Author Of 2 Presentations
P0207 - Effects of Nurse Practitioner Care compared to Community Neurologist Care on Depression and Anxiety Levels in People with MS: a randomized trial (ID 311)
Abstract
Background
Canada has one of the highest rates of MS in the world. As treatments for people with MS (PwMS) become more comprehensive, it is challenging for general community neurologists to optimally provide care with the pressures of busy office practices in a public health care system. Specialized nurse practitioners (NPs) provide advanced skills to those with complex medical conditions such as PwMS, with potential to enhance care for PwMS.
Objectives
Our objective was to evaluate the effect of NP-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS) compared to ‘usual care’ (community neurologist and MS specialized RN nursing).
Methods
PwMS followed by community neurologists were randomized to NP-led (NP) or usual care (CN) for 6 months. Primary outcome was the change in the anxiety and depression sub-scales of the HADS at 3 months. Higher scores indicate greater severity. Secondary outcomes included HADS-A and HADS-D at 6 months, quality of life as measured by the EQ5D (3, 6 months), fatigue as measured by the MSIF (3, 6 months), and the Consultant Satisfaction Survey (3, 6 months).
Results
We recruited 248 subjects; 226 completed the trial (NP arm n=118, CN arm n=108). There were no baseline differences between groups. Study subjects were highly educated (72%), working full-time (42%), living independently (69%), with mean age of 47 (SD 11.02) and mean duration since MS diagnosis of 12.45 years (SD 8.73). Most had relapsing remitting MS (85%), with mean EDSS of 2.54 (SD 2.07). The mean change in HADS-D at 3 months was: -0.41 (SD 2.81) NP group vs 1.11 (2.98) CN, p=0.001; and for HADS-A, -0.32 (2.73) NP vs 0.42 (2.82) CN, p=0.059, similar at 6 months. There were trends, but no significant changes in MSIF and EQ5D from baseline in either arm at 3 and 6 months. There was no difference in patient satisfaction with the NP-led care compared to usual care (63.83 (5.63) for NP group vs. 62.82 (5.45) for usual care, p=0.194).
Conclusions
NP-led care improved depression (at 3 and 6 months) and anxiety levels (at 6 months) in PwMS; there was no difference in patient satisfaction with care between NP and community neurologist. Further research with longer follow-up is needed to explore how NPs could enrich and supplement the care provided for PwMS in a Canadian public healthcare system.
P0919 - The Canadian Prospective Cohort (CanProCo) Study to Understand Progression in Multiple Sclerosis: Rationale and Baseline Characteristics (ID 1236)
Abstract
Background
Neurological disability progression occurs across the spectrum of people living with multiple sclerosis (PwMS). Currently, no treatments exist that substantially modify the course of clinical progression in MS, one of the greatest unmet needs in clinical practice. Characterizing the determinants of clinical progression is essential for the development of novel therapeutic agents and treatment approaches that target progression in PwMS.
Objectives
The overarching aim of CanProCo is to evaluate a wide spectrum of factors associated with the onset and rate of disease progression in MS, and to describe how these factors interact with one another to influence progression.
Methods
CanProCo is a prospective, observational cohort study aiming to recruit 1000 individuals with radiologically-isolated syndrome (RIS), relapsing-remitting MS (RRMS), and primary-progressive MS (PPMS) within 10-15 years of disease onset, and 50 healthy controls (HCs) from five large academic MS centers in Canada. Participants undergo detailed clinical evaluations annually. A subset of participants enrolled within 5-10 years of disease onset (n=500) also have blood, cerebrospinal fluid, and MRIs collected facilitating study of biological measures (e.g. single-cell RNA-sequencing[scRNASeq]), MRI-based microstructural assessment, participant characteristics (self-reported, performance-based, clinician-assessed, health-system based), and environmental factors as determinants contributing to the differential progression in MS.
Results
Recruitment commenced in April/May 2019 and n=536 patients have been recruited to date (RRMS=457, PPMS=35, RIS=25, HC=19). Baseline age, sex distribution, and Expanded Disability Status Scale (EDSS) scores (median, range) of each subgroup are: RRMS=38 years, 73% female, EDSS=1.5 (0-6.0); PPMS=52 years, 40% female, EDSS=4.0 (1.5-6.5); RIS=41 years, 68% female, EDSS=0 (0-3.0); HC=37 years, 63% female. Recruitment has surpassed the 50% target but has been paused due to the COVID-19 pandemic. scRNASeq on frozen blood samples has been validated.
Conclusions
Halting the progression of MS is a fundamental clinical need to improve the lives of PwMS. Achieving this requires leveraging transdisciplinary approaches to better characterize mechanisms underlying clinical progression. CanProCo is the first prospective cohort study aiming to characterize these determinants to inform the development and implementation of efficacious and effective interventions.
Presenter Of 1 Presentation
P0207 - Effects of Nurse Practitioner Care compared to Community Neurologist Care on Depression and Anxiety Levels in People with MS: a randomized trial (ID 311)
Abstract
Background
Canada has one of the highest rates of MS in the world. As treatments for people with MS (PwMS) become more comprehensive, it is challenging for general community neurologists to optimally provide care with the pressures of busy office practices in a public health care system. Specialized nurse practitioners (NPs) provide advanced skills to those with complex medical conditions such as PwMS, with potential to enhance care for PwMS.
Objectives
Our objective was to evaluate the effect of NP-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS) compared to ‘usual care’ (community neurologist and MS specialized RN nursing).
Methods
PwMS followed by community neurologists were randomized to NP-led (NP) or usual care (CN) for 6 months. Primary outcome was the change in the anxiety and depression sub-scales of the HADS at 3 months. Higher scores indicate greater severity. Secondary outcomes included HADS-A and HADS-D at 6 months, quality of life as measured by the EQ5D (3, 6 months), fatigue as measured by the MSIF (3, 6 months), and the Consultant Satisfaction Survey (3, 6 months).
Results
We recruited 248 subjects; 226 completed the trial (NP arm n=118, CN arm n=108). There were no baseline differences between groups. Study subjects were highly educated (72%), working full-time (42%), living independently (69%), with mean age of 47 (SD 11.02) and mean duration since MS diagnosis of 12.45 years (SD 8.73). Most had relapsing remitting MS (85%), with mean EDSS of 2.54 (SD 2.07). The mean change in HADS-D at 3 months was: -0.41 (SD 2.81) NP group vs 1.11 (2.98) CN, p=0.001; and for HADS-A, -0.32 (2.73) NP vs 0.42 (2.82) CN, p=0.059, similar at 6 months. There were trends, but no significant changes in MSIF and EQ5D from baseline in either arm at 3 and 6 months. There was no difference in patient satisfaction with the NP-led care compared to usual care (63.83 (5.63) for NP group vs. 62.82 (5.45) for usual care, p=0.194).
Conclusions
NP-led care improved depression (at 3 and 6 months) and anxiety levels (at 6 months) in PwMS; there was no difference in patient satisfaction with care between NP and community neurologist. Further research with longer follow-up is needed to explore how NPs could enrich and supplement the care provided for PwMS in a Canadian public healthcare system.