Multiple Sclerosis Final part of the Proposal

Name of Student

Name of Institution

Multiple Sclerosis is a disease that disrupts information-flow between the body and brain, and also within the brain (Freedman, 2006). It is a disabling, unpredictable disease that targets the central nervous system. Its cause is yet unknown and is assumed to be exposure to environmental factors, also unknown to people who may react. The total number of victims are unknown, but are estimated to be over two million world over. The unknown number of victims is because the symptoms may be completely invisible and because responsible bodies have not been required to register new cases.

The contraction of this disease is based on several risk factors the first of which is the age. Studies on research data have shown that the age groups of between fifteen and sixty have the highest likelihood of getting the disease (Iezzoni, 2010). The other risk factors are gender, family history, certain infections, race, climate, lifestyle and certain autoimmune diseases. Lifestyle, smoking for instance, makes an individual to be more inclined to register the second series of attack on the central nervous system (CNS). These attacks are thought to be done by the immune system of the body that has lost some of its purpose of protecting the body (Lotze and Thompson, 2004). Whilst both men and women are victims of this terrible disease and most of the cases have been registered in women (Kalb, 2008). Women, therefore, have been deduced to be more inclined to contract the illness than their male counterparts (Farrel, 1998). Through study on race and family history, it has been concluded that white people especially from Northern Europe or of this decency are more vulnerable to infection by the MS. They have reported more cases unlike their Asian, African and Native Americans counterparts (Barcelo, 1996). People who have type 1 diabetes, a thyroid disease, an inflammatory bowel disease, and other viral infections that have been linked to the MS are also more likely to develop it (Bowling, 2014). The infections make patients susceptible to the symptomatic development of the Multiple Sclerosis. Climate is thought to affect the contraction rates as individuals from the more temperate regions have been affected a lot less than individuals from the colder parts of the globe.

The objectives/ aims and purposes of this study are highlighted in the following sentences. First, the research study aims to identify the target group/ the groups that have fallen more victims to MS. The second objective is to identify the typical symptoms of MS and the root causes of these symptoms (Craighead & Charles, 2001). Thirdly, the study analyzes the fatality and effects of MS, the effectiveness of the diagnosis and available treatment.

Research Hypotheses

A hypothesis is a statement of investigation for a researcher. Usually, the development of the theory is based on the assembly of facts organized in an intricate pattern such that a relationship arises therefrom. The resultant theory has more meaning and is more concrete because it has its backing on substantial facts. From that point, relationships that do not acknowledge individual facts in the theory are examined. When doing this, the researcher normally has little knowledge of the correctness of the relationships he attributes to the facts. These formulated relationships are what makeup a hypothesis. A verified hypothesis is sufficient ground to interpret a particular theory in the future. Essentially, the hypothesis is a predictor of something unknown. Such prediction can be tested to ascertain whether it is valid. During such testing, the prediction may turn out to be in line with common sense. In the same measure, the prediction could turn out to be correct or incorrect. Overall, the testing is empirical. This means that the outcome is not necessarily important so long as it is an answer to the prediction. Inclusive, a hypothesis serves the function of relating different phenomena in some way to permit an empirical analysis of the same. This function calls for a research design that eventually proves or disproves the hypothesis based on the data gathered during the research.

Hypothesis 1

Among people with multiple sclerosis, there is no difference in recurrent fall frequency with and without physical therapy.

Hypothesis 2

Among people with multiple sclerosis, there is a difference in recurrent fall frequency with and without physical therapy.

The research is also guided by the following thesis and antithesis.

Thesis: Physical therapy helps prevent recurrent falls in people with multiple sclerosis.

Antithesis: Physical therapy does not help prevent recurrent falls in people with multiple sclerosis.

The nature of this disease is not clear yet to scientists in this field. This research proposal examines some of the facts behind the MS and restates clarity.

