Multiple Sclerosis: Haselkorn JK

Haselkorn JK, Balsdon Richer C, Fry Welch D, Herndon RM, Johnson B, Little JW, Miller JR, Rosenberg JH, Seidle ME, Anonymous00236. · MS Center of Excellence West, Department of Veterans Affairs, VA Puget Sound Health Care System, USA. · J Spinal Cord Med. · Pubmed #15889701 No free full text.

This publication has no abstract.

Haselkorn JK. · No affiliation provided · J Rehabil Res Dev. · Pubmed #16847766 No free full text.

This publication has no abstract.

Hatzakis MJ, Allen C, Haselkorn M, Anderson SM, Nichol P, Lai C, Haselkorn JK. · Multiple Sclerosis Center of Excellence West, Veterans Health Administration, Seattle, WA, USA. · J Rehabil Res Dev. · Pubmed #16847767 No free full text.

Abstract: The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagner's model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses.

Haselkorn JK, Loomis S. · VA Puget Sound Health Care System, Seattle, WA, USA. · Phys Med Rehabil Clin N Am. · Pubmed #15893682 No free full text.

Abstract: Spasticity is a common impairment in MS. It can result in significant medical complications and is associated with increased disability. Treatment strategies include skilled rehabilitation strategies, neuromuscular blocks, oral agents, intrathecal management, and surgery. Rehabilitation strategies are central, whereas other strategies are added based on the level of impairment and functional loss. Treatment strategies for spasticity management are far from optimal and are complicated in MS as a result of lesions in the brain and the spinal cord. Pharmaceutical management in MS is complicated by the numerous secondary impairments in MS and its associated polypharmacy.Head-to-head studies of the various agents are rare. The studies that exist are small and do not point to any one strategy over another. Although management is difficult, it is essential for the health, functional status, and well-being of the individual who has MS. Providers must use well-developed clinical skills to arrive at optimal individualized treatment programs and monitor them frequently. For spasticity that is unresponsive, referral to a MS Center with a spasticity program is ideal.

Turner AP, Williams RM, Sloan AP, Haselkorn JK. · VA Puget Sound Health Care System, Rehabilitation Care Service, S-117-RCS, 1660 S. Columbian Way, Seattle, WA 98108, USA. · Rehabil Psychol. · Pubmed #19618711 No free full text.

Abstract: OBJECTIVE: To evaluate the contribution injection anxiety to disease modifying therapy (DMT) adherence among individuals with multiple sclerosis (MS). Injection anxiety has been associated with medication discontinuation early in the course of treatment, but little is known about the relationship between injection anxiety and sustained DMT adherence over time. METHOD: Eighty-nine outpatients receiving care at a Veterans Administration MS clinic completed a telephone survey at baseline and monthly telephone follow-up for 6 months. RESULTS: Participants were established DMT users (M = 3.43 years, SD = 3.29), with relatively high adherence overall (over 80% achieved 80% adherence or greater). Using logistic regression and controlling for demographics, MS disability, type of DMT, and time on DMT, the authors found that baseline injection anxiety predicted lower levels of adherence at 4 months and 6 months, with a similar trend at 2 months. CONCLUSION: Sustained adherence to DMT remains a challenge for a subset of individuals with MS well beyond the initial period of acclimation. Injection anxiety is an important and promising target of psychological intervention during all periods of medication use.

Turner AP, Hawkins EJ, Haselkorn JK, Kivlahan DR. · Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Services, University of Washington, Seattle, WA 98108, USA. · Arch Phys Med Rehabil. · Pubmed #19406306 No free full text.

