Evidence Synthesis and Tables - Mar. 27 @ 9_50 pm

docx

School

Chamberlain College of Nursing *

*We aren’t endorsed by this school

Course

711

Subject

Health Science

Date

Jun 12, 2024

Type

docx

Pages

Uploaded by geminiph

1 Evidence Synthesis and Tables Patricia Mezzina Chamberlain University NR-711 Dr. Karen Myers March 31, 2024

2 Evidence Synthesis and Tables The purpose of this paper is to provide an overview of the practice problem identified at the Multiple Sclerosis (MS) Center practicum site, along with the greater significance at the population and national level, and a synthesis of the evidence to support the proposed practice change. Results of a chart review and needs assessment at the practicum site revealed a high incidence of comorbid conditions that negatively impact overall quality of life (QOL). As much as 80 % of patients living with MS suffer from fatigue, 40-70% experience anxiety-inducing cognitive dysfunction, and 24% are diagnosed with depression which synergistically impacts overall mortality (Kern & Cepeda, 2020). Finally, obesity has been tied to the evolution and progression of MS (Schreiner & Genes, 2021). The practice gap identified was a lack of an organized process to address these comorbidities and modifiable risk factor reduction. The evidence-based intervention is a wellness program that addresses the three priority focuses identified by the National MS Society including diet, exercise, and emotional well-being (Hart et al., 2011). Significance of the practice problem According to the Global Burden of Disease study, in the United States, there was a 23.9% increase in the incidence of MS, a 60.4 % increase in prevalence, a 75 % increase in disability- adjusted life years (DALYs), and as high as an 89.4% increase in mortality from 1990 to 2017 (Feigin et al., 2021). With approximately one million people living with MS in the United States today, the total economic burden has been reported to be 85.4 billion dollars annually. With annual direct excess medical expenses being approximately 65,612 dollars and indirect costs of 22, 875 dollars

3 per patient, the biggest expenses are related to disease-modifying therapy and lost wages/productivity related to comorbidities and disability (Bebo et al., 2022). A focus on secondary and tertiary prevention though a focus on wellness may impact the economic burden, DALYs, and mortality. Evidence Synthesis The Evidence-based intervention to be implemented is an 8-week wellness program that acknowledges the bio-psycho-neuro-immunological challenges experienced by patients living with MS. In a structured format, it provides education and enrichment activities that address the priorities identified by the National MS Society, modifiable risk factors and support patients to live their most authentic experience of wellness possible at every stage of the disease course and ultimately improve overall quality of life (National MS Society, n.d.-a). Meeting in a group format once per week for the course of the program, the content will also be presented in alignment with the six dimensions of wellness identified by the National MS Society, including physical, cognitive, emotional, social, occupational, and spiritual wellness (National MS Society, n.d.-b). Main themes Qualitative data obtained from separate studies involving both healthcare providers and current MS patients reveal main themes, including that the MS population was underserved, and across the board, there was a strong recommendation for a pathway to link patients with a “living well” type of program where patients can have access to expert education on lifestyle and behavior strategies to address modifiable risk factors. Both groups also identified a need for interventions addressing diet, exercise, and stress management as a perceived need to improve

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 their QOL with a high value on mental and emotional health at the same level as physical symptoms (Donkers et al., 2019, & Faraclas et al., 2022). Contrasting main points A key contrasting main point is that studies on wellness programs addressing various key comorbidities, from interventions aimed at reducing obesity and increasing physical activity to interventions such as mindfulness training to address emotional dysregulation, to behavioral programs to address symptoms such as pain, depression, and fatigue, all the interventions resulted in positive changes in the intervention groups and improvement in the quality of life domains tested (Cozart et al., 2023, Schirda et sl., 2020, Hart et al., 2011 & Weinstein et al., 2022). A second key contrasting point is that both virtual and in-person formats of wellness- focused programs yielded positive improvements in the overall quality of life measured metrics (Cozart et al., 2023, Hart et al., 2011 & Weinstein et al., 2022). Overarching Synthesis In considering all the evidence presented here, it is clear that key stakeholders have identified a need for a process for addressing interventions to improve the quality of life for patients with MS and, a formal behavioral wellness program, virtual or in-person, that addresses one or more modifiable risk factors for comorbidities can have a positive impact to improve the lives of those suffering with this disease (Cozart et al., 2023, Donkers et al., 2019, Faraclas et al., 2022, Hart et al., 2011, Schirda et al., 2020 & Weinstein et al. 2022). Conclusion Patients with MS have a significantly higher incidence of comorbid conditions including obesity, anxiety, depression, fatigue, and cognitive dysfunction, which negatively impacts the

5 overall quality of life, morbidity, and mortality (Kern et al., 2020, & Schreiner et al., 2021). The consensus among key stakeholders is that this population is underserved in the community and there is a strong interest in access to opportunities for interventions that address priority focuses identified by the National MS Society, including increasing physical activity, nutrition, and emotional wellness (Donkers et al., 2019, & Faraclas et al., 2022). Evidence in the literature supports that the evidence-based intervention of a behavioral wellness program can improve the overall quality of life for patients living with MS (Cozart et al., 2023, Donkers et al., 2019, Faraclas et al., 2022, Hart et al., 2011, Schirda et al., 2020 & Weinstein et al. 2022).

