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Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study

BACKGROUND: Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the ‘liberation’ procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often pla...

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Autores principales: Ploughman, Michelle, Manning, Olivia J, Beaulieu, Serge, Harris, Chelsea, Hogan, Stephen H, Mayo, Nancy, Fisk, John D, Sadovnick, A Dessa, O’Connor, Paul, Morrow, Sarah A, Metz, Luanne M, Smyth, Penelope, Allderdice, Penelope W, Scott, Susan, Marrie, Ruth Ann, Stefanelli, Mark, Godwin, Marshall
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424567/
https://www.ncbi.nlm.nih.gov/pubmed/25881078
http://dx.doi.org/10.1186/s12913-015-0835-y
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author Ploughman, Michelle
Manning, Olivia J
Beaulieu, Serge
Harris, Chelsea
Hogan, Stephen H
Mayo, Nancy
Fisk, John D
Sadovnick, A Dessa
O’Connor, Paul
Morrow, Sarah A
Metz, Luanne M
Smyth, Penelope
Allderdice, Penelope W
Scott, Susan
Marrie, Ruth Ann
Stefanelli, Mark
Godwin, Marshall
author_facet Ploughman, Michelle
Manning, Olivia J
Beaulieu, Serge
Harris, Chelsea
Hogan, Stephen H
Mayo, Nancy
Fisk, John D
Sadovnick, A Dessa
O’Connor, Paul
Morrow, Sarah A
Metz, Luanne M
Smyth, Penelope
Allderdice, Penelope W
Scott, Susan
Marrie, Ruth Ann
Stefanelli, Mark
Godwin, Marshall
author_sort Ploughman, Michelle
collection PubMed
description BACKGROUND: Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the ‘liberation’ procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often placing them at odds with their health providers. The purpose of this study was to determine the factors influencing older MS patients’ decision to undergo the procedure in order to develop more specific and targeted health information. METHODS: We performed secondary analysis of data collected as part of the ‘Canadian Survey of Health Lifestyle and Aging with MS’ from people over the age of 55 years with MS symptoms for 20 or more years. The survey consisted of self-reported information on impairments, disability, participation, demographics, personal and environmental factors. In order to compare respondents who underwent the procedure to those who did not and to develop a predictive model, we created a comparison group using a case–control algorithm, controlling for age, gender and education, and matching procedure cases to controls 1:3. We used multivariate stepwise least likelihood regression of ‘a priori’ variables to determine predictive factors. RESULTS: The prevalence of the ‘liberation’ procedure in our sample was 12.8% (95/743), substantially lower than reported in previous studies of complementary/alternative treatments in MS. The predictive model contained five factors; living alone (Odds ratio 0.24, 95%CI 0.09-0.63), diagnosis of anxiety (Odds ratio 0.29, 95%CI 0.10 - 0.84), rating of neurologist’s helpfulness (Odds ratio 0.56, 95%CI 0.44 -0 .71), Body Mass Index (Odds ratio 0.93, 95%CI, 0.89 - 0.98) and perceived physical impact of MS (Odds ratio 1.02, 95%CI 1.01 - 1.04). CONCLUSIONS: Predictive factors differed from previous studies of complementary/alternative treatment use likely due to both the invasiveness of the procedure and the advanced age of our study cohort. Our findings suggest that health professionals should target information on the risks and benefits of unregulated procedures to those patients who feel dissatisfied with their neurologist and they should include family members in discussions since they may be providing the logistical support to travel abroad and undergo the ‘liberation’ procedure. Our findings may be applicable to others with chronic disabling conditions who contemplate the user-pay unregulated invasive procedures available to them. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-0835-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-44245672015-05-09 Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study Ploughman, Michelle Manning, Olivia J Beaulieu, Serge Harris, Chelsea Hogan, Stephen H Mayo, Nancy Fisk, John D Sadovnick, A Dessa O’Connor, Paul Morrow, Sarah A Metz, Luanne M Smyth, Penelope Allderdice, Penelope W Scott, Susan Marrie, Ruth Ann Stefanelli, Mark Godwin, Marshall BMC Health Serv Res Research Article BACKGROUND: Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the ‘liberation’ procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often placing them at odds with their health providers. The purpose of this study was to determine the factors influencing older MS patients’ decision to undergo the procedure in order to develop more specific and targeted health information. METHODS: We performed secondary analysis of data collected as part of the ‘Canadian Survey of Health Lifestyle and Aging with MS’ from people over the age of 55 years with MS symptoms for 20 or more years. The survey consisted of self-reported information on impairments, disability, participation, demographics, personal and environmental factors. In order to compare respondents who underwent the procedure to those who did not and to develop a predictive model, we created a comparison group using a case–control algorithm, controlling for age, gender and education, and matching procedure cases to controls 1:3. We used multivariate stepwise least likelihood regression of ‘a priori’ variables to determine predictive factors. RESULTS: The prevalence of the ‘liberation’ procedure in our sample was 12.8% (95/743), substantially lower than reported in previous studies of complementary/alternative treatments in MS. The predictive model contained five factors; living alone (Odds ratio 0.24, 95%CI 0.09-0.63), diagnosis of anxiety (Odds ratio 0.29, 95%CI 0.10 - 0.84), rating of neurologist’s helpfulness (Odds ratio 0.56, 95%CI 0.44 -0 .71), Body Mass Index (Odds ratio 0.93, 95%CI, 0.89 - 0.98) and perceived physical impact of MS (Odds ratio 1.02, 95%CI 1.01 - 1.04). CONCLUSIONS: Predictive factors differed from previous studies of complementary/alternative treatment use likely due to both the invasiveness of the procedure and the advanced age of our study cohort. Our findings suggest that health professionals should target information on the risks and benefits of unregulated procedures to those patients who feel dissatisfied with their neurologist and they should include family members in discussions since they may be providing the logistical support to travel abroad and undergo the ‘liberation’ procedure. Our findings may be applicable to others with chronic disabling conditions who contemplate the user-pay unregulated invasive procedures available to them. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-0835-y) contains supplementary material, which is available to authorized users. BioMed Central 2015-04-16 /pmc/articles/PMC4424567/ /pubmed/25881078 http://dx.doi.org/10.1186/s12913-015-0835-y Text en © Ploughman et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ploughman, Michelle
Manning, Olivia J
Beaulieu, Serge
Harris, Chelsea
Hogan, Stephen H
Mayo, Nancy
Fisk, John D
Sadovnick, A Dessa
O’Connor, Paul
Morrow, Sarah A
Metz, Luanne M
Smyth, Penelope
Allderdice, Penelope W
Scott, Susan
Marrie, Ruth Ann
Stefanelli, Mark
Godwin, Marshall
Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title_full Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title_fullStr Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title_full_unstemmed Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title_short Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
title_sort predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424567/
https://www.ncbi.nlm.nih.gov/pubmed/25881078
http://dx.doi.org/10.1186/s12913-015-0835-y
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