The Impact of Cognitive Functioning on Daily Occupations for People with Multiple Sclerosis: A Qualitative Study

Background: Cognitive rehabilitation research in multiple sclerosis is ever-developing, but the impact of cognitive difficulties, seen in 40% to 80% of people, on daily occupations is not well known. The aim of this study is to explore the needs of people with MS who have self-reported cognitive deficits. Methods: An exploratory qualitative descriptive research design was used. Data was collected through semi-structured telephone interviews with the participants. Recordings were transcribed and analyzed thematically. Results: Seven participants were recruited (mean age 47). Three themes were developed through associations found in the data. “Neglected symptom” reported the participants’ frustrations around the importance afforded to cognition by health care providers. “Impact on participation in daily occupations” described the everyday impacts of cognitive difficulties. “Adaptations and adjustments to continued participation” reported how the participants manage, despite their difficulties. Conclusion: The findings describe how cognitive difficulties affect individuals with multiple sclerosis and their occupations, as well as the dissatisfaction felt with the progress in and access to cognitive treatment and research. The results indicate the need for occupation-focused interventions in cognition for people with multiple sclerosis that address daily challenges

A cluster-randomised controlled feasibility trial evaluating the Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS)

Introduction There is a high prevalence of cognitive difficulties in MS, but despite this, there are few programmes targeting cognition that focus on the ability to function well in everyday life. The Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS), an occupation-focused cognitive intervention, was developed to address this. It addresses both the functional difficulties and the wide-ranging symptoms that present in MS. Objective Here we report on the results of a cluster-randomised controlled feasibility trial (ISRCTN11462710; registered 4th September 2019) evaluating the COB-MS in terms of feasibility and initial efficacy as a cognitive intervention for people with MS. Method The eight-session COB-MS intervention was delivered remotely by occupational therapists to participants with MS in the intervention group. Following the end of the trial the COB-MS was delivered to the wait-list control group. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in the domains of cognition, quality of life, and mood. Results One hundred and eighteen people with MS and cognitive difficulties were randomised to either usual care (n = 60) or COB-MS intervention (n = 58). Ninety-four participants were retained at 6-month follow-up. The COB-MS was found to be feasible, including trial procedures and protocol. Data indicates that the COB-MS is accepted by participants and had positive impacts on daily life. Those allocated to the COB-MS group had a significant improvement in the primary outcome compared to the control condition. Progression criteria set for the feasibility trial have been met therefore further testing of the COB-MS at a definitive trial is supported by the results. Conclusion The results provide a strong basis for a pathway to a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy

A cognitive occupation-based programme for people with multiple sclerosis: a study to test feasibility and clinical outcomes

Cognitive impairments are common in MS and affect personal, social, and occupational functioning. There is a developing body of evidence highlighting the role of cognitive rehabilitation, but there is still no evidence for a validated holistic approach. The aim of this study was to assess the effectiveness of Cognitive Occupation-Based Programme for People with Multiple Sclerosis (COB-MS) for improving daily life and cognitive impairment. This study used an experimental pretest/posttest design with eight-week follow-up. Participants were recruited from MS networks using convenience sampling. The primary outcome measure was the GAS. Secondary outcomes included the OSA-DLS, CVLT-II, BVMT-R, SDMT, TMT, BRIEF-A, and EMQ-R. Twelve participants were recruited, aged 39-73 years (mean: 55.08; SD: 9.61). There were statistically significant improvements in the GAS (pThis research was supported by funding from the National University of Ireland Galway Millennium Fund 2016/2017.peer-reviewe

A cognitive occupation-based programme for people with multiple sclerosis: A new occupational therapy cognitive rehabilitation intervention

Introduction: Cognitive difficulties have been reported to have the greatest effect on function and quality of life in people with multiple sclerosis, affecting 50 60% of people. To date, few interventions have been developed to treat cognitive issues in multiple sclerosis. Here we report on a Cognitive Occupation-Based programme (COB-MS) for people with Multiple Sclerosis an evidence-based intervention to address everyday problems encountered due to cognitive difficulties. The aim of this research was to explore the views of people with multiple sclerosis and occupational therapists on the programme and its potential implementation in practice. Methods: Data were elicited from a purposive sample of 12 people from two stakeholder groups, people with multiple sclerosis (n ¼ 5) and occupational therapists (n ¼ 7), through focus groups and interviews. The programme and related materials were presented, and contributions recorded, transcribed and thematically analysed. Results: Two main themes were identified from analysis of the data: response to the intervention and challenges to implementing the programme. Occupational therapists agreed that the COB-MS is client-centred. People with multiple sclerosis thought that it was a validating intervention. The overall format was viewed to be useful and feasible. Conclusion: The COB-MS for people with Multiple Sclerosis is the first known cognitive intervention using an occupation frame of reference to address difficulties faced among persons with multiple sclerosis and was found to be timely and relevant to the needs of the population.This research is funded in part by a National MS Society Postdoctoral Fellowship Award #MB 0016 and the Occupational Science and Occupational Therapy Research Initiative Fund Seed Grant 2015.peer-reviewe

The impact of cognitive functioning on daily occupations for people with multiple sclerosis: A qualitative study

Background: Cognitive rehabilitation research in multiple sclerosis is ever-developing, but the impact of cognitive difficulties, seen in 40% to 80% of people, on daily occupations is not well known. The aim of this study is to explore the needs of people with MS who have self-reported cognitive deficits. Methods: An exploratory qualitative descriptive research design was used. Data was collected through semi-structured telephone interviews with the participants. Recordings were transcribed and analyzed thematically. Results: Seven participants were recruited (mean age 47). Three themes were developed through associations found in the data. Neglected symptom reported the participants frustrations around the importance afforded to cognition by health care providers. Impact on participation in daily occupations described the everyday impacts of cognitive difficulties. Adaptations and adjustments to continued participation reported how the participants manage, despite their difficulties. Conclusion: The findings describe how cognitive difficulties affect individuals with multiple sclerosis and their occupations, as well as the dissatisfaction felt with the progress in and access to cognitive treatment and research. The results indicate the need for occupation-focused interventions in cognition for people with multiple sclerosis that address daily challenges.peer-reviewe

Dementia service needs and recommendations for LGBTQIA+ community

Dementia service needs and recommendations for LGBTQIA+ communit

Practical tips for supporting clinicians undertaking a part-time PhD

Background: Part-time PhD students are often neglected in research and policy. Clinicians who decide to undertake a PhD usually do so on a part-time basis. It is important that supervisors are aware of the unique challenges that part-time students face. Aim: The aim is to advise supervisors on the best ways to support clinicians who are completing, undertaking, or beginning a PhD. Methods: Literature on the topic, as well as critical reflection and feedback from students was used to develop these tips. Results: Practical tips are presented here to help when supporting part-time PhD students. Conclusion: Clinicians are skilled in many areas but may require additional supports in managing time, integrating into the research environment and developing an academic identity. Supervisors have a key role in supporting their development and advocating on behalf of students when required.peer-reviewe

Advantages and disadvantages to using technology in the process of randomised controlled trial recruitment

The research aims to explore the advantages and disadvantages to using technology during the recruitment process for RCTs. Semi-structured interviews (n=7) were conducted with researchers involved in RCT recruitment in Ireland. Subsequently, a Public & Patient Involvement (PPI) panel focus group (n=3) was conducted to add further depth to these findings