Abstract: OBJECTIVE: To describe the prevalence of alcohol misuse and medical advice to reduce drinking in a national sample of veterans with multiple sclerosis (MS). DESIGN: Cross-sectional cohort study linking computerized medical record information to mailed survey data from 2004 through 2006. SETTING: Veterans Health Administration (VHA). PARTICIPANTS: Two thousand six hundred fifty-five of 4929 veterans with MS who received services in VHA between 2004 and 2006 and also a survey questionnaire (53.9% response rate). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic information, Short-Form 12-Item Health Survey Mental Component Summary and Physical Component Summary, Alcohol Use Disorders Identification Test Consumption questions, and questions assessing depressive symptoms and the receipt of alcohol-related advice from a medical professional. RESULTS: Among all survey respondents with MS, the prevalence of alcohol misuse for the sample was 13.9% (confidence interval [CI], 12.5-15.2), with 11.9% (CI, 10.6-13.2) and 2.0% (CI, 1.4-2.5) of participants scoring in the mild/moderate and severe range of alcohol misuse, respectively. In contrast to community samples there was no difference in prevalence by sex. In multivariate logistic regression, age younger than 60 years (<50y; adjusted odds ratio [AOR]=1.66; CI, 1.17-2.37, and 50-59; AOR=1.64; CI, 1.19-2.27), employment (AOR=1.54; CI, 1.06-2.24) and better physical health (AOR=1.02; CI, 1.01-1.04) were associated with a higher likelihood of alcohol misuse. Among persons who screened positive for alcohol misuse, only 26.2% (CI, 21.5-30.9) reported they had received advice from a medical provider in the past year to decrease or abstain from drinking. Self-report of advice was more likely among those endorsing severe misuse (AOR=3.65; CI, 1.85-7.17) and less likely among those with better mental health (AOR=0.97; CI, 0.94-1.00). CONCLUSIONS: Despite the numerous health and social consequences of alcohol misuse, routine screening and intervention for people with MS remain uncommon. Brief screening and advice to reduce or refrain from alcohol use can be accomplished in as little as 5 minutes and can be incorporated into the regular course of medical care.

Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. · Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA. · Arch Phys Med Rehabil. · Pubmed #19345781 No free full text.

Abstract: OBJECTIVE: To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables. DESIGN: Cross-sectional cohort study linking computerized medical record information to mailed survey data. SETTING: Veterans Health Administration (VHA). PARTICIPANTS: Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Items assessing pain intensity, pain interference, and physical and mental health functioning. RESULTS: Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (beta=.73), physical health functioning (beta=-.07), and mental health functioning (beta=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (beta=-.03). CONCLUSIONS: Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization.

Turner AP, Kivlahan DR, Haselkorn JK. · Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Services, University of Washington, Seattle, WA 98108, USA. · Arch Phys Med Rehabil. · Pubmed #19254606 No free full text.

Abstract: OBJECTIVE: To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. DESIGN: Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999. SETTING: Veterans Health Administration. PARTICIPANTS: Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency. RESULTS: Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties). CONCLUSIONS: Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.

Khurana SR, Bamer AM, Turner AP, Wadhwani RV, Bowen JD, Leipertz SL, Haselkorn JK. · Department of Rehabilitation Medicine, University of Miami, Coral Gables, Florida, USA. · Am J Phys Med Rehabil. · Pubmed #19169174 No free full text.

Abstract: OBJECTIVES: To estimate the prevalence and factors associated with overweight and obesity in veterans with multiple sclerosis (MS) enrolled in the Veterans Health Administration (VA) and to compare the prevalence in this group with gender-specific published rates for the general population of veterans receiving outpatient care at VA medical facilities. DESIGN: Cross-sectional cohort study linking electronic medical record information to mailed survey from 1999 to 2004. A total of 4703 veterans with MS enrolled in VA who returned questionnaires as part of two cross-sectional studies. Main outcome measures included body mass index, demographic information, Veteran RAND 36-item Health Survey, frequency of physical exercise, and other health conditions. RESULTS: Overall, 28% of female and 42.8% of male veterans with MS were overweight. Another 25% of women and 21.2% of male veterans met the criteria for obesity. Compared with a historical cohort of veterans enrolled in the VA, veterans with MS had a slightly higher adjusted prevalence of overweight than did veterans in general (42.3% vs. 39.6%, respectively) but a lower adjusted prevalence of obesity (20.1% vs. 33.1%). In adjusted logistic regression, age, smoking, and lower levels of pain were associated with a lower likelihood of overweight or obesity. Being male, married, employed and having arthritis and diabetes were associated with a greater likelihood of overweight or obesity. CONCLUSIONS: Overweight and obesity are a problem for more than 60% of veterans with MS in the VA. Screening for overweight and obesity should be done routinely. Interventions to prevent and manage excessive weight in individuals with MS should be developed and evaluated.

