The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study.

INTRODUCTION: Electrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries. METHODS: Data from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables. RESULTS: A total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p<0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p<0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p=0.002). There were no significant differences in SWLS and SF-12 MCS between groups. CONCLUSIONS: Adult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population.

Prevalence of sleep problems in individuals with multiple sclerosis.

BACKGROUND: Sleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact. OBJECTIVE: To estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis. METHODS: A cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure. RESULTS: The prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men. CONCLUSION: Sleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.

Setting the agenda for multiple sclerosis rehabilitation research.

BACKGROUND: Recognizing the need for more evidence-based multiple sclerosis (MS) rehabilitation, in the mid-2000s several initiatives were undertaken to explore why there had been a paucity of such research and to determine strategies to reverse this pattern. EXPERT-OPINION-PAPER: In 2004 the National Multiple Sclerosis Society (NMSS) convened an expert opinion panel, reviewed evidence-based MS rehabilitation research, and published the paper on the web. It was concluded that much of the MS rehabilitation carried out was based on experience, with little research backing it up. INCREASING THE QUALITY AND QUANTITY OF MS REHABILITATION RESEARCH: Largely as a result of the conclusions of the Expert-Opinion-Paper, the NMSS convened a conference of a large number of MS and rehabilitation experts in New York in May, 2005. This conference made many recommendations of ways to increase the quantity and quality of MS research. STATE OF THE SCIENCE CONFERENCE: In September, 2006, a follow-up conference was held in Washington, D.C... This conference, primarily sponsored by the University of Washington Multiple Sclerosis Rehabilitation Research and Training Center (MS RRTC), focused on some of the under-studied "hidden" disabilities present in persons with MS. This paper discusses the details and recommendations of these latter two conferences.

Comparing a self report questionnaire with physician assessment for determining multiple sclerosis clinical disease course: a validation study.

Determining multiple sclerosis (MS) clinical course is important in research and clinical practice. However, many patients do not know their clinical course, limiting the option to use self-report in research studies including surveys. In order to address this, we developed a self-report item to be used in self-administered mailed surveys displaying graphically the courses of MS. The validity of this item was then evaluated by comparing physician-assessed disease clinical course to patient response on the self-report item on 94 of 99 consecutive patients seen in an MS specialty clinic. Kappa statistics were calculated comparing self-assessed versus physician-assessed MS clinical course for the four common MS clinical courses (kappa=0.45) and for relapsing remitting versus other courses (kappa=0.62) indicating substantial agreement. Subsequent administration of the item by mail to 1371 individuals with MS in Washington and Montana determined that while most individuals responded as intended to the item, persons with less than a high school education (P=0.009) or over the age of 60 ( P = 0.002) were significantly more likely to leave the item blank. It appears that this item may be used to obtain a rough estimate of MS clinical course in research using self-report surveys where physician assessments are impractical.