Supportive Interventions for Caregivers of Individuals With Multiple Sclerosis: A Systematic Review.

BACKGROUND: Caregivers of individuals with multiple sclerosis (MS) are key members of the treatment team. Their needs and challenges should be met as interventions can be effective in improving not only their own health, well-being, and quality of life but also that of those they care for. The aim of this systematic review was to investigate supportive interventions for caregivers of individuals with MS. METHODS: We conducted a database search of PubMed, Google Scholar, Science Direct, Scopus, and the Cochrane Library from 2000 to 2021. English-language studies that examined interventions administered directly to caregivers of individuals with MS and evaluated various outcomes were included. The Downs and Black checklist was used to assess the methodological quality of included studies. RESULTS: Twenty of 367 relevant papers fit the eligibility criteria outlined in the methods of this study and were subsequently selected for this review. Of the included studies, there was a notable variance in key characteristics such as methods, outcome measures, sample size, and procedures. Supportive interventions, psychoeducational group interventions, and behavioral-adaptive therapies were the 3 main categories of interventions reviewed; however, each study had a significant correlation between the intervention and outcomes. CONCLUSIONS: Despite the small sample size in this study, this review showed that various intervention models that target caregivers of individuals with MS have been successful.

Online occupational therapy in the caregivers of people with Multiple sclerosis: a randomized control trial.

PURPOSE: Caregivers of people with Multiple sclerosis (MS) face various challenges in the occupations of daily lives. We investigated the effect of an online occupational therapy program on the mastery and performance in caregivers of people with MS. METHOD: In a single-blind randomized controlled trial twenty-four eligible caregivers of people with MS participated in the control and an occupational therapy group program. Caregivers completed The Canadian Occupational Performance Measure (COPM) and the Relative Mastery Scale (RMS) before and after the intervention and one-month later. FINDINGS: The level of performance, satisfaction and mastery were significantly improved in the intervention group after the intervention (p<.001) and there were significant differences in performance and satisfaction scores between the groups (p<.001). IMPLICATIONS: Online Occupational therapy shows promising results in facilitating the adaptation process and improving caregivers' performance and satisfaction levels.IMPLICATIONS FOR REHABILITATIONCaregivers of people with multiple sclerosis face various challenges when engaging in their daily occupations.Managing the challenges faced by caregivers as essential members of the treatment team contributes to improving their performance level in daily occupations and can finally enhance the quality of treatment interventions for patients.Online delivery can overcome caregivers' time constraints for attendance in the treatment centers for training.Online occupational therapy can enhance mastery, occupational performance level, and satisfaction, and is recommended for caregivers of people with multiple sclerosis.

Comparing the Life Satisfaction of Older Immigrants and Refugees to Canadian-Born Older Adults: The Role of Immigrant Admission Classes.

OBJECTIVES: Immigrant admission classes represent different entry routes to Canada and potential divergent pathways for later-life well-being. This study examined later-life satisfaction, an important correlate of well-being, comparing levels between Canadian-born older adults with those of older immigrants and refugees by admission class and considering the role of residency time in Canada. METHODS: This study used data from the Canadian Community Health Survey (2009-2014) linked to landing records for those 55 years and older. Regression models explored the association between admission class and later-life satisfaction adjusting for covariates and stratified by residency time in Canada. RESULTS: After accounting for a range of demographic, socioeconomic, and health characteristics, economic class principal applicants and refugees had significantly lower life satisfaction than Canadian-born older adults. The negative association with life satisfaction among economic class principal applicants persisted even after accounting for residency time in Canada. CONCLUSIONS: Both admission class and length of residency in Canada are associated with levels of later-life satisfaction. Future studies should look beyond aggregated measures of immigrant status when examining determinants of well-being in later-life. CLINICAL IMPLICATIONS: Vulnerable subgroups of immigrants and refugees are at risk of experiencing lower later-life satisfaction and adverse later-life outcomes.

Immigrants' Experience of Health Care Access in Canada: A Recent Scoping Review.

