[Survey validity of translation for Persian and cultural adaptation of Fatigue Impact Scale [FIS] questionnaire in multiple sclerosis patients in Iran]

Fatigue is one of the most common problem of multiple sclerosis. It is a sign of inefficiency in the physical, social, and cognitive function. It is a major factor in limiting the responsibilities of social work of patients. The aim of this study was to translate and culturally adapt the Fatigue Impact Scale [FIS] in Iranian and create an appropriate tool for measuring the impact of fatigue and effectiveness of treatment and also rehabilitation interventions on fatigue in Iranian patients. In order to use the FIS in Iranian patients, the forward and backward translation and assessing the patient's perspective was done and the Persian version of the questionnaire was prepared. The questionnaire was completed by twenty patients with multiple sclerosis. The time duration of filling out of each questionnaire took ten to twenty minutes .The final corrections was carried out. All questions of patients was acceptable and understandable and questions of "sexual activity" was completed only by married patients. The question of "financial support" was completed only by employed person [working people]. Finally, as much as possible, this questionnaire was adapted with Iranian culture and sentences were confirmed by MAPI Institute. Persian version of the FIS is an appropriate tool for measuring the impact of fatigue, effectiveness of treatment and rehabilitation interventions on fatigue in patients with multiple sclerosis

[Effect of applying progressive muscle relaxation technique on fatigue in multiple sclerosis patients]

Fatigue is the most frequent and disabling symptom in 92% of multiple sclerosis [MS] patients. Fatigue interferes with daily functioning and prevents sustained physical exertion, limits work and social role performance, and is related to lower quality of their life. Complementary therapies are widely used in treatment of people with MS and Progressive Muscle Relaxation Technique [PMRT] is a form of complementary therapies. The aim of this study was to assess the effects of applying PMRT on fatigue in MS patients. In this Quasi-experimental study, a total of 66 MS patients were selected with convenient sampling according to specific criteria and then were divided randomly into two groups of experimental and control [33 patients in each group]. PMR performed for 63 sessions on experimental group during two months but no intervention was done for control group. Data were collected using demographic questionnaire, Fatigue Severity Scale [FSS], and Self report checklists. Statistical analysis was done by SPSS software and use of paired-t test, student-t test, analysis of variance [ANOVA] and correlation between variables. Student t-test showed that there was no significant difference between two groups in mean scores of fatigue before the study but this test showed significant difference between the two groups, one month [4.69 +/- 1.03 and 5.43 +/- 0.96, P<0.01] and two months [4.09 +/- 1.06 and 5.43 +/- 1.08, P<0.001] after intervention, respectively. ANOVA test with repeated measurements showed that there is a significant difference in mean score fatigue between two groups in 3 times [P<0.01]. The results of this study showed that PMR is practically feasible and could decrease fatigue of MS patients, so that applying this technique offered to these patients

[ effect of Orem based self-care program on physical quality of life in multiple sclerosis patients]

Multiple sclerosis is a chronic, progressive and degenerative myelin sheath of the central nervous system. Which significantly affects quality of life? The aim of this study was to assess the effect of Orem based self-care program on physical quality of life in multiple sclerosis. In this clinical trial a total of 70 patients with multiple sclerosis with age range 20-40 years, [members of multiple sclerosis association] were randomly divided into two groups of experimental and control [35 patients in each group]. The experimental group was treated with self-care program based on Orem self-care frame work compared to the control group. Data were analyzed using x[2], t, and paired t tests. There was no significant difference in the cases of quality of life and demographic characteristics of patients in the control and test groups, before intervention. The mean score of life quality, after intervention, in the test group [66.5 +/- 41.8] was more than that [43.24 +/- 12.79] in the control group [P<0.001]. In the test group and after the intervention, life quality was significantly increased [P<0.001], but no significant difference was seen in the control groups. Drawing and utilizing self care program base on the Orem frame work on physical quality of life in the multiple sclerosis patients would be beneficial. This is a non-invasive intervention and is safe, inexpensive and is complementary to medical intervention that can be used in the multiple sclerosis centers

[Fatigue in multiple sclerosis: a study of fatigue and some factors influencing it in Iran]

Fatigue is one of the most common and important disabling symptoms in multiple sclerosis [MS] patients. Fatigue in patients could be due to neuroimmunology, disability secondary to the disease process, muscular fatigue due to spasticity, drugs and problems such as depression and sleep disorders. In order to evaluate the prevalence and degree of fatigue severity in MS patients and to determine some influencing factors, we studied sixty patients with definite MS in Iran and assessed fatigue [According to FSS score] and also some factors such as depression [According to BDI score], disability status [according to EDSS score] in them. In our 60 patients the range of age was 20-24 years. 73% of the patients were female. In 70% of the patients clinical course of MS was compatible with Relapsing-Remitting type and in 30% secondary progressive form. The prevalence of fatigue [According to FSS] was very high; exactly 100% but only 10% of the patients had self-complaint of fatigue. There are some correlations between fatigue and presence of disability [according to EDSS], depression and age of the patients. Fatigue was more frequent in Secondary Progressive form of MS. We didn't find any correlations between fatigue and sex, duration of the disease, the rate of attacks during the first year of the disease, using MS-specific drugs and fatigue modifying drugs in the patients. It seems that fatigue is more frequent in MS Iranian patients than it has been thought. The correlation between fatigue and depression and degree of disability in patients should alert physicians in considering proper treatment of depression and prevent the progression of MS in the patients as much as possible

