Research by Dr Ferghal McVerry, winner of the MS MasterClass intermodule project award 2017

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This project won the MS Academy MasterClass Project Award for 2017, and this snapshot gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

If you would like to contact the alumni who did the research, drop us a line and we’ll put you in touch where possible.

 

Aim

To understand how relapses in MS are currently being responded to and managed in this district general hospital, with reference to treatments stated by NICE guidance, evidence-based management through physiotherapy, and the challenge to ultimately aim for ‘no evidence of disease activity’ (NEDA) in people with MS.

Headlines

  • The study carried out a retrospective review of case notes for patients with an MS relapse, both in inpatient and outpatient care.
  • Case notes were searched for evidence that showed:
    • NICE guidance was followed
    • referral(s) to allied health professionals
    • imaging (MRI) to measure disease activity was used
    • whether escalating disease-modifying treatment (DMT) was discussed where a patient was already on a DMT.

Key findings

  • In a group of 57 patients who had shown relapse symptoms, NICE guidelines were largely followed, though IV rather than oral steroids were mostly used (45 versus 12). 5 were treated as inpatients.
    • Treatment was usually prompted by a patient call to their MS nurse.
    • Prescriptions were commonly by a non-MS neurologist, raising governance issues.
  • Apart from steroid prescription, though, other MS care was usually neglected, with access to additional care like imaging, physiotherapy or DMT discussion more likely for those managed as inpatients:
    • Only six patients were given physiotherapy despite most relapses showing motor symptoms. Five of these were inpatients.
    • MRI imaging was used in eight cases.
    • A change in DMT was given in 12 cases, though 32 of the group had been given steroids for relapse in the previous 12 months, showing evidence that their MS was active.
  • Post-relapse follow up only occurred in eight cases.

Core recommendations

  • To create a specific MS relapse pathway where:
    • Patients are seen by an MS nurse or MS neurologist before being prescribed steroids
    • MRIs are quickly accessible
    • Allied health professionals input is specified
  • It is essential that the same level of care found for inpatients is available to all MS patients managed within the Trust.

 

Take action

  • Read the full report.
  • The relapse pathway is still in its early days, though work has definitely begun locally. See a copy of the standardised form the team has introduced to start all patients off from the same point.
  • Contact the researcher to discuss their work. Dr McVerry has given a direct contact: ferghalmcverry@doctors.org.uk
  • Learn more about the issues raised in this report. Click the scattered links to access further information.