Randomized Controlled Trial to Improve Self-Efficacy in People With Multiple Sclerosis: The Community Reintegration for Socially Isolated Patients (CRISP) Program
OBJECTIVE:We examined the efficacy of a 12-wk educational socialization program, Community Reintegration for Socially Isolated Patients (CRISP), in improving self-efficacy for people with multiple sclerosis (MS). We also examined whether participants in the experimental group with increased self-efficacy experienced reduced loneliness and depression. METHOD/METHODS:This randomized controlled group design included 91 participants with MS (experimental group, n = 51; control group, n = 40). Participants were between ages 20 and 68 yr, and the majority experienced a relapsing-remitting MS course (86%) and mild to moderate disability. Participants completed baseline and posttreatment assessments, including questionnaires assessing self-efficacy, loneliness, and depression. RESULTS:Experimental group participants significantly improved in self-efficacy compared with control group participants. Experimental group participants who demonstrated improved self-efficacy reported reduced perceptions of loneliness but not depressive symptoms. CONCLUSION/CONCLUSIONS:CRISP is a promising intervention to improve self-efficacy for people with MS. However, results need to be treated with caution given the study's limitations.
The sound lateralization test demonstrates slowed processing speed in MS patients with minimal to mild disability and shows no learning effects in multiple testing sessions over a 1-year period [Meeting Abstract]
Transfer of information across the corpus callosum is slowed in patients with multiple sclerosis compared to healthy controls [Meeting Abstract]
Sound Lateralization Test Distinguishes Unimpaired MS Patients from Healthy Controls
There is an urgent need to develop a practical and reliable clinical measure of disease progression in early and mild MS. We hypothesized that a test of sound lateralization, which is exquisitely sensitive to transmission delays in auditory brainstem, could be more useful for detecting processing speed deficits in mildly impaired MS subjects than standard cognitive tasks. Objective. To develop a practical test of sound lateralization for the clinic and to compare performance of MS subjects with variable disability and healthy subjects on Sound Lateralization Test (SLT) and two speed-of-processing tasks. Design. 42 healthy controls and 90 subjects with clinically definite MS, divided into no, mild, and moderate disability strata, were administered the Symbol Digit Modalities Test (SDMT), and 3-second Paced Auditory Serial Addition Test (PASAT). Results. All of the tests showed an overall difference in performance between controls and the three MS groups, but only the SLT measured a significant difference between controls and the no disability group. Conclusion. SLT is rapidly applied, technically simple, and superior to standard processing speed tests for discriminating between healthy controls and nondisabled MS subjects. SLT should be investigated as an outcome measure in early-phase trials and for monitoring early disease progression in the clinic.
A sound localisation test discriminates between controls and multiple sclerosis patients with no measurable disability [Meeting Abstract]
Background: Sound lateralization is dependent upon precise timing of neuronal discharges in the auditory brainstem. Slowed processing speed in auditory brainstem pathways interferes with MS patients' ability to lateralize sound. A test of sound lateralization may be useful for detecting subtle brainstem deficits even among minimally impaired MS subjects. Objective: To determine whether a test of sound lateralization may be more sensitive to differences between controls and minimally impaired MS subjects than standard cognitive tasks. Design/Methods: 16 healthy controls and 45 MS subjects were recruited. Patients were divided into three disability strata: No Disability (Expanded Disability Status Scale (EDSS) =0; N=15), Mild Disability (EDSS=1 to 3.5; N=17), and Moderate Disability (EDSS=4 to 6.5; N=13). Using an interleaved staircase method, the interaural time difference (ITD) to a dichotically presented 910 Hz tone burst was varied to determine ITD thresholds for the tone localized just to the right or just to the left of center. Two standard tests used to assess processing speed, the Paced Auditory Serial Addition Test (PASAT3 and PASAT2) and the Symbol Digit Modalities Test (SDMT), were also administered. Results: Right and left threshold ITDs were averaged to provide a deviation score for each subject. The mean threshold ITD score was lowest for controls (M=196.9 mus, SD=76.4), increased for the No and Mild Disability groups (M=280.7 mus, SD=77.5 and M=268.8 mus, SD=105.3, respectively), and was greatest for the Moderate Disability group ( M=342.3 mus, SD=62.2). A MANOVA showed highly significant effects for IDT (p<.001, eta2=.28) and for the three other dependent variables (PASAT3, p<0.02; eta2=.23; PASAT2, p<.01, eta2=.18; SDMT, p<.001, eta2=.30). However, post hoc analysis showed that only the IDT test was sensitive to differences between controls and each MS group including, most importantly, the No Disability group(p<0.02). Conclusions: In our study, sound localization was the only te!