Turner AP, Kivlahan DR, Sloan AP, Haselkorn JK. · VA Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA 98108, USA. · Mult Scler. · Pubmed #17967842 No free full text.

Abstract: OBJECTIVE: To evaluate ongoing adherence to disease modifying therapies (DMT) among individuals with multiple sclerosis and test the utility of the Health Beliefs Model (HBM) to predict adherence. DESIGN: Telephone survey completed at baseline with monthly telephone follow-up for 6 months. SETTING: Veterans Health Administration. PARTICIPANTS: Eighty-nine veterans with MS actively enrolled in a regional VA MS outpatient clinic currently prescribed DMT. MEASURES: Demographic information. Selected items from the Adherence Determinants Questionnaire (ADQ) and Barriers to Care Scale (BACS). RESULTS: Adherence in this population of ongoing DMT users was relatively high (over 80% achieved 80% adherence at follow-up time points). Logistic regression and hierarchical multiple regression analyses controlling for demographics and disease duration were employed to examine the relationship of HBM constructs of perceived susceptibility, severity, benefits, and barriers to DMT adherence and satisfaction at 2-, 4- and 6-month follow-up. Of the four HBM constructs, only perceived benefits uniquely predicted both outcomes across multiple time points. CONCLUSION: Sustained adherence to DMT remains a challenge for an important minority of individuals with MS. The Health Beliefs Model provides insight into psychosocial mechanisms that maintain adherence behavior. In particular, focus upon the perceived benefits of ongoing DMT therapy may be a promising focus for future interventions.

Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. · VA Puget Sound Health Care System, Seattle, WA, USA. · Arch Phys Med Rehabil. · Pubmed #17964878 No free full text.

Abstract: OBJECTIVE: To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS). DESIGN: Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999. SETTING: Veterans Health Administration (VHA). PARTICIPANTS: Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Items assessing smoking, quit attempts, and unmet need for smoking services. RESULTS: Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity. CONCLUSIONS: Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.

Turner AP, Williams RM, Bowen JD, Kivlahan DR, Haselkorn JK. · VA Puget Sound Health Care System, Seattle, WA 98108, USA. · Arch Phys Med Rehabil. · Pubmed #16876552 No free full text.

Abstract: OBJECTIVE: To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN: Cohort study linking computerized medical records with a mailed self-report survey. SETTING: Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS: VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS: One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS: Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.

Campbell DG, Turner AP, Williams RM, Hatzakis M, Bowen JD, Rodriquez A, Haselkorn JK. · Department of Veterans Affairs (VA) Puget Sound Health Care System (PSHCS), Health Services Research and Development Service, Seattle, WA 98108, USA. · J Rehabil Res Dev. · Pubmed #16847776 No free full text.

Abstract: The present study explored complementary and alternative medicine (CAM) use in veterans with multiple sclerosis (MS). We administered self-report questionnaires to 451 veterans who received healthcare from Veterans Health Administration facilities. CAM use among veterans with MS was widespread; 37% of respondents reported current or past use. Roughly 33% of CAM users reported using multiple interventions, and 40% of respondents desired interventions that they were not already using. Logistic regression suggested that CAM use was more likely among participants with graduate-level education, poor self-reported health over the past year, and a progressive relapsing MS subtype. Participants who used traditional medical services were also more likely to use CAM, which suggests that CAM services are used in addition to, as opposed to in place of, traditional services. As others have proposed, these results suggest that care providers who work with persons with MS would be well served to understand, routinely screen for, and make use of CAM when appropriate.

