Editorial - Volume 16, Issue 3 - October 2014

The field of health-care delivery is rapidly changing. While many of you will feel like thanking me for stating the obvious, it is worthwhile at times to stop and reflect on this sweeping reconfiguration of our activities. It is undeniable that health-care providers and patients alike often perceive that these changes are thrust upon them by external forces beyond their control. However, this also represents an opportunity to reassess our beliefs, particularly with regard to the comprehensive management of chronic progressive conditions such as multiple sclerosis. It is more important than ever to demonstrate the value of our tests, treatments, and interventions. The articles included in this issue of the IJMSC contribute, each in its own way, to this endeavor.

While magnetic resonance imaging (MRI) has become an essential component of the early diagnosis and monitoring of MS, MRIs ordered for a variety of reasons sometimes lead to incidental discovery of white matter lesions, and to a consultation for “possible diagnosis of MS.” This is a stressful situation for patients, who are confronted with the prospect of a lifelong disabling disease, and a challenge for clinicians. Nakamura et al. followed 30 patients over an average period of 5 years, and assessed the predictive value of published MRI diagnostic criteria, clinical information, and cerebrospinal fluid analysis in “real world” clinical practice.

The high incidence and profound impact of walking limitations in MS are well documented in the literature, and efficacious interventions are still too few. The pooled analysis of two large phase 3 clinical trials of dalfampridine by Goodman et al. confirms previous safety data and expands on efficacy findings. Downing et al. report promising results from a short-term uncontrolled pilot study of peroneal nerve functional electrical stimulation for footdrop in 19 MS patients. Both articles illustrate how the clinician's and the patient's perspective can be easily integrated in assessing treatment effects, and the same approach can be used routinely in the clinic.

The treatments mentioned above both aim at improving function by reducing impairment (also referred to as alteration of body function in the International Classification of Functioning, Disability, and Health). The article by Kalina reminds us that the home environment also has an impact on the ability to move around and to carry out daily activities, and proposes an educational intervention to help patients manage clutter, a sometimes overlooked environmental barrier.

While physical impairments are the most visible consequences of MS, psychological distress is no less pervasive and impactful. Some studies have even linked stress to disease activity. Reynard et al., through their review of the literature, present an overview of stress-management interventions that have demonstrated some efficacy in patients with MS, and highlight the need for further evidence in this domain.

Finally, two articles present information on different aspects of patient perception. Skovgaard et al. explored the assumptions driving individuals with MS to use complementary and alternative medicine (CAM) interventions exclusively to manage their disease. While a majority of MS patients report using CAM treatments, only a fraction of those choose to exclude “conventional” treatments, including disease-modifying therapies. The themes identified by the study participants may help health-care providers communicate with their patients about CAM use.

Pozniak et al. report on how perceived worsening of health insurance coverage (one of the factors affecting access to specialized MS care) in the past 12 months is influenced by the patients' type of insurance. The data were collected in the context of the Sonya Slifka Longitudinal Multiple Sclerosis Study in 2009, before the health-care reform in the United States was enacted. It would be interesting to evaluate how these perceptions have evolved now that some of the provisions of the health-care reform have been implemented.

I am glad to report that the IJMSC has won three publishing awards in 2014. I am thankful to the Consortium of Multiple Sclerosis Centers (CMSC) as well as our editorial team, editorial board members, authors, and reviewers for their contributions to our achievements. Thank you also to our readers for your continued support. I hope that, in turn, the contents of this issue will help you further our mission, which is to improve the lives of those directly and indirectly affected by MS.