Existing literature has reported inequities in access to Canadian health care services among immigrants. The aim of this scoping review was (a) to explore research regarding Canadian immigrants' unique experiences in accessing healthcare, and (b) to provide suggestions for future research and programming considering the identified immigrant-specific service gaps in health care. We searched MEDLINE, CINAHL, EMBASE, and Google Scholar, following the Arksey and O'Malley (2005) framework. The review's findings suggest unmet health care access needs specific to immigrants in Canada, with the most common access barriers including communication, socioeconomic, and cultural barriers. The scoping review expands on the immigrant health care experiences and accessibility factors through a thematic analysis. Findings suggest that developing community-based programming, improving training for health care providers in culturally competent care, and policies that address the social determinants of health can improve health care accessibility among immigrants.

Profiling the Research Activities of Canadian Occupational Therapy and Occupational Science Faculty Members.

Background. There is a lack of knowledge on the scope and nature of the research by faculty members in occupational science (OS) and/or occupational therapy (OT) programs in Canada. Purpose. To describe the research activities of faculty members in these programs and directions. Method. A cross-sectional survey was distributed to 173 faculty members across all 14 Canadian OT that addressed: 1) research topics and methods, 2) populations, and 3) funding. Findings. Based on respondents (N = 121), research is focused on a range of topics and populations with most conducting qualitative research. Many conduct research examining the effectiveness of interventions, with few respondents focused on OS research. Federal and provincial grants agencies were the largest source of funding. Implications. Research topics studied were not always proportional to practice although emerging areas were being investigated that can expand the evidence base and scope of practice. Despite limited occupation-specific funding options, respondents were accessing funding from varied sources. Collaborations among faculty members, clinicians, and individuals with lived experience can create priorities for future OS and/or OT research in Canada.

Characteristics of peer-based interventions for individuals with neurological conditions: a scoping review.

PURPOSE: Peer-based interventions are increasingly popular and cost-effective therapeutic opportunities to support others experiencing similar life circumstances. However, little is known about the similarities and differences among peer-based interventions and their outcomes for people with neurological conditions. This scoping review aims to describe and compare the characteristics of existing peer-based interventions for adults with common neurological conditions. MATERIALS AND METHODS: We searched MEDLINE, CINAHL, PsychInfo, and Embase for research on peer-based interventions for individuals with brain injury, Parkinson's, multiple sclerosis, spinal cord injury, and stroke up to June 2019. The search was updated in March 2021. Fifty-three of 2472 articles found were included. RESULTS: Characteristics of peer-based intervention for this population vary significantly. They include individual and group-based formats delivered in-person, by telephone, or online. Content varied from structured education to tailored approaches. Participant outcomes included improved health, confidence, and self-management skills; however, these varied based on the intervention model. CONCLUSION: Various peer-based interventions exist, each with its own definition of what it means to be a peer. Research using rigorous methodology is needed to determine the most effective interventions. Clear definitions of each program component are needed to better understand the outcomes and mechanism of action within each intervention.IMPLICATIONS FOR REHABILITATIONRehabilitation services can draw on various peer support interventions to add experiential knowledge and support based on shared experience to enhance outcomes.Fulfilling the role of peer mentor may be beneficial and could be encouraged as part of the rehabilitation process for people with SCI, TBI, Stroke, PD, or MS.In planning peer-based interventions for TBI, Stroke, SCI, PD, and MS populations, it is important to clearly define intervention components and evaluate outcomes to measure the impact of the intervention.

An Interpretative Phenomenological Analysis of Living with Chronic Low Back Pain in Ethiopia.

Background: People with chronic low back pain experience myriads of problems from living with their condition. This study aimed to explore the lived experience of people with chronic low back pain in Ethiopia. Design: This is a qualitative semi-structured study design which used an interpretative phenomenological analysis approach for data analysis. Participants: Fifteen adults (10 women and 5 men) with chronic low back pain (duration ≥ 3 months) with age ranging from 19 to 66 years old were interviewed. Setting: Participants were recruited from the outpatient departments of the University of Gondar hospital in Gondar, Ethiopia. Methods: Data was collected through an in-depth semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed through an iterative process, beginning with a line-by-line coding to identify the lived experience of chronic low back pain. Findings: Five main themes related to the lived experience of people with chronic low back pain emerged: 1) CLBP impacts life on a day-to-day basis, 2) The invisibility of pain results in misunderstanding, misjudgment, and loneliness, 3) The cause of pain is a mystery, 4) The search for the cure is a quest, 5) Each person has their ways of managing, coping, and living with pain. Conclusion: The findings from this study improve our understanding of the experience of people with chronic low back pain and its impact on their day-to-day life in Ethiopia. The findings from this study could inform the development of culturally centered chronic low back pain interventions such as self-management programs in the Ethiopian context.

