Predictors for Employment Status in People With Multiple Sclerosis: A 10-Year Longitudinal Observational Study.

OBJECTIVE: To identify predictors for employment status after 10 years in a cohort of people with multiple sclerosis (MS), with the aim to increase knowledge concerning factors present at an early stage that are important for working life and work-life balance. DESIGN: A 10-year longitudinal observational cohort study. SETTING: University hospital. PARTICIPANTS: A consecutive sample of people with MS (N=154) of working age were included at baseline, of which a total of 116 people participated in the 10-year follow-up; 27 people declined participation and 11 were deceased. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Baseline data on personal factors and functioning were used as independent variables. Employment status 10 years after baseline, categorized as full-time work, part-time work, and no work, was used as the dependent variable. A generalized ordinal logistic regression was used to analyze the predictive value of the independent variables. RESULTS: Predictors for full- or part-time work after 10 years were young age (P=.002), low perceived physical impact of MS (P=.02), fatigue (P=.03), full-time work (P=.001), and high frequency of social/lifestyle activities (P=.001) at baseline. Low perceived physical impact of MS (P=.02) at baseline also predicted full-time work after 10 years. CONCLUSIONS: This study underlines the complexity of working life for people with MS, and indicates that it may be valuable to give more attention to the balance between working and private life, both in clinical practice and future research, to achieve a sustainable working life over time.

Clinical frailty scale as a predictor of disease severity in patients hospitalised with COVID-19 - an observational cohort study.

BACKGROUND: The coronavirus disease 2019 pandemic makes proper resource allocation and prioritisation important. Frailty increases the risk of adverse outcomes and can be quantified using the Clinical frailty scale. The aim of this study was to determine the role of the Clinical frailty scale, in patients ≥65 years of age with coronavirus disease 2019, as a risk factor either for critical coronavirus disease 2019 measured as intensive care unit admission or death or as a risk factor for death. METHODS: This was a retrospective observational study on patients ≥65 years hospitalised with coronavirus disease 2019 verified by polymerase chain reaction between 5 March 5 and 5 July 2020. The association between Clinical frailty scale and the composite primary outcome intensive care unit admission or death within 30 days post hospitalisation and the secondary outcome death within 30 days post hospitalisation was analysed using multivariable logistic regression models adjusting for gender, age, body mass index, hypertension, and diabetes. Clinical frailty scale was used as a categorical variable (fit score 1-4, frail score 5-6, and severely frail score 7-9). RESULTS: In total, 169 patients were included (47.3% women, mean age 79.2 ± 7.8 years). In the fully adjusted model, adjusted odds ratio for intensive care unit admission or death was 1.84 (95%-confidence interval 0.67-5.03, p = .234) for frail and 6.08 (1.70-21.81, p = .006) for severely frail compared to fit patients. For death, adjusted odds ratio was 2.81 (0.89-8.88, p = .079) for frail and 9.82 (2.53-38.10, p = .001) for severely frail compared to fit patients. CONCLUSIONS: A high Clinical frailty scale score was an independent risk factor for the composite outcome intensive care unit admission or death and for the secondary outcome death.

Employment status of people with multiple sclerosis in relation to 10-year changes in functioning and perceived impact of the disease.

