Biomedical subjects

L Coulthard-Morris

Publications and source records attributed to L Coulthard-Morris.

4 recordsLinked to original sources

PubMed1997

The quality-of-life effects of interferon beta-1b in multiple sclerosis. An extended Q-TWiST analysis.

BACKGROUND: A recombinant form of interferon beta-1b (Betaseron) was given Food and Drug Administration approval for use in the treatment of relapsing-remitting multiple sclerosis in 1993 based on a documented reduction in exacerbation rate. However, its effect on disease progression is less clear. It costs $11,000 per year and has documented adverse effects such as fatigue, feverlike symptoms, and depression. OBJECTIVES: To evaluate a recombinant form of interferon beta-1b in the treatment of relapsing-remitting multiple sclerosis and to discuss treatment trade-offs and comprehensive quality-of-life (QOL) outcomes. METHODS: We present a randomized evaluation of treatment with a recombinant form of interferon beta-1b in 79 patients with multiple sclerosis who participated in a random allocation lottery and were followed up for 12 months, during which data on QOL and clinical outcomes were collected. The data were analyzed using the Extended Quality-Adjusted Time Without Symptoms and Toxicity (Q-TWiST) method, which evaluates treatment trade-offs by incorporating several QOL domains and patient preferences regarding these domains. RESULTS: Over the 12 months of follow-up, the case patients reported 10.6 months of quality-adjusted time, while the control patients reported 10.4 months of quality-adjusted time (P = .50). CONCLUSIONS: Thus, the first year of treatment with interferon beta-1b did not significantly improve or detract from QOL. Results are discussed in terms of acceptable trade-offs depending on the nature of therapy. Future observational and clinical studies should incorporate measures of patient preference.

Adjuvants, Immunologic↗

PubMed1996

Measuring self-efficacy in people with multiple sclerosis: a validation study.

OBJECTIVE: To assess the psychometric properties of a measure of self-efficacy in people with multiple sclerosis (MS). DESIGN: Cross-sectional study by mail with retest. SETTING: MS Clinic registry of a large Boston teaching hospital . PATIENTS: 141 MS patients representing a broad range of disability. MAIN OUTCOME MEASURES: The MS Self-Efficacy Scale (MSSE), the Expanded Disability Status Scale, the Sickness Impact Profile, and the mastery subscale of the Ryff Happiness Scale. RESULTS: The MSSE has high internal consistency and test-retest reliability, both for the overall scale and for the SE Function and SE Control subscales. Results of convergent and divergent validity analyses suggest that the scale is both sensitive and specific. CONCLUSIONS: We conclude that MSSE is appropriate for assessing self-efficacy in the MS population.

Adult↗

PubMed1996

Psychosocial correlates of fatigue in multiple sclerosis.

OBJECTIVE: To explore: (1) the interrelation among the neuropsychological, psychological, and psychosocial factors and fatigue as measured by the Multidimensional Assessment of Fatigue scale, and (2) the impact of fatigue on role performance. DESIGN: Clinical interview with neuropsychological testing and cross-sectional study by mail. SETTING: Multiple sclerosis (MS) clinic registry of a large Boston teaching hospital. PATIENTS: 139 MS patients representing a broad range of disability. MAIN OUTCOME MEASURES: The Multidimensional Assessment of Fatigue (MAF) scale, the Extended Disability Status Scale, the Sickness Impact Profile, Rao cognitive battery, the Trailmaking Test, depression, anxiety, and social activity limitations subscales from the Arthritis Impact Measurement Scales, and the Ryff Happiness Scale. RESULTS: Stepwise multiple regression analyses revealed that having a low sense of environmental mastery was the best psychosocial predictor of both global fatigue and fatigue-related distress, after adjusting for sociodemographic and medical factors. Further, people who reported being more depressed tended to report more severe fatigue. Neuropsychological performance was not associated with fatigue. Fatigue was found to limit social, work, and overall role performance, but not physical role performance. CONCLUSIONS: People who feel that they can choose or create environments suitable to their psychic or physical conditions report less global fatigue and less fatigue-related distress, and fatigue can have an important impact on role performance. The implications of these findings for designing fatigue management interventions are discussed.

Activities of Daily Living↗

PubMed1985

Effectiveness of hypnosis as an adjunct to behavioral weight management.

This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.

Adolescent↗