Multimorbidity in clinical practice

Multimorbidity is defined as two or more chronic conditions in the same individual. It is associated with significant impacts on quality of life, poor functional status, enhancement of the challenges of medical care and cost implications, unnecessary hospitalizations, increases the terms of hospital stay, and affects the evaluation of the interventions effectiveness. The article reviews the prevalence of multimorbidity, combinations of conditions in people with multimorbidity, especially, in patients with cardiovascular diseases. This review also identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities as presented in WHO manual, Guiding principles for the care of older adults with multimorbidity of the American Geriatrics Society and NICE clinical guidelines (NG56). The paper outlined key problems posed by current healthcare organization and experienced by patients with multimorbidity – the need for the development of accurate and reliable methods of comorbidity assessment and evidence-based outcome measurement criteria and tools.

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Peer Support for People with Chronic Conditions: A Systematic Review of Reviews

10.21203/rs.3.rs-908557/v1 ◽

2021 ◽

Author(s):

Dean M. Thompson ◽

Lesley Booth ◽

Jonathan Mathers

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Lived Experience ◽

Peer Support ◽

Chronic Conditions ◽

Outcome Measurement ◽

Behavioural Change ◽

Increased Risk ◽

Review Of Reviews

Abstract Background: People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions.Methods: A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis.Results: The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects.Conclusions: The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need.

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Misophonia: An Evidence-Based Case Report

American Journal of Audiology ◽

10.1044/2020_aja-19-00111 ◽

2020 ◽

Vol 29 (4) ◽

pp. 685-690

Author(s):

C. S. Vanaja ◽

Miriam Soni Abigail

Keyword(s):

Quality Of Life ◽

Case Report ◽

Case History ◽

Pure Tone ◽

Physiological Responses ◽

Evidence Based ◽

Management Option ◽

Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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A RETROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOME MEASUREMENT AFTER RECEIVING PROLOTHERAPY FOR SACROILIAC JOINT PAIN

10.26226/morressier.5ab3c880a874c600265592e6 ◽

2018 ◽

Author(s):

Imrat Sohanpal

Keyword(s):

Quality Of Life ◽

Retrospective Study ◽

Sacroiliac Joint ◽

Joint Pain ◽

Outcome Measurement ◽

Sacroiliac Joint Pain

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Translation and Validation of the Thai Version of the Wisconsin Quality of Life Questionnaire (TH WISQoL) for Kidney Stone Patients

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.11.11450 ◽

2020 ◽

Vol 103 (11) ◽

pp. 1194-1199

Keyword(s):

Quality Of Life ◽

Internal Consistency ◽

Kidney Stone ◽

Convergent Validity ◽

Large Scale ◽

Short Form ◽

Outcome Measurement ◽

Life Questionnaire ◽

Sf 36

Objective: To develop and validate a Thai version of the Wisconsin Quality of Life (TH WISQoL) Questionnaire. Materials and Methods: The authors developed the TH WISQoL Questionnaire based on a standard multi-step process. Subsequently, the authors recruited patients with kidney stone and requested them to complete the TH WISQoL and a validated Thai version of the 36-Item Short Form Survey (TH SF-36). The authors calculated the internal consistency and interdomain correlation of TH WISQoL and compared the convergent validity between the two instruments. Results: Thirty kidney stone patients completed the TH WISQoL and the TH SF-36. The TH WISQoL showed acceptable internal consistency for all domains (Cronbach’s alpha 0.768 to 0.909). Interdomain correlation was high for most domains (r=0.698 to 0.779), except for the correlation between Vitality and Disease domains, which showed a moderate correlation (r=0.575). For convergent validity, TH WISQoL demonstrated a good overall correlation to TH SF-36, (r=0.796, p<0.05). Conclusion: The TH WISQoL is valid and reliable for evaluating the quality of life of Thai patients with kidney stone. A further large-scale multi-center study is warranted to confirm its applicability in Thailand. Keywords: Quality of life, Kidney stone, Validation, Outcome measurement

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Development of the Quality of Life in Youth Services Scale (QOLYSS): Content-Related Validity Evidence Based on Adolescents’ and Expert Reviewers’ Perspectives

Applied Research in Quality of Life ◽

10.1007/s11482-021-09921-x ◽

2021 ◽

Author(s):

Chris Swerts ◽

Laura E. Gómez ◽

Jessica De Maeyer ◽

Goedele De Nil ◽

Wouter Vanderplasschen

Keyword(s):

Quality Of Life ◽

Evidence Based ◽

Validity Evidence ◽

Youth Services

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The impact of e-Health interventions on promoting Self-Care in Chronic Patients: an Umbrella Review

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1104 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Renzi ◽

G Gasperini ◽

V Baccolini ◽

C Marzuillo ◽

C De Vito ◽

...