BACKGROUND: Although it is well known that people with multiple sclerosis (PwMS) retire from work early, little is known about how long-term changes in functioning and perceived impact of multiple sclerosis (MS) interact with sustainability of employment. OBJECTIVE: To explore changes in functioning and in perceived impact of MS over 10 years, in relation to employment status of PwMS. METHODS: In order to measure functioning, data on activities (walking ability, fine hand use, personal activities in daily living); participation in activities of everyday life (domestic, outdoor and leisure activities); body functions (cognitive function, fatigue, depressive symptoms); and perceived impact of MS were collected in 116 PwMS at baseline and at a 10-year follow-up. Ten-year changes were explored with the participants divided into four subgroups based on employment status at the follow-up: 1) full-time work at the 10-year follow-up; 2) part-time work at the 10-year follow-up; 3) declined from working at baseline to not working at the 10-year follow-up; and 4) not working at baseline nor at the 10-year follow-up. RESULTS: Patterns of change in functioning for PwMS who worked showed a more apparent deterioration over 10 years among those working part-time with regard to walking ability, fatigue and depressive symptoms. Members of the subgroups who declined from working at baseline to not working at the 10-year follow-up or who were working neither at baseline nor at the follow-up deteriorated the most in functioning. The subgroup whose employment status declined from baseline to follow-up showed a significant decrease in cognitive function and an increase in perceived physical impact of the disease. All subgroups experienced a deterioration in walking ability over the 10-year span, and in all subgroups a majority had limited fine hand use over the span of the study period. CONCLUSION: The deterioration in functioning was most apparent in those PwMS whose employment status declined from working at baseline to not working at the 10-year follow-up. Close monitoring of work situation and frequency of activities and participation in everyday activities, as well as recurrent training of functioning, are suggested for maintaining a high level of functioning and work status, or for supporting transition to an appropriate number of working hours.

Construct validity and test-retest reliability of the Swedish version of the Acceptance of Chronic Health Conditions Scale.

The Acceptance of Chronic Health Conditions Scale was developed to measure acceptance in chronic health conditions like multiple sclerosis (MS) and has been translated into Swedish (The Swedish Acceptance of Chronic Health Conditions Scale). The purpose of the present study was to evaluate construct validity and test-retest reliability of the Swedish Acceptance of Chronic Health Conditions Scale in a sample of 138 people with MS. Predefined hypotheses about relationships between the Swedish Acceptance of Chronic Health Conditions Scale and other measures, and the scale's ability to differentiate between groups were explored. Evaluations of reliability and measurement error were performed for both Swedish Acceptance of Chronic Health Conditions Scale sum scores and individual items. Most (78%) a priori formulated construct validity hypotheses were confirmed. Reliability was considered good (intraclass correlation coefficient = 0.80, and weighted kappa values ranging from 0.29 to 0.74). Measurement errors were acceptable (standard error of measurement 3.3 points, limits of agreement -7.5 and 10, and percentage agreement ranging from 42% to 58%). The findings give evidence of both satisfactory construct validity and test-retest reliability and indicate that the Swedish Acceptance of Chronic Health Conditions Scale can be considered for use in both research and clinical practice.

The Swedish version of the Acceptance of Chronic Health Conditions Scale for people with multiple sclerosis: Translation, cultural adaptation and psychometric properties.

OBJECTIVES: To translate and culturally adapt the Acceptance of Chronic Health Conditions (ACHC) Scale for people with multiple sclerosis into Swedish, and to analyse the psychometric properties of the Swedish version. SUBJECTS: Ten people with multiple sclerosis participated in translation and cultural adaptation of the ACHC Scale; 148 people with multiple sclerosis were included in evaluation of the psychometric properties of the scale. METHODS: Translation and cultural adaptation were carried out through translation and back-translation, by expert committee evaluation and pre-test with cognitive interviews in people with multiple sclerosis. The psychometric properties of the Swedish version were evaluated using Rasch analysis. RESULTS: The Swedish version of the ACHC Scale was an acceptable equivalent to the original version. Seven of the original 10 items fitted the Rasch model and demonstrated ability to separate between groups. A 5-item version, including 2 items and 3 super-items, demonstrated better psychometric properties, but lower ability to separate between groups. CONCLUSION: The Swedish version of the ACHC Scale with the original 10 items did not fit the Rasch model. Two solutions, either with 7 items (ACHC-7) or with 2 items and 3 super-items (ACHC-5), demonstrated acceptable psychometric properties. Use of the ACHC-5 Scale with super-items is recommended, since this solution adjusts for local dependency among items.