Self-Management in Neurological Disorders: Systematic Review of the Literature and Potential Interventions in Multiple Sclerosis Care

By Rae-Grant, Alex D.; Turner, Aaron P. et al. | Journal of Rehabilitation Research & Development, September 2011 | Go to article overview

Self-Management in Neurological Disorders: Systematic Review of the Literature and Potential Interventions in Multiple Sclerosis Care


Rae-Grant, Alex D., Turner, Aaron P., Sloan, Alicia, Miller, Deborah, Hunziker, James, Haselkorn, Jodie K., Journal of Rehabilitation Research & Development


INTRODUCTION

Multiple sclerosis (MS) is a degenerative disorder of the central nervous system affecting as many as 350,000 persons in the United States [1]. Its presentation varies, but typically includes both acute exacerbations and remissions as well as chronic progression of disability over time. It is associated with heterogeneous symptoms that include, but are not limited to, sensory and motor loss, fatigue, difficulties with balance and sexual functioning, pain, cognitive impairment, and depression [2-5]. MS is typically diagnosed in patients between the ages of 20 and 40 and is associated with a relatively normal lifespan. As a result, individuals often face the challenge of a prolonged course of illness [1].

Providing care for chronic neurological diseases such as MS occurs in a framework much different from the treatment of acute episodic diseases for several reasons--persons with MS have an ongoing disorder that requires monitoring and management, and health services delivery is often provided by multiple providers and in different healthcare settings. Care may not focus on urgent issues as much as on preparation, planning, and maintenance to avoid the development of urgent issues. It is important that individuals with MS understand their disorder so that they take charge of as many aspects of managing MS and its associated impairments as possible [6].

The Chronic Care Model (CCM) is a frequently cited methodology used to frame disease care in a measurable, iteratively modifiable setting that can be applied to multiple disease states [7]. The CCM is premised on the concept that the processes healthcare providers use for acute care are poorly designed for use with chronic illnesses [8]. This model is divided into various elements designed to assess all aspects of care and provide decision support tools and self-assessment strategies for healthcare teams [9-10]. The CCM has helped reframe the concept of chronic disease management from a healthcare provider-focused endeavor to a systems-based activity. A significant component of the CCM is a person who is active and informed about his or her health condition and is able to use self-management strategies.

For many chronic conditions, individuals and their caregivers either provide substantial portions of their own care or could do so if their healthcare team provided them with an organized self-management framework that encouraged and supported participation [11]. In diabetic management, diet, exercise, glucose measurement, weight monitoring, and medication administration are influenced, and in many instances effectively controlled, by patients. The CCM defines self-management support as collaboratively helping patients and families acquire the skills and confidence to manage their chronic illness, providing self-management tools, and routinely assessing problems and accomplishments [7]. Data from multiple studies show that measures of disease treatment improve as self-management efficacy improves [12]. Components of care such as medication compliance, diet, exercise, avoidance of negative behaviors have been shown to improve in chronic disease with effective self-management strategies [13-14]. Recent models of healthcare emphasize systematic approaches to care change. Bergeson and Dean note the importance of self-management support and the lack of effectiveness of education without a concurrent emphasis on building confidence and skills [15].

MS is a lifelong neurological disorder that affects persons during their peak work and reproductive years [16]. As in many other chronic diseases, individuals require ongoing care coordination, including medication, disease and symptom management, and education as well as strategies for addressing acute exacerbations. Multiple issues that emerge during the course of MS and cross specialty lines demand active participation by the person and his or her family or other caregivers [17].

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Self-Management in Neurological Disorders: Systematic Review of the Literature and Potential Interventions in Multiple Sclerosis Care
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.