Keyword(s):

Public Health ◽

Quality Of Life ◽

Chronic Conditions ◽

Self Care ◽

Health Interventions ◽

Self Management ◽

Improve Quality ◽

Umbrella Review ◽

Copd Patients

Abstract Background Promoting self-care is one of the most promising strategies to manage people with chronic conditions and to improve the Public Health System resilience. In this context, the use of e-Health could facilitate self-care promotion, assure continuity of care and save time. Methods We performed an umbrella review on Cochrane, Scopus, Medline, PsychInfo, CINAHL to analyse e-Health self-care promoting intervention in patients with Type- 2 Diabetes Mellitus (T2DM), Cardiovascular Diseases (CVD) and Chronic Obstructive Pulmonary Disease (COPD) compared to traditional intervention. AMSTAR-2 was used for quality appraisal. Results 10 systematic reviews were included for an amount of 376 RCTs and 3 quasi-experimental studies. All the e-Health interventions retrieved were categorized in 4 subgroups: Phone Reminder, Telemonitoring, Psychoeducational intervention supported by PCs/Apps and Combined Intervention. Nurses (271/379 studies) and physicians (149/379 studies) were the healthcare workers mostly involved in the administration of e-Health interventions. T2DM (5 reviews; 175 studies) and CVD (7 reviews; 164 studies) patients gained more progresses in self-management than COPD patients (3 reviews; 8 studies). E-Health appeared effective both in promoting self-management and disease awareness. Globally, all the e-Health interventions seemed to improve Quality of Life and clinical outcomes. Phone reminders were most effective to increase Medication Adherence. All Causes Mortality registered a positive effect through Telemonitoring. Hospital Admission and Cost-Efficacy were explored only by telemonitoring and it did not show differences with traditional intervention. Conclusions E-Health is an effective strategy to promote self-care in patients with chronic conditions and to improve quality of life and clinical outcomes. Further research is required to test e-Health intervention in COPD patients and to examine if there is different efficacy among e-Health subgroups. Key messages E-Health should be integrated in Primary Care strategies to improve Public Health systems resilience. Nurses, as frontline Primary Health Care workers, should be advised for e-Health administration.

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Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management

Autism ◽

10.1177/1362361320962366 ◽

2020 ◽

pp. 136236132096236

Author(s):

Joanne Tarver ◽

Effie Pearson ◽

Georgina Edwards ◽

Aryana Shirazi ◽

Liana Potter ◽

...

Keyword(s):

Quality Of Life ◽

Intellectual Disability ◽

Language Use ◽

Management Strategies ◽

Assessment Tools ◽

Evidence Based ◽

Structured Interviews ◽

Verbal Language ◽

Parental Recognition

Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (mage = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words. Lay abstract Anxiety is a common condition in autistic individuals, including those who also have an intellectual disability. Despite this, autistic individuals who have severe to profound intellectual disability, or use few or no words, are often excluded from autism research. There are also very few assessment tools and interventions with known effectiveness for autistic individuals with intellectual disability. In this study, we aimed to learn more about parent/carers experiences of recognising and managing anxiety in autistic individuals who use few or no words. We conducted semi-structured interviews with parents and carers to address three research questions: (1) what techniques and management strategies do parents describe for anxiety-related behaviour in their child; (2) how do communication difficulties impact parental understanding and management of anxiety provoking situations and behaviours; (3) what is the impact of anxiety-related behaviours on the quality of life of autistic individuals and their families? During the interviews, parents described difficulties recognising anxiety in their child, mostly due to reduced verbal language use and anxiety behaviours overlapping with other behaviours (e.g. autism characteristics). However, parents also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. We will use the findings of this study to inform future research to develop assessment tools and interventions for anxiety in autistic individuals who use few or no words.

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