Adding Nursing Care in MS May Ease Patient Depression, Anxiety

Nurse practitioner care helped meet patients' needs sooner, study found

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Adding a specialized nurse practitioner (NP) to a neurologist-based standard care team was found to significantly lessen depression and anxiety in patients with multiple sclerosis (MS), according to data from a six-month study in Canada.

People with multiple sclerosis — dubbed “PwMS” by researchers — who received the add-on nursing intervention were equally satisfied with their care as those receiving standard treatment alone.

But according to researchers, the addition of NP-led disease management may enable patients’ needs to be better and sooner met, while easing the burden on neurologists with very busy practices.

“This study suggests that NPs could address many of the unmet needs identified by PwMS: improved education, coping strategies, more timely and effective interventions, urgent relapse management, in addition to helping PwMS optimize their functioning,” the researchers wrote.

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The study, “The effect of nurse practitioner (NP-led) care on health-related quality of life in people with multiple sclerosis — a randomized trial,” was published in BMC Neurology

Due to the complex nature of MS, many patients require decades of individualized and ongoing care to manage their disease. Such care is usually provided to multiple sclerosis patients by a multidisciplinary team of healthcare professionals, including neurologists, physical therapists, and nursing staff.

With MS rates on the rise, neurologist practices are increasingly busy. This can lead to significant delays in patient access to a neurologist, posing a barrier to optimal care for these patients. This issue may be particularly pertinent in Canada, a country with one of the highest incidence rates of MS globally, the team noted.

Adding nurse practitioners to care teams

In addition, “even when meeting with healthcare providers, multiple studies reported that PwMS do not receive enough education or support from their health-care providers in order to meet their needs,” the researchers wrote.

As such, “in pressured public healthcare systems, alternate ways of supporting and treating PwMS need to be explored and supported to optimize the experience and functioning of PwMS,” they added.

It has been increasingly recognized that nurse practitioners are critical members of healthcare teams who can serve to fill in these care gaps, providing meaningful knowledge, treatment, and support to patients.

Allowing NPs — particularly specialized nursing staff —to manage the care of people with multiple sclerosis could potentially serve to improve quality of life for patients and ease the burden on neurologists.

Now, researchers in Canada conducted a clinical trial (NCT04388592) to investigate the impact of add-on NP-led care on depression and anxiety among MS patients. These patients were seeing neurologists at community practices across Edmonton, in Alberta — the province with the highest MS rates in the country.

NP-led care involved a comprehensive consultation at the study’s start. This consultation included individualized lifestyle and/or medication strategies to manage symptoms, exploration of the patient’s local community, and discussion of resources to optimize mood and quality of life.

Patients also underwent follow-up NP visits at three and six months, which were conducted in person, via telehealth, or on the phone. The study’s NP had been thoroughly trained by MS specialists before the study and had worked in the community setting for one month.

Usual care “included limited support to community neurologists by registered nurses who also work within a tertiary MS clinic setting,” the team wrote.

Of the 248 screened participants, 228 completed the trial and were included in the final analysis. Altogether, there were 189 women and 39 men, with a mean age of 47.5.

Among these multiple sclerosis patients, 120 received the NP-led care intervention, with specialized nursing, and 108 received usual care from their community neurology practice.

Demographic and clinical characteristics were generally similar between the two groups at the study’s start.

The trial’s main goal was to assess changes in depression and anxiety, as measured by the patient-reported Hospital Anxiety and Depression Scale, after three months.

Secondary goals included changes in depression and anxiety at six months, as well as quality of life, fatigue, and patient satisfaction — all assessed with validated measures — after three and six months.

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Helping lower depression, anxiety

Results showed that patients in the NP care group saw significant reductions in depression at three months, and in both depression and anxiety at six months, compared with those in the standard care group.

Trends favoring NP-led care were observed for fatigue and quality of life at both timepoints, but group differences failed to reach statistical significance. Also, patients of both groups reported similar levels of satisfaction regarding care.

“Despite statistically significant improvements in depression and anxiety scores in our study, further research on the minimal clinically important difference (MCID) score for PwMS is needed before conclusions can be drawn about the clinical significance of these findings,” the researchers wrote.

Among study limitations, the researchers noted a potentially pre-existing bias for participants to view NP-led care positively, as they opted into the trial, and the study’s short duration.

However, the findings “are consistent with what has been reported in the literature,” the team wrote, adding that even with a short duration, there was “an encouraging trend that NP-led care can positively influence or delay the decline of [quality of life] measures such as depression for [people with] MS.”

“This study provides an alternate and possibly cost-saving management strategy to complex management of symptoms and [quality of life] measures for PwMS,” the researchers concluded.