The role of specialist nurses in multiple sclerosis: a rapid and systematic review.
BACKGROUND
Multiple sclerosis (MS) is a disease of the central nervous system. The cause is unknown. There are about 80-160 people with MS per 100,000 population, with twice as many women affected as men. The management of individuals with MS includes treatment of acute relapses and chronic symptoms. The care of MS patients is provided by various healthcare professionals, such as general practitioners (GPs), neurologists, physiotherapists, occupational therapists and nurses. Some MS patients have access to an MS specialist nurse, although this provision varies geographically.


OBJECTIVE
The aim of this report is to assess the effectiveness and relative cost-effectiveness of MS specialist nurses in improving care and outcomes for patients with MS.


METHODS
A systematic review of the literature, involving a range of databases, was performed. Full details are described in the main report.


RESULTS
Only one study was identified that tried to evaluate the benefit of MS specialist nurses. The study concluded that MS patients and their carers found the MS specialist nurse to be helpful, particularly in improving their knowledge of MS, ability to cope, mood and confidence about the future. GPs also reported finding the nurse to be helpful with their MS patients, and 40% of the GPs stated they would purchase the services of an MS specialist nurse if their practices became fundholding. However, there were considerable methodological weaknesses inherent in the study design, and it was unclear whether the results of the study could be extrapolated to other settings or to other MS patient groups. RESULTS - ONGOING RESEARCH: There are two ongoing research studies regarding MS specialist nurses. One of these studies involves the provision of MS nurses to several areas, but also has two control populations to allow evaluation of the health benefits of the nurses to MS patients and their carers. This study will help to fill the evidence gap. RESULTS - COSTS: The costs of providing MS specialist nurses consist of their yearly salary (usually NHS grade G), as well as additional costs for travelling, administration, computer and telephone use, a pension scheme, National Insurance and study leave. The MS Society of Great Britain and Northern Ireland allows a generous total yearly cost to the employer of 40,000 pounds.


CONCLUSIONS
The present evidence does not make it possible to comment with any certainty on the value of specialist nurses in MS. The best evidence available to the authors is specialist opinion from neurologists and nurses, and comments from patients with MS; this opinion supports the provision of MS specialist nurses. CONCLUSIONS - RECOMMENDATIONS FOR RESEARCH: Further research is needed before it will be feasible to make firm recommendations on the value of MS specialist nurses relative to other possible uses of funds.
De Broe
S
S
Wessex Institute for Health Research and Development, University of Southampton, UK.
Christopher
F
F
Waugh
N
N
D003920:Diabetes Mellitus / Q000451:nursing; D004827:Epilepsy / Q000451:nursing; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000451:nursing*; D009313:National Health Programs / Q000191:economics*; D009720:Nurse Clinicians; D010300:Parkinson Disease / Q000451:nursing; D019057:Quality-Adjusted Life Years; D006113:United Kingdom / Q000453:epidemiology