6 References Bebo, B., Cintina, I., LaRocca, N., Ritter, L., Talente, B., Hartung, D., Ngorsuraches, S., Wallin, M., & Yang, G. (2022). The economic burden of multiple sclerosis in the United States. Neurology , 98 (18). https://doi.org/10.1212/wnl.0000000000200150 Cozart, J. S., Bruce, A. S., Befort, C., Siengsukon, C., Lynch, S. G., Punt, S., Simon, S., Shook, R. P., Huebner, J., Bradish, T., Robichaud, J., & Bruce, J. M. (2023). A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis. Preventive Medicine Reports , 36 , 102437. https://doi.org/10.1016/j.pmedr.2023.102437 Donkers, S. J., Oosman, S., Milosavljevic, S., & Musselman, K. E. (2019). Addressing physical activity behavior in multiple sclerosis management. International Journal of MS Care , 22 (4), 178–186. https://doi.org/10.7224/1537-2073.2019-029 Faraclas, E., Merlo, A., Lynn, J., & Lau, J. D. (2022). Perceived facilitators, needs, and barriers to health-related quality of life in people with multiple sclerosis: A qualitative investigation. Journal of Patient-Reported Outcomes , 6 (1). https://doi.org/10.1186/s41687-022-00496-1 Feigin, V. L., Vos, T., Alahdab, F., Amit, A. L., Bärnighausen, T., Beghi, E., Beheshti, M., Chavan, P. P., Criqui, M. H., Desai, R., Dhamminda Dharmaratne, S., Dorsey, E., Wilder Eagan, A., Elgendy, I. Y., Filip, I., Giampaoli, S., Giussani, G., Hafezi-Nejad, N., Hole, M. K.,...Murray, C. L. (2021). Burden of neurological disorders across the us from 1990- 2017. JAMA Neurology , 78 (2), 165. https://doi.org/10.1001/jamaneurol.2020.4152

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 Hart, D. L., Memoli, R. I., Mason, B., & Werneke, M. W. (2011). Developing a wellness program for people with multiple sclerosis. International Journal of MS Care , 13 (4), 154–162. https://doi.org/10.7224/1537-2073-13.4.154 Kern, D. M., & Cepeda, M. (2020). Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States. BMC Neurology , 20 (1). https://doi.org/10.1186/s12883-020-01882-2 National MS Society. (n.d.-a). Living Well with MS . Retrieved November 28, 2023, from https://www.nationalmssociety.org/Living-Well-With-MS National MS Society. (n.d.-b). Pathways to wellness in MS . Retrieved March 21, 2024, from https://www.nationalmssociety.org/Resources-Support/Library-Education-Programs/ PathwaystoWellness Reece, J. C., Yu, M., Bevens, W., Simpson-Yap, S., Jelinek, G., Jelinek, P., Davenport, R., Nag, N., Gray, K., & Neate, S. (2023). Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: The multiple sclerosis online course (msoc). BMC Neurology , 23 (1). https://doi.org/10.1186/s12883-023-03298-0 Schirda, B., Duraney, E., Lee, H., Manglani, H. R., Andridge, R. R., Plate, A., Nicholas, J. A., & Prakash, R. (2020). Mindfulness training for emotion dysregulation in multiple sclerosis: A pilot randomized controlled trial. Rehabilitation Psychology , 65 (3), 206–218. https://doi.org/10.1037/rep0000324 Schreiner, T.-G., & Genes, T.-M. (2021). Obesity and multiple sclerosis—a multifaceted association. Journal of Clinical Medicine , 10 (12), 2689. https://doi.org/10.3390/jcm10122689

8 Weinstein, S. M., Reilly, E., Garland, N., Zimmerman, V., & Jacobs, D. (2022). Impact of a virtual wellness program on quality of life measures for patients living with multiple sclerosis during the COVID-19 pandemic. International Journal of MS Care , 24 (6), 282– 286. https://doi.org/10.7224/1537-2073.2021-134

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Evidence Synthesis and Tables - Mar. 27 @ 9_50 pm

Related Documents