Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis. (April 2018)

• Record Type: Journal Article
• Authors: Solari, Alessandra; Giordano, Andrea; Patti, Francesco; Grasso, Maria Grazia; Confalonieri, Paolo; Palmisano, Lucia; Ponzio, Michela; Borreani, Claudia; Rosato, Rosalba; Veronese, Simone; Zaratin, Paola; Battaglia, Mario Alberto
• Is Part Of: Multiple sclerosis. Volume 24:Number 5(2018)
• Page Start: 663
• Page End: 674
• Publication Date: 2018-04
• Subjects: Multiple sclerosis -- palliative care -- randomized controlled trial -- quality of life -- symptom burden -- caregivers; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458517704078
• Languages: English
• ISSNs: 1352-4585

Abstract

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, 3 months, and 6 months. 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 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, 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.