The Background of Multiple Sclerosis

The first case of multiple sclerosis was registered in Rotterdam in the late 1300s on a woman who has been canonized as St. Lidwina (Kesselring, 1996). Through to the 1800s, no one understood this disease. For a long period, individual cases of MS have been stated in great detail. Jean-Martin Charcot, the father of modern neurology, introduced the first cohesive perspective of MS in 1869. The diagnosis of MS is not easy, but has been made simpler to technicians by introduction of technically advanced resources (Lotze & Thomson, 2004). Previously, there were no neurologists with the skill to carry out this diagnosis. At the moment, the FDA approved treatments for MS are six (Ehrman, 2009). There are also seventy new therapies at different stages of the trial that will be tested at Stanford. There is a Multiple Sclerosis center at Stanford that has a team of highly qualified neurologists offering a special diagnostics and treatment. The treatment offers comprehensive individualized care combined with great research opportunities. It also has access to clinical trials and state-of-the-art technology that include the electrodiagnostics and the Magnetic Resonance Imaging (MRI). It has services like immunology infusion, information on current treatment and research, and follow-up services (Ehrman, 2009).

Early Signs and Symptoms of MS

It has symptoms that include optic neuritis (vision problem). In this case, an individual’s central vision is disrupted because of the inflammation of the optic nerve. The degenerative effect is slow, so this makes the vision problem not be noticed immediately. The other symptom is numbness and tingling on the fingers, arms, legs and face. It occurs when the MS affects the brain and spinal column prompting them to send mixed signals. Involuntary spasms of muscles and chronic pain are also common occurrences (Schapiro, 2014). The condition also comes with knee jerking movements that are involuntary and extremely painful. The third symptom is unexplained weakness and fatigue that affects 80% of victims at the early stages of the infection (Weiner, 2005). MS is also characterized by problems in balance coupled with dizziness. In addition, affecting an up to 80% population of total victims, problems with the bladder, bowels and sexual dysfunctions are characterizing MS. The problems occur because most of these activities are controlled by the central nervous system that is attacked by the MS. Problems with language, memory loss, shortened attention span and reduced levels of concentration mark another symptom. The cognitive malfunction affects at least half the total victims. Major depression and the pseudo bulbar affect are also common among people with the MS (Sadock, Sadock & Sadock, 2008). Other symptoms may include seizures, memory loss, uncontrollable shaking, breathing problems, slurred speech and problems in swallowing.

There is mixed information on the group that is targeted by the Multiple Sclerosis. Whilst previously scientists, still held on to the ground that it affects no particular group or race of the human, contradictory information and research have proven otherwise. Scientists have now observed that the Multiple Sclerosis is more common among people from Northern Europe, or of this line of decency (Malley, 2005). They hold that it has become more common among the Latino or people with Latino backgrounds. Their research holds that people of African decency, Asians or Native Americans have the lowest risk. The findings of this research have a created a presumption that vitamin D plays a factor in the level of risk. People around the equator, who are exposed to more sunlight hence more vitamin D, have low levels of risk of contraction.

Timely and early diagnosis of MS can be achieved through tools like the Optical Coherence Tomography (OCT). It is a new painless imaging tool that is non-invasive. The OCT is used for viewing the internal retinal structures to assess the optic nerve for optic-neuritis. The criteria for diagnosis for MS are as follows. First find evidence of damage in at least two areas of the CNS. Secondly, find evidence that the damage at two different point and time. The third is, rule out all other possible diagnoses (Olek, 2005). The tools for making a diagnosis are medical history and neurologic exam and blood tests (Orient and Sapira, 2010). There are no set up procedurals for testing for the MS in the blood (Malley, 2005). What the tests do though, is to cancel out possibilities of other infections that bear the same symptomatic appearances (Flemming, 2002).