The Bangladeshi Rights and Protection of Persons With Disability Act of 2013: A Policy Analysis.

The government of Bangladesh enacted the Rights and Protection of Persons with Disability Act of 2013 (the Act) in line with the United Nations Convention on the Rights of Persons with Disabilities. This article sheds light on the Act with particular emphasis on (a) support offered to children with disabilities (CWDs) and their families to address their needs; and (b) the extent to which the Act is in line with the international disability policy analysis framework. We compared the Act with the 18 core concepts of disability policy developed by Turnbull et al. (2001). The results affirm the government's effort toward Sustainable Development Goals in providing support to CWDs and their families. They indicate a high degree of congruency of the Act with the core concepts. The findings also highlight the need to embrace the concepts of autonomy, confidentiality, and family-centeredness in great detail in any policy initiatives pertaining to CWDs. Furthermore, the finding shows that collaboration and coordination among ministries are imperative to achieve the goal of policies related to disability. In addition, the results highlight the need for more budgetary allocation and robust monitoring systems to track the progress of policy initiatives. As policy implementation is affected by changes in global contexts such as the coronavirus disease 2019 pandemic, policymakers in Bangladesh and other low- and middle-income countries should ensure that emergency responses are disability-inclusive and appropriate for CWDs. To ensure a disability-inclusive response, it is critical to engage individuals with disabilities and their families in meaningful consultations to identify their needs.

Empowered patient: A program to improve people with Parkinson's communication with health care professionals.

Background: Communication breakdown between patients and health care professionals poses an accessibility gap preventing adequate health care. The Empowered Patient Program was developed to support people with Parkinson's in improving their health communication skills/strategies and thus facilitate the accessibility gap in their care. Objective: Our pilot study aimed to test the feasibility and preliminary effect of the Empowered Patient Program within a small cohort of individuals with Parkinson's disease. Methods: We completed a pre-test-post-test pilot study. Eight participants completed the Empowered Patient Program for this pilot study. Data collection was completed by administering a questionnaire prior to the program, immediately after program completion, and three months post-completion. We additionally conducted two telephone interviews with the participants to qualitatively gather feedback on the program. Results: The program elucidated statistically significant improvement across domains/areas of knowledge (p = 0.01) and self-perceived communication skills (p = 0.04) among the participants. Through feedback from the patient interviews, it was confirmed that these significant improvements were owed largely to the high level of organization, intuitive user interface, and suitable content of the program for this cohort. Conclusions: The Empowered Patient Program pilot resulted in a desired outcome indicating its satisfactory development. The next steps are to test the Empowered Patient program in a larger sample.

The Role of Immigrant Admission Classes on the Health and Well-being of Immigrants and Refugees in Canada: A Scoping Review.

Many countries offer different pathways through which migrants can enter a new country. In Canada, there are three main immigrant admission classes: economic, family, and refugee. Previous research suggests that there are differences in health outcomes among various subgroups of migrants. A scoping review was conducted to characterize the role of immigrant admission classes on the health and well-being of immigrants and refugees in Canada. MEDLINE, Embase, PsycINFO, Sociological Abstracts, and EconLit databases were searched for quantitative studies published in English after 1990. The screening and selection process identified 27 relevant studies. Studies were categorized into four key reported outcomes: health care and services utilization, self-rated health and mental health, medical conditions and chronic illnesses, and social integration and satisfaction. Findings confirm that certain subgroups have worse health outcomes after arrival, particularly refugees, family class and other dependent immigrants. Health outcomes vary significantly across immigrant subgroups defined by the admission class through which they entered Canada.

Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description.

BACKGROUND: Healthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia. METHODS: Health care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews. FINDINGS: Twenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers' had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition. CONCLUSIONS: Self-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers' self-management support competencies through training.

Service providers' perspectives in providing services to children with disabilities and their families in Bangladesh.

