Understanding Health Care Professional-Patient Interactions in Multiple Sclerosis: A Systematic Review and Thematic Synthesis

Aim: To examine the experiences of health care professional (HCP)-patient interactions in Multiple Sclerosis (MS), identifying factors that can influence these interactions. Methods: A three-stage systematic review and thematic synthesis of qualitative and quantitative research was undertaken. Stage 1: the systematic literature search;Stage 2: methodological appraisal of the qualitative papers;Stage 3: thematic synthesis of all qualitative papers and the integration of quantitative findings into the synthesis. Results: Forty-nine qualitative studies were identified. This included 1014 individuals with MS (244 male, 755 female and 15 unknown) and 106 carers and 86 HCPs. Seventeen quantitative studies were identified which included 7680 (2008 male, 5812 females, and 40 unknown) participants as well as 224 carers. Two themes are discussed: 1) The expectations, experiences and perceptions of interactions with HCPs, and 2) The factors that influenced interactions and relationships. Discussion: There is need for improvement in the content and provision of information to patients with MS from HCPs. Specific strategies are suggested and implications for patients and health care providers are considered.

The Hope and Adaptation Scale (HAS): Establishing Face and Content Validity

Purpose: To develop and test the face and content validity of a scale that assesses an individual’s adaptation and expression of hope to a life changing events, disease or trauma. Method: The Hope and Adaptation Scale was developed and tested across three stages. Stage 1 involved the use of a review of literature to conceptually map the tool. Stage 2 required exploratory investigations of the questionnaire by members of an expert panel. Stage 3 assessed the construct validity of the resulting scale. Results: Through the processes of Stage 1 and 2, the tool was developed and reduced to a 3-item scale that assessed a spectrum of hope-related responses and a spectrum of adaptation-related responses. Stage 3 identified fifteen independent health care professionals who assessed the scale. The content validity index of the resultant scale was 0.6 that was above the required level to be acceptable. The hope spectrum responses scored the highest content validity ratio (0.73). Discussion: The proposed scale appears to have face and content validity for application to a various number of events, disease or trauma experiences. Further testing of the scale is required for application in specific population groups.

The Psychosocial Impact and Value of Participating in a Storytelling Intervention for Patients Diagnosed with Cancer: An Integrative Review

Background: Interventions have recently been developed to test the therapeutic value of storytelling for people with cancer. This evidence includes different designs, as a result an integrative review is needed that can determine the impact and value of storytelling interventions for people with cancer. Aims: To undertake an integrative review of evidence identifying the impact and outcomes from storytelling interventions for people with cancer. Methods: An integrative review of group based storytelling interventions using a qualitative led-synthesis. Results: Eleven studies were identified with a total of 493 (49 female, 16 male, 428 not disclosed) people included. Two major themes were identified: 1) content of interaction and 2) outcomes from the interventions. Six sub-themes were identified. The results provided a unique insight into the psycho-emotional impact of storytelling interventions. Conclusions: It is essential that health care professionals understand the core benefits of storytelling for people with cancer. Further interventions are needed to identify an approach which could be applied within clinical settings.

Supported Rehabilitation for Individuals Who Have Experienced a Stroke: A Pilot Control Trial

The purpose of this study was to pilot an innovative and supported intervention for individuals with a stroke. A pilot control trial with qualitative interviews was undertaken within a university- community setting. Thirteen individuals who had experienced a stroke for periods of least 6 months (6 male, average 71 years) were assigned to the intervention group and 7 individuals (2 male, average age 67.9 years) assigned to the control group. Eight individuals from the intervention group completed a single interview. The procedures that related to recruitment and retention and data collection methods were considered. Outcome measures including;self-efficacy, falls self-efficacy and group membership, for both groups were taken at baseline, 11 weeks, 22 weeks. There was an additional assessment at 52 weeks for the intervention group. The structured interview was designed to focus on experiences of the intervention. Self-efficacy remained stable across time for both groups. An improvement in falls self-efficacy was noted in the intervention group at 11 weeks. Consistent improvement (from baseline) was observed in the identity scale across the 52 weeks. Qualitative data provided additional findings related to identity and confidence. Details considering recruitment and retention are also provided. This pilot study provided data that can be used for a further full-scale trial to be considered.

Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain

Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.