Research news
Open Door - May 2009 pages 4-5
- Factors that increase the risk of falling
- Need for more and better vocational rehabilitation
- Cognitive rehabilitation can help
- Consent and access to a register of MS
- MS affects partners too
- Does MS cause headaches?
- Reflexology and muscle relaxation combat stress and anxiety
Factors that increase the risk of falling
As MS symptoms can increase the risk of a fall, Scandinavian researchers investigated the impact of changes in clinical measures of mobility, balance, spasticity and cognition.
76 people with MS were monitored, with 48 of these people recording 270 falls. A change of one point on EDSS (Expanded Disability Status Scale), a standard measure of disability and mobility in MS, doubled the risk of falling. The risk was more than doubled for each degree of increased spasticity. People needing walking aids were five times more likely to fall (the walking aids indicating a greater degree of poor balance rather than necessarily being the cause of the fall). Proprioception, the sense or awareness of the parts of the body, is sometimes affected by MS making it difficult to judge walking and movements. This can also greatly increase the risk of falling. The researchers suggest that health professionals should be aware of these risk factors when assessing if a person with MS has a higher risk of experiencing falls.
Nilsagård Y, et al.
Predicting accidental falls in people with multiple sclerosis - a longitudinal study.
Clinical Rehabilitation 2009;23(3):259-269.
- Read, order or download the MS Trust's book Falls: managing the ups and downs of MS
Need for more and better vocational rehabilitation
Cochrane Reviews are systematic reviews that examine the best available evidence about healthcare interventions. A recent review looked at the benefits and cost effectiveness of vocational rehabilitation programmes as compared with other approaches for people with MS who are returning to work. The reviewers found that the evidence did not support this approach but felt that this was due to the quality of the research. They call on health professionals to be aware of issues affecting working and to understand and manage barriers to maintaining employment. They suggest vocational rehabilitation should include both practical solutions and education for employers and work colleagues. They also call on the government to encourage work focused vocational rehabilitation and for more and better research into the approach.
Khan F, et al.
Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.
Cochrane Database Of Systematic Reviews 2009 Jan 21; (1):CD007256.
Cognitive rehabilitation can help
Although cognitive problems such as poor memory, reduced attention span and difficulty concentrating are experienced by many people with MS, there has been little research looking at rehabilitation programmes to help with these symptoms. This study looked at of a group-based, self-management approach and involved 41 people with cognitive symptoms. The course involved increasing knowledge of cognitive symptoms and a set of challenges to exercise problem-solving abilities, backed up with homework to practice the strategies. Overall, the participants reported a positive impact on their ability to manage symptoms and recommended that their caregivers be included in future programmes.
Shevil E, Finlayson M.
Process evaluation of a self-management cognitive program for persons with multiple sclerosis.
Patient Education And Counseling 2009;76(1):77-83.
- For more on memory, attention span and concentration, see the other articles in this issue - Losing concentration and StayingSmart
Consent and access to a register of MS
With plans being discussed for a UK register of people with MS, this study looked at opinions concerning confidentiality, consent and access to data. Using focus groups and interviews, the researchers spoke to 68 people with MS, health and social care professionals, managers and representatives from pharmaceutical companies.
On the basis that the register should be governed by a guardianship committee composed of a range of stakeholders, the people with MS generally agreed that a register could help with service development and research. However, they felt that access to data by pharmaceutical companies should be administered by the committee. They did not want their personal information to be used by marketing agencies or to be available to their employers. The professionals were more cautious in their approach to the use of personal data within a register. All participants felt that any register must incorporate robust security and guardianship measures to protect privacy.
Baird W, at al.
Holding personal information in a disease-specific register: the perspectives of people with multiple sclerosis and professionals on consent and access.
Journal Of Medical Ethics 2009;35(2):92-96.
MS affects partners too
Using semi-structured telephone interviews, interviewers talked to 15 people about their experience of the first years of their partner's diagnosis with MS. The issues that came out most strongly were being unsure of what the future might hold and feeling helpless and out of control. The partners reported that other people could not understand and support them, which led to feelings of social isolation. The researchers suggest support should include partners' needs to help them cope with the disruptive impact that MS has on the whole family.
Bogosian A, et al.
Experiences of partners of people in the early stages of multiple sclerosis.
Multiple Sclerosis 2009;15(7):876-884.
- For more on the effect of MS on partners, see another article in this issue - Blokes talking
Does MS cause headaches?
A number of people with MS experience headaches, but is this due to their condition or is it coincidental? To explore this question, German researchers followed 491 people with different types of MS and 447 people without MS for a year.
During the study, 56.2% of people had either a tension headache or migraine. Prevalence rates did not differ between the people with MS and the control group. Amongst people with MS, headache was also not associated with level of disability or treatment. Whilst a small proportion of headaches can be attributed to MS symptoms such as trigeminal neuralgia, the researchers conclude that most are not due to the condition.
Putzki N, et al.
Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis.
European Journal Of Neurology 2008;16(2):262-267.
Reflexology and muscle relaxation combat stress and anxiety
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. After a four week break, the groups swapped therapies. Unfortunately, this proved too short a gap and people had not returned to their pre-treatment levels before starting the second therapy, which made comparing the two approaches difficult. However, positive results were seen for both therapies with reflexology seeming to be better at reducing measures of stress and anxiety. Progressive muscle relaxation training seemed better at reducing blood pressure.
Mackereth PA, et al.
Reflexology and progressive muscle relaxation for people with multiple sclerosis: a crossover trial.
Complementary Therapies In Clinical Practice 2009;15(1):14-21.
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Open Door articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.