Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.
EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada.
BMC Neurol. 2022 Jul 25;22(1):275. doi: 10.1186/s12883-022-02809-9.
Care for People with Multiple Sclerosis (PwMS) is increasingly complex, requiring innovations in care. Canada has high rates of MS; it is challenging for general neurologists to optimally care for PwMS with busy office practices. The aim of this study was to evaluate the effects of add-on Nurse Practitioner (NP)-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS), compared to usual care (community neurologist, family physician).
PwMS followed by community neurologists were randomized to add-on NP-led or Usual care for 6 months. Primary outcome was the change in HADS at 3 months. Secondary outcomes were HADS (6 months), EQ5D, MSIF, CAREQOL-MS, at 3 and 6 months, and Consultant Satisfaction Survey (6 months).
We recruited 248 participants; 228 completed the trial (NP-led care arm n = 120, Usual care arm n = 108). There were no significant baseline differences between groups. Study subjects were highly educated (71.05%), working full-time (41.23%), living independently (68.86%), with mean age of 47.32 (11.09), mean EDSS 2.53 (SD 2.06), mean duration since MS diagnosis 12.18 years (SD 8.82) and 85% had relapsing remitting MS. Mean change in HADS depression (3 months) was: -0.41 (SD 2.81) NP-led care group vs 1.11 (2.98) Usual care group p = 0.001, sustained at 6 months; for anxiety, - 0.32 (2.73) NP-led care group vs 0.42 (2.82) Usual care group, p = 0.059. Other secondary outcomes were not significantly different. There was no difference in satisfaction of care in the NP-led care arm (63.83 (5.63)) vs Usual care (62.82 (5.45)), p = 0.194).
Add-on NP-led care improved depression compared to usual neurologist care and 3 and 6 months in PwMS, and there was no difference in satisfaction with care. Further research is needed to explore how NPs could enrich care provided for PwMS in healthcare settings.
Retrospectively registered on clinicaltrials.gov ( ClinicalTrials.gov Identifier: NCT04388592 , 14/05/2020).
多发性硬化症（MS）患者的护理日益复杂，需要创新护理。加拿大 MS 发病率较高，普通神经科医生在忙碌的诊所实践中难以优化 MS 患者的护理。本研究旨在评估对 MS 患者进行附加护士从业者（NP）主导护理与常规护理（社区神经科医生、家庭医生）相比，对抑郁和焦虑（医院焦虑和抑郁量表，HADS）的影响。
由社区神经科医生随访的 MS 患者被随机分配至附加 NP 主导护理或常规护理，为期 6 个月。主要结局为 3 个月时 HADS 的变化。次要结局为 3 和 6 个月时的 HADS、EQ5D、MSIF、CAREQOL-MS 和 6 个月时的顾问满意度调查。
我们招募了 248 名参与者；228 名完成了试验（NP 主导护理组 n=120，常规护理组 n=108）。两组在基线时无显著差异。研究对象受教育程度较高（71.05%），全职工作（41.23%），独立生活（68.86%），平均年龄为 47.32（11.09），平均 EDSS 为 2.53（SD 2.06），平均 MS 诊断后时间为 12.18 年（SD 8.82），85%为复发缓解型 MS。HADS 抑郁（3 个月）的平均变化：NP 主导护理组为-0.41（SD 2.81），常规护理组为 1.11（2.98），p=0.001，持续至 6 个月；焦虑方面，NP 主导护理组为-0.32（SD 2.73），常规护理组为 0.42（SD 2.82），p=0.059。其他次要结局无显著差异。NP 主导护理组的护理满意度（63.83（5.63））与常规护理组（62.82（5.45））无差异，p=0.194）。
与常规神经科医生护理相比，附加 NP 主导护理改善了 MS 患者的抑郁症状，且在 3 个月和 6 个月时的抑郁症状均得到改善，并且在护理满意度方面没有差异。需要进一步研究探索如何在医疗保健环境中让 NPs 为 MS 患者提供更丰富的护理。
在 clinicaltrials.gov 上进行回顾性注册（ClinicalTrials.gov 标识符：NCT04388592，2020 年 5 月 14 日）。