The MS is not easy to diagnose because the early warning signs are always not directly associated with it as they are also caused by other conditions (Lotze & Thomson, 2004). Symptoms like poor vision and memory loss are often handled for what they are because MS tend to appear with different symptoms in victims. The MS is not easy to diagnose because it has no single tests. It also takes time because diagnosis can only be confirmed after evidence of at least two episodes of activities of the disease on the central nervous system (Schapiro, 2014). Despite all the challenges, however, a series of technical advances have been made that make the whole process possible, though it still is gradual.

There are no death cases directly linked to the Multiple Sclerosis. The medication has also been considered very safe with mild side effects (Murray, 2005). Though conditions like severe pulmonary complications, severe sepsis and aspiration pneumonia may lead to death. Aspiration Pneumonia is a result of deposition of food and liquid particles in the respiratory tract as a result of difficulty in swallowing. Poor nutrition decreased sensation; immobility/ inactivity and bladder incontinence may cause sepsis, especially if left untreated. The MS also limits an individual’s ability to exercise, weakens the muscles and make them vulnerable to other infections. It is the contraction of such diseases like cancer, heart complications and stroke that may lead to an individual’s demise. Cases of victims committing suicide to avoid the problems they are going through have also been reported. Multiple Sclerosis is, therefore, not directly fatal, but both the physical and mental conditions that come with it are what may be fatal.

The MS has no permanent cure, and the only available treatments are control measures (Weiner, 2005). A number of disease-modifying drugs have been proven to sluggish the process of MS in some people. These drugs suppress or alter the activities of the body’s immune system and are based on the theory that the immune system attacks the myelin surrounding nerves. The drugs serve to reduce the development of new brain lesions and the frequency and severity of attacks like the convulsions (Frontera, 2008). Early diagnosis is imperative as it creates time to find the drug that a patient can use comfortably. It also helps in curbing the developments of the disease, by slowing its growth and advances from early stages.

The objectives that have been set to examine the research proposal serve to explain diagnosis and treatments for MS. They also examine vulnerability of some individuals and the environmental factors that propagate this disease.

The Conceptual Framework of the Proposal

Multiple Sclerosis;

Factors for Infection;Symptoms;

environmental, diet, gender, genetic weakening of muscles, breathing problems, cognitive problems, balance problems, dizziness and fatigue

Diagnosis;Other Infections;

MRI, Cerebrospinal Fluid(CSF), Respiratory Pneumonia, Heart attacks

Evoked Potentials(EP)Sepsis

Treatment/ Control;

Drugs; oral and injections (intravenous, subcutaneous, intrathecal)Therapy

This conceptual framework explains the relationship among the variables of the proposal (Gerish, 2010). The independent variable is the factors for infection. It leads to infection and symptoms. The symptoms lead to diagnosis, other infections and treatment. Diagnosis, affected by symptoms, also leads to treatment and control.

Research Methodology

Introduction

This proposal identifies the target group of the proposal and the reasons for their high likelihood of infection. Research conducted on information throughout the years from the first case in 1300 to date has pointed to geographical locations among other factors. The other factors include lifestyle, genetically factors and climatic factors. The research points out that people from a place of high infection rate who move out before puberty reduce the levels of risks. Now whilst diet and lifestyle may be the same among different populations, factors like climate and family trees make others more susceptible to infections. Most cases of MS are not diagnosed early because of the less obvious symptoms. The proposal examines the symptoms and their relation to each other. It scrutinizes the irregular symptomatic infections because so far, no two known patients have suffered from symptoms at the same rate, stage and style. The symptoms are always bare, but there are no measures that can help medics diagnose MS (Martin & Bridgmon, 2012). The only option is to wait for the second attack by the Ms on the central nervous system, and this takes time. The time taken/ lost leads to further development of the Multiple Sclerosis yet the earlier its arrested, the better and more stable an individual’s condition remains.

