Short Report: Adherence to Neuropsychological Recommendations in Patients with Multiple Sclerosis

Abstract

Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.

A neuropsychologically-based intervention with increased follow-up support for employed women with multiple sclerosis: a pilot randomized controlled trial

“…Given that research has identified low adherence rates to neuropsychological testing recommendations in multiple sclerosis (38%), it may be preferable to provide additive follow-up care (in-person feedback and case management) where possible, to improve compliance and increase utility for such an intervention. 14,31,35,36…”

A Scoping Review of Communicating Neuropsychological Test Results to Patients and Family Members

“… Ruppert & Attix, 2014 Book chapter Brief summary of purposes and recommended practices for providing feedback on cognitive test results to patients and caregivers P: patients with a cognitive impairment N/A Recommendations given for in-person feedback, such as clear communication, querying understanding throughout session, allowing patients/family to take notes, and provide written materials. Stimmel et al, 2019 Research paper Explore rates of adherence to neuropsychological recommendations, reasons for nonadherence, and the effect of oral (phone call) and written feedback over written feedback alone D: quantitative, descriptive P: 55 patients with MS S: MS center (medical center) M: semi-structured interview, retrospective record review O: adherence to treatment recommendations Self-reported adherence to recommendations was 38%, but this varied per recommendation type (high adherence for pharmacological management and lower for psychotherapy or psychiatry referral/cognitive rehabilitation). Reasons for nonadherence were needing more information and wanting to speak with physician.…”

“…Most research papers used in-person feedback (Arffa & Knapp, 2008 ; Cheung et al, 2014 ; Connery et al, 2016 ; Fallows & Hilsabeck, 2013 ; Farmer & Brazeal, 1998 ; Foran et al, 2016 ; Holst et al, 2009 ; Kirkwood et al, 2016 , 2017 ; Lanca et al, 2019 ; Lopez et al, 2008 ; Malla et al, 1997 ; Meth et al, 2016 ; Rosado et al, 2018 ; Tharinger & Pilgrim, 2012 ; Westervelt et al, 2007 ; Gruters et al, 2020 ; Martin & Schroeder, 2020 ), and most of the other publications recommended in-person feedback (Allen et al, 1986 ; Carone et al, 2010 ; Carone et al, 2013 ; Carone, 2017 ; Crosson, 2000 ; Gass & Brown, 1992 ; Gorske, 2007 ; Gorske & Smith, 2009 ; Green, 2000 ; Griffin & Christie, 2008 ; Postal & Armstrong, 2013 ; Ruppert & Attix, 2014 ). A minority gave feedback via phone (Stimmel et al, 2019 ), via telemedicine (Clement et al, 2001 ; Turner et al, 2012 ) or via a written report (Evans et al, 2019 ). Usually, feedback was given by the neuropsychologist a few weeks after the assessment.…”

“…The majority of participants were positive and experienced recommendations as helpful (Quillen et al, 2011 ; Cheung et al, 2014 ). However, the overall adherence to recommendations was found to be approximately 40% in four different quantitative studies (Quillen et al, 2011 ; Cheung et al, 2014 ; Stimmel et al, 2019 ; Westervelt et al, 2007 ). Identified barriers were unwillingness to adapt to the recommendations of the family member, patient misunderstandings, a need for more information, disagreement with recommendations, a desire to speak with a physician regarding the recommendations, and level of difficulty obtaining recommended services (Cheung et al, 2014 ; Stimmel et al, 2019 ; Westervelt et al, 2007 ).…”

Examining the Clinical Utility of Selected Memory-Based Embedded Performance Validity Tests in Neuropsychological Assessment of Patients with Multiple Sclerosis

“…Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating condition that can present with diverse patterns of physical, cognitive, and psychiatric symptoms [1][2][3][4]. In addition to expert care provided by neurologists who may provide clinical monitoring and pharmacological intervention (e.g., dimethyl fumarate, interferons, monoclonal antibodies) [5,6], clinical neuropsychologists are often called upon to assess such patients and provide targeted treatment recommendations for them from a neurocognitive and psychological perspective [7,8]. Several attempts to standardize the clinical neuropsychological assessment of patients with MS (pwMS) have been made.…”