PURPOSE: This study seeks to gain an understanding of access to rehabilitation services and disability allowances for children with disabilities and their families from the perspectives of service providers. METHOD: We interviewed 21 service providers in Bangladesh and used thematic analysis to analyze data. RESULTS: Participants reported their perspectives on two major themes: (a) challenges in providing services to children with disabilities (e.g., limited availability of services and favouritism); and (b) facilitators in providing services to children with disabilities (e.g., cooperation from community leaders and satisfaction). CONCLUSION: Providers' perspectives revealed unique insights that might be interesting for policymakers, practitioners, and researchers. The findings reinforce the need to consider the availability of rehabilitation professionals and disability allowances to meet the greatest needs of children with disabilities and their families in Bangladesh. The findings also call for further research on policymakers' perspectives on addressing the systemic issues encountered by providers in providing support to children with disabilities and their families in Bangladesh.Implications for RehabilitationRehabilitation services are critical for children with disabilities to achieve optimal health, wellbeing and human rightsThe government of Bangladesh has increased rehabilitation services for children with disabilities, but there is a need for further investment to increase rehabilitation workforceIt is important to strengthen monitoring and evaluation of disability-specific programs to ensure equitable access to services for children with disabilities.

Experience of families in accessing government-led support for children with disabilities in Bangladesh.

PURPOSE: The purpose of the study was to understand the experiences of families in accessing government support (i.e., disability allowances and rehabilitation services) for their children with disabilities (CWDs) in Bangladesh. METHOD: We employed a qualitative descriptive method of study and interviewed 27 family members of CWDs. A thematic analysis was applied to analyze data using the following access dimensions to organize themes: availability, accommodation, accessibility, affordability, acceptability, and awareness. RESULTS: Participants shared both positive and negative experiences across the access dimensions in accessing government support. Participants appreciated the government's effort in providing support to CWDs. In particular, disability allowances and coordinated rehabilitation services at one-stop were important for families. Further, positive attitudes, such as respect and support from providers, were reported by many families. However, a majority of participants reported a long wait time to get the disability allowance for CWDs. Participants also reported that a shortage of rehabilitation professionals in the public sector was a major concern. Finally, inaccessible infrastructure (e.g., facilities and transportation) and stigma were barriers for many participants of the study. CONCLUSION: The results suggest that the government's commitment "on paper" is yet to meet the needs of its intended beneficiaries "in practice". There is a need for policy intervention to address barriers faced by families within the context of current access pathways.Implications for rehabilitationShortage of rehabilitation services and limited availability of disability allowances [negatively] affect family member's access to government-led support for their CWDs in Bangladesh.The government has increased services for people with disability significantly but there is a need for it to ensure the availability of all forms of rehabilitation and increase the quota for disability allowances to meet the needs of families.It is imperative to improve mechanisms of monitoring the commitment of enacting tangible results from policies in order to ensure equitable distribution of disability allowance and rehabilitation services.

Cross-cultural adaptation and validation of the Amharic version of Roland Morris Disability Questionnaire in people with low back pain in Ethiopia.

