The publication of this issue of the International Journal of MS Care coincides with the Consortium of Multiple Sclerosis Centers' annual meeting, where delegates from various parts of the world gather to share their knowledge on the comprehensive care of MS. Despite significant variations in the epidemiology of the disease, cultural and psychosocial factors, and health-care systems, the symptoms of MS—and the challenges faced by affected individuals—are very similar around the globe. Have you ever wondered how “international” the IJMSC truly is? In 2014, manuscript submissions were received from 26 countries covering 6 continents. Concomitant with a rise in the number of submissions has been a shift in the geographic distribution of scientific contributions, with an increasing proportion of manuscripts originating from outside of North America. This issue, which includes articles from Norway, Germany, Australia, and the United States, illustrates our international scope.
Two articles emphasize how qualitative information sought directly from patients can inform our daily practice. While access to rehabilitation services is often found to be limited by lack of availability and financial barriers, Helland and colleagues point out that, even when rehabilitation is widely available and offered at low or no out-of-pocket cost, patients do not always take advantage of these interventions. Through focus group discussions, the authors identified a variety of barriers and facilitators, mainly demonstrating a need for better communication between health-care providers and patients.
Individuals with MS are strongly encouraged to maintain or enhance their physical activity, but there are few studies of physical activity and exercise in patients who rely primarily on a wheelchair for their mobility. Learmonth and colleagues interviewed a sample of 15 wheelchair users with MS, of whom 11 exercised at least once per week. Along with the barriers and opportunities identified by the patients, the role of health-care providers was again highlighted.
High-quality evidence from multicenter randomized clinical trials (RCTs) is often lacking for symptomatic medications in MS. Dalfampridine was previously shown, in two phase 3 RCTs, to improve walking in MS patients at the dose of 10 mg twice daily, based on improved performance on the Timed 25-Foot Walk, a short walking test at fast speed. Yapundich and colleagues present the results of a new RCT demonstrating that dalfampridine also improved performance on the 6-Minute Walk test, a walking endurance test, and that a lower dose was not effective.
Scientific evidence should also guide the use of nonpharmacologic interventions in the management of MS symptoms. Mackay and colleagues report that adding biofeedback (based on breathing and muscle tension) to relaxation and mindfulness helped further alleviate anxiety, fatigue, and stress. The pilot study by Pöttgen and colleagues shows enhanced self-efficacy, fatigue, and mood following a cognitive-behavioral group intervention based on the concept of metacognition.
Developing effective strategies for improving function in individuals with MS requires knowledge of the relationship between neurologic impairment and functional status. For example, instrumented measurement of postural sway can help elucidate the pathophysiology of balance impairment, a common consequence of MS and predictor of falling. McLoughlin and colleagues found that postural sway is increased in MS patients compared to healthy controls, and that increased sway is associated with higher disability scores and with cerebellar and sensory dysfunction, but not with strength or spasticity.
Members of the editorial team and editorial board of the IJMSC are attending the CMSC annual meeting, and will be happy to answer any questions and hear any comments or suggestions regarding the journal. Remember to visit our booth in the exhibit hall. We also encourage you to attend the Writing for Publication course on Wednesday, May 27. Finally, please note that the winner of the Robert M. Herndon Award for the best article published in the IJMSC in 2014 will be announced at the end of the meeting.
I wish you a pleasant summer—or winter, if you are reading this from the other side of the equator.