Energy conservation for fatigue management in multiple sclerosis: a pilot randomized controlled trial.

OBJECTIVE: To develop and test the feasibility of an energy conservation programme to manage fatigue in multiple sclerosis. DESIGN: A pilot randomized controlled trial. SETTING: Community setting. SUBJECTS: People with multiple sclerosis reporting fatigue. INTERVENTIONS: An energy conservation programme was compared to a peer support group. Both interventions were delivered in group format with 2-hour sessions once a week for five weeks. Patients' views about the interventions were sought in discussion groups one week post intervention. MAIN MEASURES: The primary feasibility outcomes were recruitment and adherence. Other outcome measures were the Fatigue Impact Scale, Fatigue Severity Scale, MS-Impact Scale-29, MS Self-efficacy Scale, Beck's Depression Scale-Fast Screen and Epworth Sleepiness Scale. Outcomes were administered at baseline, post intervention, 6-week and 3-month follow-up. RESULTS: Almost 30% of the people approached to take part in the study did not commit to participation because of transport/time issues. Twenty-three patients took part in the study. Three patients dropped out, one reporting adverse effects. A power calculation indicated that a sample of 56 (28 per group) would be required for a main randomized controlled trial. Patients valued peer support and those in the energy conservation group described the programme as useful, but reported difficulties completing some practice activities. CONCLUSION: An energy conservation programme in the community is feasible and welcomed by people with multiple sclerosis. However, future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients' needs.

Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study.

BACKGROUND: Constipation affects many people with multiple sclerosis (MS), negatively impacting on their quality of life. The use of abdominal massage has been reported in several populations and has been shown to increase the frequency of defaecation. OBJECTIVE: The objective of this study was to determine the feasibility of undertaking abdominal massage in people with MS. METHODS: Following ethical approval, 30 patients with MS and constipation were recruited. After providing informed written consent and completion of baseline outcome measures, participants were randomly allocated to a massage group or a control group. The massage group participants were provided with advice on bowel management, and they or their carers were taught how to deliver abdominal massage and were recommended to perform it daily during the 4-week intervention period. The control group received bowel management advice only. Outcomes were measured pre (Week 0) and post treatment (Week 4), and at Week 8 and included: the Constipation Scoring System (CSS) (primary outcome), the Neurogenic Bowel Dysfunction Score, and a bowel diary. RESULTS: Both groups demonstrated a decrease in CSS score from Week 0 to Week 4, indicating an improvement in constipation symptoms; however, the massage group improved significantly more than the control groups (mean difference between groups in score change -5.0 (SD 1.5), 95% CI -8.1, -1.8; t = -3.28, df = 28, p = 0.003). CONCLUSION: The results of this small study suggest a positive effect of the intervention on the symptoms of constipation, and support the feasibility of a substantive trial of abdominal massage for the alleviation of the symptoms of constipation in people with MS.

Does abdominal massage relieve constipation?

BACKGROUND: Abdominal massage has been used to treat constipation since the 19th century, yet questions remain over its effectiveness and which patient groups benefit from it the most. AIM: To determine whether abdominal massage is effective for the relief of constipation. METHOD: A review of observational studies, case reports and randomised controlled trials was carried out to determine whether abdominal massage is effective in relieving constipation. RESULTS: Abdominal massage can relieve constipation of various physiological causes. It stimulates peristalsis, decreases colonic transit time and increases the frequency of bowel movements. It also reduces discomfort and pain, induces. CONCLUSION: Abdominal massage should be considered when treating patients with constipation. It has no adverse side-effects and can easily be taught to patients and carers so they can undertake it themselves.

Physiotherapy management of cancer-related fatigue: a survey of UK current practice.

