Abdominal functional electrical stimulation for bowel management in multiple sclerosis.

Aim: Functional constipation is common in multiple sclerosis (MS) and first line treatments are frequently ineffective. The current study explored the use of abdominal functional electrical stimulation (ABFES) for treating constipation in MS. Patients/methods: 20 people with MS and constipation (ROME IV criteria). The patient assessment of constipation-related quality of life questionnaire was administered at baseline and after 6 weeks of ABFES treatment alongside semi-structured interviews. Results: All patient assessment of constipation-related quality of life subscales were significant: satisfaction (p = 0.003), psychosocial discomfort (p = 0.008), physical discomfort (p = 0.001) and worries and concerns (p = 0.003). A long-term therapeutic effect, reduction in laxative use and improved sexual functioning were also reported. Conclusion: ABFES provides a potential alternative treatment intervention for people with MS and constipation.

A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury.

CONTEXT/OBJECTIVE: The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). SETTING: A specialist FES outpatient centre. PARTICIPANTS: Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. INTERVENTIONS: FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. OUTCOME MEASURES: The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). RESULTS: A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). CONCLUSION: The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

A study analysing inconsistent responses from people with multiple sclerosis in a recent national audit.

PURPOSE: An audit of NHS services for people with multiple sclerosis (PwMS) revealed inconsistency in individuals' responses to different types of questions. The main aim of this subsequent study was to analyse systematically the qualitative data gathered as part of the audit and use the findings to investigate the disparity between the global expressions of satisfaction and the negative, and at times heart wrenching, free text comments made. METHOD: This study analysed questionnaires completed by 557 PwMS, 336 of which had made free text comments. This qualitative data was analysed using content analysis by grouping content into positive and negative comments and then into more detailed categories and sub-categories. Inter-coder and intra-coder reliabilities were confirmed and the data manipulated to address the aim of the study. RESULTS: The study found that PwMS who gave conflicting reports of satisfaction with services were more likely to give negative comments regarding the provision of service rather than the quality of service. CONCLUSION: This study has revealed that simple, single questions on satisfaction with services do not offer a valid measure of patient experience. It has shown that there is a place for qualitative research in the area of patient satisfaction.