Backward masking paradigm captures delays in speed of processing in multiple sclerosis on a millisecond scale [Meeting Abstract]
Objective: To test the utility of a backward masking task for assessing speed of processing in Multiple Sclerosis (MS) on a millisecond scale. Background: Slowed speed of processing is a central component of cognitive impairment in patients with MS. Standard methods of assessing speed of processing, such as the Processing Speed Index, Symbol Digit Modalities Test, or the Paced Auditory Serial Addition Test provide a global measure of processing speed, but do not capture more subtle changes that might occur in the millisecond range. In the present study, we used a backward masking paradigm, in which the stimulus to be reported is followed by a masking pattern. A longer interstimulus interval (ISI) needed to correctly identify the primary stimulus is indicative of slower processing speed and the ISIs producing backward masking would be expected to occur in the range of less than 100 milliseconds. Method/Design: 11 healthy controls and 42 MS patients with scores on the Expanded Disability Status Scale (EDSS) ranging from 0 to 6.5 were recruited for the study. Stimuli consisted of 4 to 6 lower-case- letter words presented on a computer screen. The stimulus word was followed by a mask of upper-case letters forming a nonsense word. The letters of the mask overlay the stimulus word. The ISI between the stimulus word and mask was increased in increments of 5 milliseconds (msec) until the subject was unable to report the word correctly. At that point, 5 iterations of the staircase method were presented to zero in on the threshold ISI. Results: A regression analysis with EDSS as the independent variable and Backward Masking ISI threshold as the dependent measure showed that EDSS was a significant predictor of ISI threshold (unstandardized coefficient B=7.51, t(51)=4.58, p<.001). EDSS also accounted for a significant amount of the variance in ISI scores (R2=.28, F(1,51)=20.96, p<.001). ISI thresholds ranged from an average of 45 msec for controls to an average of 115 msec for EDSS of 6.5. The slope (B) in!
Trend for decreasing Multiple Sclerosis Severity Scores (MSSS) with increasing calendar year of enrollment into the New York State Multiple Sclerosis Consortium
Background: Although the natural history of multiple sclerosis has been charted extensively, it is still not known whether the trajectory of disability accumulation has changed in the era of disease-modifying therapies (DMTs). Objective: The objective of this study was to examine trends in Multiple Sclerosis Severity Score (MSSS) with regard to calendar year of enrollment into the New York State MS Consortium (NYSMSC). Methods: Distributions of MSSS were calculated for each year of enrollment, from 1996 to 2007. Quantile regression was used in a multivariable analysis to model for conditional distribution of MSSS quantiles as functions of potential confounders. Results: The cohort consisted of 6238 patients. Mean age at enrollment was 38 years (SD = 10) and mean disease duration was 10.1 years (SD = 7.3); 57% were on DMTs. The quantile regression model of trends in MSSS between 1996 and 2007 controlled for age, sex, ethnicity, diagnostic delay, and disease duration and demonstrated a robust trend toward lower MSSS with increasing year of enrollment. The model-predicted median MSSS at enrollment in 1996 was 5.04 (95% CI, 4.86-5.21), and in 2007 was 3.78 (95%CI, 3.36-4.20; p < 0.001). The downward trend in MSSS during the enrollment period was confirmed by analysis of Expanded Disability Status Scale (EDSS) distributions, adjusted for disease duration, in successive years of enrollment. Conclusions: The recent enrollees into the NYSMSC had lower MSSSs compared to the earlier enrollees. The apparent slowing in disability accumulation is likely due to a complex combination of factors: advent of DMTs and improvements in MS care, as well as selection, migration, and recall biases
The Effect of Occupational Therapy on Resilience in Individuals with Multiple Sclerosis [Meeting Abstract]
Cognitive Rehabilitation Benefits Multiple Sclerosis Patients Only If They Are Active Participants in the Program [Meeting Abstract]
Decrease in Individual Multiple Sclerosis Severity Scores during Follow-Up Period: Analysis of the New York State Multiple Sclerosis Consortium Dataset [Meeting Abstract]