reported mobility. Although the trial is underpowered, current findings are in line with previous trials. Future studies should further explore beneficial effects of caregiver involvement in stroke rehabilitation targeting psychosocial wellbeing.

Health of the Pandemic Dementia Paid Staff and Unpaid Caregiver Workforce in Congregate Care and Community Settings

ObjectivesThe objective of this study was to assess the impact of the pandemic on the health, well-being, and access to services of paid staff and unpaid caregivers of persons living with dementia. DesignQuestionnaires were developed to capture the experiences of paid staff and unpaid caregivers throughout the pandemic, leveraging a pre-existing clinical trial collaborative. SettingCommunity and long-term care locations in Miami, Florida, Boston, Massachusetts, and the greater Baltimore, Maryland, and D.C. areas. ParticipantsPaid staff from Miami Jewish and Benchmark who worked with patients with dementia during the first two years of the pandemic. Unpaid caregivers who lived within the catchment area of the study sites and provided care for community-based persons with dementia. MeasurementsMeasures included the Coronavirus Impact Scale, the Herth Hope Index, NPI-Q, the Modified Caregiver Strain Index, PHQ-8, items about workplace changes, caregiving relationship, and changes to caregiver support. ResultsPaid staff were statistically more likely to have been exposed to, tested for, hospitalized, or seriously ill with COVID-19 and indicated moderate to severe impacts to medical and mental health services compared to unpaid caregivers. Unpaid caregivers exhibited significantly higher rates of depressive symptom severity and overall lower scores on the Herth Hope Scale compared to paid staff. ConclusionsOur findings suggest that the pandemic had significant impacts on the mental health and general well-being of unpaid caregivers. While notable that paid staff suffered from increased exposure and decreased access to services, policies supporting both workforces should respond to the unique outcomes that each faced, post-pandemic.

Can tele-physiotherapy help in filling treatment gaps during pandemics in multiple sclerosis?

ABSTRACT Background: Published data demonstrate promising results for rehabilitation in patients with multiple sclerosis (MS), including telerehabilitation technologies. Given the travel limitations during the coronavirus disease 2019 (COVID-19), telerehabilitation may provide a viable alternative to in-person physiotherapy. Objective: To determine the efficacy of telerehabilitation in MS patients during COVID-19. Design/Methods: A total of 42 patients participated in the study of which 24 were followed up till the end of 6 weeks. The investigated group consisted of 15 females and 09 males; the mean age was 42 ± 10 years. The telerehabilitation was provided for a duration of 6 weeks at a frequency of three classes per week. The patients used either laptops or mobile phones for attending these sessions. The inclusion criteria were a 6-minute walk test (with or without assistance). Motor function was evaluated using the Timed Up and Go (TUG) test and the 30-Second Sit-to-Stand (30STS) test. Patients were required to fill out two questionnaires also: 12-item MS Walking Scale (MSWS) and Modified Fatigue Impact Scale (MFIS). All the patient assessments were made by an independent physiotherapist before and after the intervention. Results: There was a statistically significant improvement in motor performance and MFIS and 12-item MSWS. The following results were observed: statistically improved parameters of TUG, 30STS, 12-item MSWS and MFIS. Conclusions: Based on the findings, it is reasonable to infer that the use of telemedicine in the rehabilitation of MS patients is very promising.

Association of depression in multiple sclerosis with fatigue, sleep disturbances, disability, and health-related quality of life: Outcomes of a cross-sectional study

IntroductionDepression affect individuals with multiple sclerosis (MS) more frequently compared with the general population. It can worsen the symptoms of MS, influence disability progression, and significantly reduce the quality of life (QoL). MethodWe investigated the prevalence of depressive symptoms in a cohort of 200 patients with MS (76% women) and their association with sleep patterns, fatigue, QoL, demographics, and other clinical characteristics in real-world settings. The study was conducted through clinical evaluations and questionnaires related to depression: Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS); fatigue: Modified Fatigue Impact Scale; sleep quality: Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale; and QoL: Multiple Sclerosis Quality of Life-54 (MSQOL-54). ResultsAccording to the BDI and HDRS, the prevalence of depressive symptoms was 40.5 and 28.27%, respectively. Patients with depressive symptoms exhibited higher disability scores, longer ambulation times, worse cognitive function in the Symbol Digit Modalities Test, and poorer sleep quality. They also had significantly higher fatigue and daytime somnolence scores, as well as lower scores on the MSQOL-54: physical (40.55 vs. 62.3; P<.001) and mental (44.49 vs. 71.89; P<.001) health composites. We demonstrated the correlation between depression and fatigue, as well as their negative impact on QoL in patients with MS. ConclusionThis study underscores the prevalence and impact of depression in MS, emphasizing the importance of routine screening and active management of psychiatric comorbidities in individuals with MS. These findings contribute valuable insights into the complex interplay between mental health, disease variables, and QoL in MS.

Exploring key factors associated with falls in people with multiple sclerosis: The role of trunk impairment and other contributing factors

BackgroundFalls are a common and consequential concern for persons with multiple sclerosis (PwMS), with trunk impairment frequently observed even in the early stages of the disease. However, the relationship between falls and trunk impairment using the trunk impairment scale in this population remains unclear. This study aims to explore this association and identify potential factors contributing to falls in PwMS. MethodSixty-four patients were assessed for falls or near falls in the past 6 months, trunk impairment using the Trunk Impairment Scale (TIS), balance and gait using the Performance-Oriented Mobility Assessment (POMA), depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), fatigue using the Modified Fatigue Impact Scale (MFIS), and fear of falling using the Modified Falls Efficacy Scale (MFES). ResultsSimple binary logistic regression revealed significant associations for TIS (OR = 0.75, p = 0.001, 95 % CI: 0.63 to 0.88), POMA (OR = 0.75, p ≤ 0.001, 95 % CI: 0.65 to 0.87), MFES (OR = 0.96, p ≤ 0.001, 95 % CI: 0.93 to 0.98), MFIS (OR = 1.05, p = 0.002, 95 % CI: 1.02 to 1.08), and HADS (OR = 1.09, p = 0.01, 95 % CI: 1.02 to 1.17). The multiple logistic regression model identified TIS (OR = 0.78, p = 0.007, 95 % CI: 0.66 to 0.94) and MFES (OR = 0.96, p = 0.005, 95 % CI: 0.93 to 0.98) as significant factors of falls. ConclusionThis study confirms the significant impact of trunk impairment, tested by the trunk impairment scale and fear of falling as factors of falls among PwMS. Additionally, it highlights the roles of balance, gait, fatigue, and depression as factors that contribute to fall risk. These findings suggest that a comprehensive assessment incorporating these elements may be crucial for developing effective fall prevention strategies in this population. This research underscores the need for targeted interventions that address both physical and psychological aspects to mitigate the risk of falls in PwMS.