1. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis.
- Author
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Solari A, Giordano A, Patti F, Grasso MG, Confalonieri P, Palmisano L, Ponzio M, Borreani C, Rosato R, Veronese S, Zaratin P, and Battaglia MA
- Subjects
- Activities of Daily Living, Aftercare, Aged, Caregivers, Disease Progression, Female, Homebound Persons, Humans, Italy, Male, Middle Aged, Multiple Sclerosis mortality, Multivariate Analysis, Quality of Life, Severity of Illness Index, Treatment Outcome, Home Care Services, Multiple Sclerosis pathology, Multiple Sclerosis therapy, Palliative Care methods
- 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.
- Published
- 2018
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