Kalina J Tamar
New York University Langone Medical Center, MS Care Center, New York, NY, USA.
Int J MS Care. 2014 Fall;16(3):117-22. doi: 10.7224/1537-2073.2013-035.
Although there is substantial anecdotal evidence that clutter is common among people with multiple sclerosis (MS), the literature contains no reports of studies on the actual prevalence of the problem or its impact on functional performance in this population. Clutter promotes confusion and places individuals in potentially dangerous situations by increasing their risks of falling, losing medications, and misplacing important documents. In addition, it may negatively affect activities of daily living (ADLs). Many common MS symptoms such as decreased mobility, visual or cognitive changes, fatigue, and depression can exacerbate clutter accumulation, which in turn can have detrimental effects on physical, financial, emotional, cognitive, and social functioning. It is critical for MS clinicians to address clutter management in order to improve patients' overall functional independence and participation.
A clutter reduction protocol was developed and implemented at our institution for individuals with MS. Our group program addresses psychosocial issues preventing organization and offers practical strategies for clutter removal and management to improve performance in ADLs. A clutter questionnaire is administered to individuals before and after their participation in the group program.
Anecdotal reports indicate that the intervention helped to reduce clutter, promote a more realistic attitude toward "possessions," and establish a sense of accomplishment in controlling one's environment. Participants also reported fewer falls, feeling less isolated, increased ease in finding their medications, and a general sense of cognitive clarity in accomplishing ADLs. Outcome assessments are now being developed to objectively measure these effects as well as the prevalence of clutter within the MS population.
Clutter management is an important area for MS clinicians to address because it can significantly affect patients' functioning, safety, performance of ADLs, and quality of life.
尽管有大量传闻证据表明杂乱在多发性硬化症（MS）患者中很常见，但文献中没有关于该问题实际患病率或其对该人群功能表现影响的研究报告。杂乱会加剧混乱，并使个体面临潜在危险情况，增加他们跌倒、丢失药物和错放重要文件的风险。此外，它可能对日常生活活动（ADL）产生负面影响。许多常见的MS症状，如行动能力下降、视觉或认知变化、疲劳和抑郁，会加剧杂乱的堆积，而这反过来又会对身体、财务、情感、认知和社会功能产生不利影响。对于MS临床医生来说，解决杂乱管理问题以提高患者的整体功能独立性和参与度至关重要。
我们机构为MS患者制定并实施了一项减少杂乱的方案。我们的小组项目解决了妨碍整理的心理社会问题，并提供了去除和管理杂乱的实用策略，以提高ADL的表现。在个体参加小组项目前后，会对他们进行一份杂乱调查问卷。
传闻报告表明，该干预措施有助于减少杂乱，促进对“物品”形成更现实的态度，并在控制自身环境方面建立成就感。参与者还报告说跌倒次数减少、感觉不那么孤立、更容易找到药物，并且在完成ADL时有总体认知清晰感。目前正在开发结果评估，以客观衡量这些影响以及MS人群中杂乱的患病率。
杂乱管理是MS临床医生需要解决的一个重要领域，因为它会显著影响患者的功能、安全、ADL表现和生活质量。