[Clinical course and prognosis of 203 patients with MS in Shahid Mostafa Khomeini Hospital, Tehran 2002]

Multiples sclerosis is a common demyelinating disease of CNS and the main cause of disability in young adults all over the world so any research in different aspects of the disease has great value. researches in Iran are few in quantity and low in sample size. To determine clinical course and prognosis of the disease in Iranian MS patients we have studied these items in a considerable sample size. Two hundred and three definite MS patients [according to MC'donalds 2001 criteria] included in this study and a planned questionnaire completed by visiting the patients or by degree of disability estimated according to EDSS [Expanded Disability Status Scale] score system. The results analyzed with SPSS software. Mean age of the patients was 35. All required examinations have been done by a neurologist and 60.6 percent were female. Mean duration of disease was 8.3 years. the main form of onset of symptoms was sensorimotor [mixed]. Mean Attack rate was 5.5 times during the disease duration. Clinical course in 72.4 percent was relapsing-remitting type. Mean disability scale number according to EDSS was 5.2. Death rate was two percent. 69.3 percent of patients were able to work in the society. The degree of disability increased with increasing age, in lower educational state, in longer duration of the disease and in male gender. The results of clinical course and type of MS, mean of disease duration from the onset and mean EDSS are compatible and comparable with similar studies in other countries though some results are different. For future large sample, multicenter studies recommended

investigation of human apolipoprotein e polymorphisms in multiple sclerosis patients of Iran

Multiple sclerosis [MS] is a chronic inflammatory disorder of the central nervous system, with a complex etiology that includes a strong genetic component. The chromosome 19q13 region surrounding the apolipoprotein E [APOE] gene has shown consistent evidence of involvement in MS. In a cross-sectional study, to show the APOE genotype and allele frequency in the MS population of Iran in comparison with the control group, we genotyped its polymorphisms [sigma 2, sigma 3 and sigma 4 alleles]. The authors investigated 81 patients with clinically definite MS and 93 asymptomatic elderly volunteers. The frequency of the APOE allele in the MS population in comparison with controls was 9.3% vs. 0.5% for sigma 4, 44.4% vs. 51.6% for sigma 3, and 46.3% vs. 47.8% for sigma 2. The highest frequency of APOE genotype was from sigma 2/sigma 3 with 66.7% vs. 94.6% and the lowest, sigma 4/sigma 4 genotype with 2.5% vs. 0%. The authors found significant differences in the distribution of 84 allele between patients with MS and controls [9.3% vs. 0.5%; X[2]=15.2;df=2; p<0.001]. The highest frequency of sigma 4 allele in MS patients was in Pure Turkish [25.0% vs. 5.3%] ethnicity. There was no significant relation between ethnicity and genotype. In the present study sigma 2/sigma 4, sigma 3/sigma 4 and sigma 4/sigma 4 genotypes were more common in bout-onset cases compared to primary progressive cases, and the secondary progressive disease was higher in carriers of sigma 4 allele. Also, the sigma 2 allele was higher in relapsing remitting disease

clinical survey in determination of common side effects of AVONEX [b if 1a] therapy in 50 Iranian MS patients

To determine common systemic, local and laboratory side effects of Avonex therapy in Iranian multiple sclerosis patients. 50 confirmed MS patients [according to McDonald 2001criteria] treated with 30mcg weekly bifia, Avonex, were studied and questioned for presence of common known adverse effects of the drug and probable depression induced or aggravated by it. The study was following up regularly at the onset of Avonex therapy and afterl,3 and 6 months. At the end of 6 months follow up study the data was analyzed. 70% of the patients were between 20 to 30 years. 78% were female. The patients had a duration of MS of 0-12 years. The most common side effects were systemic type out of which flu like syndrome was predominant [90%]. Local [injection site] side effects were seen in 42% and anemia was seen in 8% as a predominant laboratory side effect. Reduction of the frequency of all of the side effects except local one was seen in the follow up duration. No correlations were found between side effects and sex and age of the patients. Avonex therapy had no effect in inducing induction or aggravating depression in our patients. Discontinuation of Avonex therapy was not seen among these patients because of the side effects. It seems that Avonex therapy in Iranian MS patients has more and relatively prolonged adverse effects but mainly these side effects fade away with continuation of therapy. The side effects do not lead to discontinuation of therapy. In spite of frequent complaints of the patients, all of the adverse effects are well tolerated