Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis

被引:27
作者
Solari, Alessandra [1 ]
Giordano, Andrea [1 ]
Patti, Francesco [2 ]
Grasso, Maria Grazia [3 ]
Confalonieri, Paolo [4 ]
Palmisano, Lucia [5 ]
Ponzio, Michela [6 ]
Borreani, Claudia [7 ]
Rosato, Rosalba [8 ]
Veronese, Simone [9 ]
Zaratin, Paola [6 ]
Battaglia, Mario Alberto [10 ]
机构
[1] Fdn IRCCS Neurol Inst C Besta, Unit Neuroepidemiol, Via Celoria 11, I-20133 Milan, Italy
[2] Univ Hosp Policlin Vittorio Emanuele, MS Ctr, Neurol Clin, Catania, Italy
[3] IRCCS S Lucia Fdn, Multiple Sclerosis Unit, Rome, Italy
[4] Fdn IRCCS Neurol Inst C Besta, Dept Neuroimmunol & Neuromuscular Dis, Milan, Italy
[5] Ist Super Sanita, Natl Ctr Drug Evaluat & Res, Rome, Italy
[6] Italian Multiple Sclerosis Fdn FISM, Sci Res Area, Genoa, Italy
[7] Fdn IRCCS Ist Nazl Cura Tumori, Unit Clin Psychol, Milan, Italy
[8] Univ Turin, Dept Psychol, Turin, Italy
[9] FARO Charitable Fdn, Turin, Italy
[10] Univ Siena, Dept Life Sci, Siena, Italy
关键词
Multiple sclerosis; palliative care; randomized controlled trial; quality of life; symptom burden; caregivers; CARE; REHABILITATION; QUALITY; SCALE; LIFE; NEED;
D O I
10.1177/1352458517704078
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce. Objective: To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers. Methods: Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3months, and 6months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients). Results: Of 78 dyads randomized, 76 (50HPA, 26UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC (p=0.047). Effect size was 0.20 at 3months and 0.32 at 6months, and statistical significance was borderline in per-protocol analysis (p=0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes. Conclusion: HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.
引用
收藏
页码:663 / 674
页数:12
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