PURPOSE: Cross-culturally translate, adapt, and validate Roland Morris Disability Questionnaire (RMDQ) in Amharic language in Ethiopia. METHODS: The English version RMDQ was translated into Amharic and back-translated into English. An expert review committee reviewed the translations and created Amharic version of the RMDQ (RMDQ-Am). Pilot testing and cognitive debriefing of the RMDQ-Am were conducted with a sample of 20 individuals with LBP. The RMDQ-Am was administered to 240 individuals with LBP from three rehabilitation centers to determine its psychometric properties. Internal consistency of the tool was determined by Cronbach's alpha. Test-retest reliability was determined by the Intraclass correlation coefficient. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), and the Bland Altman Limit of Agreement (LOA) was also determined. The Short-Form Health Survey (SF-36) Bodily Pain and Physical Functioning subscales were used to assess convergent validity. Exploratory Factor Analysis (EFA) was used to determine the dimensionality of the tool. RESULTS: RMDQ-Am demonstrated good internal consistency (α = 0.88), excellent test-retest reliability (ICC = 0.91), SEM (1.64), MDC (3.55), and good LOA. There is a significant moderate correlation between RMDQ-Am and the Physical Functioning (Rho = -0.62, p < 0.01) and Bodily Pain (BP) (Rho = -0.41, p < 0.01) subscales of the SF-36. Exploratory Factor Analysis demonstrates that the Amharic version of RMDQ is a primary one and secondary four-factor model [The Kaiser Meyer Olkin = 0.877, X2 (df) =1413.278/190, p < 0.001]. CONCLUSION: RMDQ-Am is a reliable and valid tool that can be used in both clinical practice and research with the Ethiopian LBP population.IMPLICATION FOR REHABILITATIONDespite LBP being a concern in Ethiopia, the magnitude of disability related to this phenomenon is not studied in the country, mainly due to the absence of validated LBP specific patient-reported outcome measures such as the Roland Morris Disability Questionnaire (RMDQ).The RMDQ was successfully translated, adapted, and validated into the Amharic language and the Ethiopian context (RMDQ-Am).The RMDQ-Am is a reliable outcome measure among the Ethiopian population with LBP, as demonstrated by the good internal consistency (α = 0.88) and excellent test-retest reliability (ICC = 0.91).There is a moderate negative correlation between the RMDQ-Am and the Physical Functioning (Rho = -0.62, p < 0.01) and Bodily Pain (Rho = -0.41, p < 0.01) subscales of the SF-36.The RMDQ-Am can be used in clinical and research settings to measure LBP-related disability and its impact among individuals living with LBP in Ethiopia.

Barriers to Accessing Healthcare Services for People with Parkinson's Disease: A Scoping Review.

Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably.

Identifying Barriers to and Facilitators of Health Service Access Encountered by Individuals with Multiple Sclerosis.

BACKGROUND: The symptoms of multiple sclerosis (MS) can be diverse, complex, and progressive, creating a need for frequent and long-standing health care services. The purpose of this scoping review was to identify the barriers people with MS encounter when attempting to access multidisciplinary health services and the reported facilitators for better access to health services. METHODS: The MEDLINE, Embase, and CINAHL databases were searched, without date or geographic restrictions, using the following terms: multiple sclerosis, health services accessibility, health care access, health care delivery, and delivery of health care. After screening based on exclusion criteria, 23 articles were included in the final review. RESULTS: Five main themes were identified as barriers and facilitators to accessing health services: 1) information (information available to people with MS, health care provider knowledge of and familiarity with MS), 2) interactions (interactions between health care providers and people with MS, social networks and support of people with MS, collaboration among health care providers), 3) beliefs and skills (personal values and beliefs, perceived time to travel to and attend appointments, and self-assessment of symptoms and needs of people with MS), 4) practical considerations (wait times, physical barriers, affordability of services), and 5) nature of MS (complexity and unpredictability of disease symptoms). CONCLUSIONS: People with MS and their health care providers may benefit from structured and comprehensive MS-specific education to address barriers to accessing health care services. The education can ultimately facilitate the process of addressing unmet health care needs and contribute to a greater quality of life for people with MS.

Cross-cultural translation, adaptation, and validation of the Amharic version pain self-efficacy questionnaire in people with low back pain in Ethiopia.

BACKGROUND: The Pain Self-Efficacy Questionnaire (PSEQ) is a valid and reliable instrument that evaluates pain self-efficacy beliefs in people with pain conditions. However, it has not been validated and used in Ethiopia. We conducted this study to translate, adapt, and test the psychometric properties of the PSEQ in the Amharic language and Ethiopian context for its use with people experiencing low back pain (LBP). METHODS: The PSEQ was translated into Amharic and then back-translated into English. An expert review committee created a final Amharic version of the tool (PSEQ-Am), followed by pilot testing and cognitive debriefing with a sample of 20 people with LBP. The psychometric properties of the final version of PSEQ-Am were assessed in a sample of 240 people with LBP recruited from three rehabilitation centers in Ethiopia. Cronbach's alpha and Intra-class correlation coefficient were calculated to describe the reliability and internal consistency of the tool. The SF-36-Am bodily pain subscale was used to assess convergent validity. Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to determine the dimensionality of the instrument. RESULTS: PSEQ-Am demonstrated excellent test-retest reliability (ICC = 0.93) and internal consistency (Cronbach's alpha = 0.91). As hypothesized, the tool demonstrated a significant moderate correlation with the Bodily Pain subscale of the SF-36-Am (Rho = 0.51, p < 0.01). EFA analysis shows that the Amharic version of PSEQ is a dominant one factor and secondary two factor structure. CONCLUSION: This study shows that PSEQ-Am is a reliable and valid tool that can be used in both clinical practice and research in the Ethiopian low back pain population.