Turner AP, Martin C, Williams RM, Goudreau K, Bowen JD, Hatzakis M, Whitham RH, Bourdette DN, Walker L, Haselkorn JK. · Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA. · J Rehabil Res Dev. · Pubmed #16847769 No free full text.

Abstract: Our objective was to survey experienced multiple sclerosis (MS) care providers, determine their ongoing professional educational needs, and develop future education programs. We asked providers across a variety of disciplines to identify the areas in which clinical consultation and continuing medical education (CME) would most improve their ability to provide care to individuals with MS; their preferred education modalities; and their confidence in providing care related to disease-modifying agents (DMAs), fatigue, depression, spasticity, and bladder management. At a national meeting of MS professionals, 152 MS care providers completed a self-report survey that was designed for this cross-sectional cohort study. Areas of greatest interest for clinical consultation and CME were identical and included cognition, fatigue, DMA use, spasticity, pain, sex, diagnosis of MS, and depression. Participants expressed a preference for live and interactive CME modalities. Confidence in providing specific disease-related care sometimes differed between Veterans Health Administration (VHA) and non-VHA providers. The results indicate that clinical consultations and CME should be targeted to the topics of greatest interest identified by providers and delivered in a live or interactive modality whenever possible.

Hatzakis M, Turner AP, Williams RM, Bowen JD, Rodriquez AA, Haselkorn JK. · Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA 98108, USA. · Arch Phys Med Rehabil. · Pubmed #16003667 No free full text.

Abstract: OBJECTIVE: To determine predictors of fatigue-modifying medication use. DESIGN: Cross-sectional cohort. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: Veterans with multiple sclerosis (MS) in the VHA in the northwestern United States from 1995 to 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A self-administered survey distributed by mail sought information from veterans with MS about demographics, symptoms, barriers to care, and disease characteristics. The variables were compared with prescriptions for fatigue-modifying medications during the study period. RESULTS: Of 1032 patients, 451 (44%) completed the survey, and 306 (68%) reported moderate or high fatigue levels. Only 40% of the 306 were prescribed fatigue-modifying medications. Those using specialized fatigue services or who received care at tertiary centers were more likely to receive fatigue treatments. Patient-perceived barriers to accessing care and other patient characteristics were not associated with prescription rates. CONCLUSIONS: Fatigue is undertreated among veterans with MS. However, there is considerable variability in the provision of fatigue care. Interventions to improve the quality and uniformity of fatigue care are warranted.

Williams RM, Turner AP, Hatzakis M, Bowen JD, Rodriquez AA, Haselkorn JK. · Department of Veterans Administration Puget Sound Health Care System, Seattle Division, Rehabilitation Care Services, S-117, 1660 S. Columbian Way, Seattle, WA 98108, USA. · Neurology. · Pubmed #15642907 No free full text.

Abstract: OBJECTIVES: To establish the prevalence of major depressive episode (MDE) in a large sample of veterans with multiple sclerosis (MS); to identify demographic characteristics, aspects of disease presentation, and perceptions of disability associated with greater concurrent risk for MDE; and to examine the relationship between MDE, service utilization, and activity participation. METHODS: Veterans with MS (n = 1,032) were identified via computer database and surveyed by mail; 451 (43.7%) responded. RESULTS: Twenty-two percent of the sample met criteria for current MDE. Low income, unemployment, presence of falls, younger age, absence of a marital partner, and high levels of perceived disability due to bowel functioning were independently associated with MDE. Disease subtype, disease duration, use of disease modifying therapies, and perceived disability due to mobility or bladder problems were unrelated to MDE. Current MDE was in turn associated with increased primary care visits and increased impact of disease upon activity participation. Similar correlates were associated with minor depressive episode. CONCLUSIONS: Unlike the general population, rates of depression in this predominantly male sample were similar to those found in predominantly female samples of persons with multiple sclerosis. Specific aspects of disability were differentially associated with depression, and depression was independently associated with increased service utilization and increased participation limitations.