PURPOSE: To establish physiotherapy management of cancer-related fatigue (CRF), in particular, to determine physiotherapy exercise management of CRF. METHODS: All physiotherapist members of the UK Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) received a questionnaire. RESULTS: The response rate was 65% (223/341). Therapists had a mean of 6.8 years (+/-5.6) experience in oncology and/or palliative care. Seventy-eight percent of therapists recommend and/or use exercise as part of the management of CRF; 74% teach other strategies, most commonly energy-conservation techniques (79%). Therapists recommend and/or use exercise in similar frequencies with a range of cancer types, before (32%), during (53%) and following treatment (59%) and during advanced stages of the disease (68%). The most common barrier encountered by therapists in recommending and/or using exercise was related to the lack-of-exercise guidelines for patients with CRF (71%). CONCLUSION: Physiotherapists' management of CRF includes recommending and using exercise and teaching energy-conservation techniques. Therapists recommend and/or use exercise with a variety of cancer populations, across all stages of the disease trajectory, in particular during advanced stages of the disease. Findings show therapists feel their practice is affected by the lack of exercise guidance for the cancer population. CRF management and physiotherapy practice would benefit from further research testing the efficacy of exercise in understudied patient groups, in all stages of the disease trajectory.

Pelvic floor training for lower urinary tract dysfunction in MS.

The aim of this study was to determine if pelvic floor muscle training (PFMT) improves lower urinary tract function in people with multiple sclerosis (MS). The authors found that a nine-week PFMT programme improved the function of the PFM, reduced the symptoms associated with lower urinary tract dysfunction and increased the quality of life in people with MS.

Efficacy of transcutaneous electrical nerve stimulation (tens) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial.

OBJECTIVE: This study was designed to investigate the hypoalgesic effects of self-applied transcutaneous electrical nerve stimulation (TENS) on chronic low-back pain (LBP) in a multiple sclerosis (MS) population. METHODS: Ninety participants with probable or definite MS (aged 21 to 78 y) presenting with chronic LBP were recruited and randomized into 3 groups (n=30 per group): (1) low-frequency TENS group (4 Hz, 200 micros); (2) high-frequency TENS group (110 Hz, 200 micros); and (3) placebo TENS. Participants self-applied TENS for 45 minutes, a minimum of twice daily, for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10, and 32. Primary outcome measures included: Visual Analog Scale for average LBP and the McGill Pain Questionnaire. Secondary outcome measures included: Visual Analog Scale for worst and weekly LBP, back and leg spasm; Roland Morris Disability Questionnaire; Barthel Index; Rivermead Mobility Index; Multiple Sclerosis Quality of Life-54 Instrument, and a daily logbook. Data were analyzed blind using parametric and nonparametric tests, as appropriate. RESULTS: Results indicated a statistically significant interactive effect between groups for average LBP (P=0.008); 1-way analysis of covariance did not show any significant effects at any time point once a Bonferonni correction was applied (P>0.05). However, clinically important differences were observed in some of the outcome measures in both active treatment groups during the treatment and follow-up periods. DISCUSSION: Although not statistically significant, the observed effects may have implications for the clinical prescription and the use of TENS within this population.

Monitoring of symptoms and interventions associated with multiple sclerosis.

We have utilized the Structured Data Entry approach to build a prototype interface for the recording of personalized symptoms associated with Multiple Sclerosis (MS). The software provides both graphical input and output, to facilitate efficient data entry and monitoring. Graphical input is transformed to textual information, which is stored in a database in a hierarchical tree structure. Pain management in MS may be achieved by careful monitoring of the symptom in response to treatment. Pain location is selected on a body image and severity and other attributes represented using a graphical visual analog scale, leading to more convenient input and a less ambiguous coding than is achievable with narrative text alone. The Internet can be used to record and provide access to clinical data, assisting the citizen by providing a healthcare professional partnership approach to care. This approach could provide an objective means of monitoring symptoms and hence provide a more personalized approach to MS management.

The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue.

BACKGROUND: Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary. OBJECTIVE: The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF. DESIGN: An exploratory, descriptive, qualitative design was used. METHODS: Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category. RESULTS: Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits. CONCLUSIONS: Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.

Examining adversarial growth in illness: the factor structure of the Silver Lining Questionnaire (SLQ-38).

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.