A Qualitative Exploration of Occupational Adaptation in Caregivers of People with Multiple Sclerosis.

Due to the unpredictable and progressive nature of multiple sclerosis, the burden of care is placed on the primary caregivers. This study aimed to explore occupational adaptation strategies implemented by primary caregivers to adapt to occupational challenges of caregiving. Seventeen primary caregivers of people with MS were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Two main categories of strategies were determined: (a) Strategies to alleviate intrapersonal challenges of occupational adaptation; and (b) Strategies to alleviate environmental challenges of occupational adaptation. These included various skills and solutions that aided primary caregivers' adaptation toward occupational challenges. Based on the results of this study, occupational adaptation is a means of achieving mastery in alleviating occupational challenges to cope with adverse circumstances. The results of this study can be used to help therapists design appropriate caregiver-focused interventions, ultimately improving caregiver performance.

REFRESH protocol: a non-inferiority randomised clinical trial comparing internet and teleconference to in-person 'Managing Fatigue' interventions on the impact of fatigue among persons with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. It is considered a major cause of non-traumatic disability in young adults. One of the most common and disabling symptoms of MS is fatigue. MS fatigue can impact all aspects of quality of life, including physical, mental and social function. Fortunately, fatigue self-management interventions, such as 'Managing Fatigue: A 6 week energy conservation course', can decrease the impact of fatigue and improve health-related quality of life. The purpose of this study is to compare three modes of delivering the Managing Fatigue intervention-two remote delivery formats (teleconference and internet) and one in-person format-on perceptions of fatigue and its impact on physical, mental and social function. METHODS AND ANALYSIS: A non-inferiority randomised clinical trial is being conducted to compare the three delivery formats (1:1:1 allocation ratio) among 582 participants with MS living in the Midwestern and Northeastern United States. The hypothesis is that teleconference and internet versions of the intervention are non-inferior to the traditional mode of clinical service delivery (ie, one to one, in person) in terms of the primary outcome of self-reported fatigue impact (ie, Fatigue Impact Scale) and the secondary outcome of health-related quality of life (ie, Multiple Sclerosis Impact Scale). Outcomes are being measured at baseline, 2 months, 3 months and 6 months. The primary analysis tool will be linear mixed effects model. The prespecified inferiority margin for the primary outcome is 10 points. We will also examine whether baseline characteristics (eg, sociodemographic) moderate outcomes of the Managing Fatigue intervention and whether changes in self-efficacy and fatigue self-management behaviours mediate changes in outcomes. ETHICS AND DISSEMINATION: The protocol is approved centrally by the institutional review board at Case Western Reserve University. Eligible participants give consent before being enrolled and randomised into the study. The study results will be disseminated through relevant advocacy organisations, newsletters to participants, publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: NCT03550170; Pre-results.

Exploring access to government-led support for children with disabilities in Bangladesh.

While access to support for individuals with disabilities has attracted international attention, children with disabilities and their families continue to face a range of barriers that limit their timely access to the needed support, including health service. This is even worse for children with disabilities living in resource poor settings like Bangladesh. The objective of this study was to determine the extent to which families of children with disabilities have knowledge about and access to government support for their children with disabilities in Bangladesh. We employed a cross-sectional study among 393 families of children with disabilities who sought services from the Centre for the Rehabilitation of the Paralysed for their children with disabilities in Bangladesh. We used chi-square test to measure the association between categorical variables and, Mann-Whitney U-test to compare mean across different sub-groups. Overall, family members of children with disabilities have limited knowledge about and access to government support. We found a significant association between knowledge and access to government support (p<0.001). Family members with children with disabilities aged younger than six years had less access to government support (p<0.001). We thus concluded with an urgent call on government agencies and service providers to provide relevant and timely information to families of children with disabilities to enable them to access the needed support.