The MS itself has proven to be controllable, but the diseases/ opportunistic infections that may set in as its result have adverse effects. Through therapy and administering of drugs, the adverse effect of the immune system on the central nervous system is reduced. This leaves the patient in a more stable state. But the problems it causes like weakened muscles lets in other infections like heart diseases. Patients diagnosed with Multiple Sclerosis leave in fear of these other infections than their primary health state.

The Study Design

There are two designs for research. They include the qualitative and quantitative (Martin and Bridgmon, 2012). This research proposal adopts a qualitative design. It examines whether physical therapy helps avoid recurrent falls among people with Multiple Sclerosis. Information about the subject was collected through questionnaires, interviews and observations (Ott & Longnecker, 2008). This is a narrative research that has focused on a particular individual. Data in this research have been gathered through the collection and study of his testimonials.

Intervention

Multiple Sclerosis lacks a cure, but measures to control it have been implemented. The methods for its control are known as interventions (Fraser, Clemmons & Bennett, 2002). Drugs that target to reduce the activities of the immune system, which is believed to be the primary cause of the disease, have been invented. When the immune system’s activities that target the central nervous system have been reduced, the speed with which the MS advances are curbed Givens, Reeds & Touwaide, 2006). The other mode of intervention is through the Behavioral Intervention. This has been effective in improving depression, motor function as well as fatigue. It has the potential to modify the disease by ameliorating the symptoms.

The method of intervention recommended by this study is therapy. There are two kinds of therapy that have been employed in the intervention against Multiple Sclerosis (Colburn, 2011). The first is Physical Therapy (PT). The Physical Therapy can be used to intervene on the following symptoms; fatigue, walking difficulties, weaknesses, poor balance/ fall risk (Bryant, 2011). It can also be used to intervene on stiffness, spasms and spasticity (Roy, 2008). It can also intervene on pain, tremor/ ataxia, sensory changes that include proprioception and decreased functional independence. The second is Occupational Therapy (OT). The Occupational Therapy can be used to intervene on fatigue, weakness, balance/ fall risk, stiffness, spasms, spasticity and cognitive changes. It can also intervene on reduced manual dexterity, pain, tremor and sensory changes that include proprioception (Soderback, 2009).

The reason for the choice of therapy is that unlike drugs and medication, it just does not try to stop the development of the disease. It makes an attempt at reversing some of the conditions (Jelinek, 2010). It recreates psyche where hope had been lost, serves to strengthen weakened muscles and encourages the victim to take on the conditions head on. Occupational Therapy does not let the victim mentally fall into a state of regression; instead it instills in him the confidence to fight back and hold on.

Study Sample

The study is conducted at The Walden University Department of Online Students Registered with Disability. The choice for Walden University is factored by the love for the students whose mobility has been impaired. It, therefore, has a wide base from which proper and detailed information on Multiple Sclerosis, the biggest cause for mobility impairment can be collected. Information should be collected from large frames of samples (Neal-Boglan, 2011)

Sampling Strategy

There are four sampling strategies overly (Babbie, 2013). They include simple random, systematic, stratified random and cluster sampling strategies. The strategy chosen for this study is the systematic in which the produced samples are treated as random. It addresses the following issues. The first issue is to get sincere respondents who can help avoid response bias. Response bias results when a respondent deliberately conceals information from the researcher for various reasons. The second strategy is to help avoid non-response especially when respondents fail to answer phone calls, turn up for meetings or fill questionnaires. The third strategy is to get detailed full-cycle information. Therefore, the respondents should be experienced and well versed with social and scientific factors on Multiple Sclerosis.

Sampling frames

A sampling frame is the list of all the intended respondents for the study. It is a list of other device that a researcher uses to define his population of interest. The randomness of choice of sampling depends on the level of accuracy of the information required by the study. The element is introduced by picking a random number from and with which the selection should be started and based (Ott, & Longnecker, 2008). Its samples form a block sample frame. There are two kinds of sampling frames which are list and non-list. Rarely can a researcher get direct contact to the population of his interests. The researcher must, therefore, rely upon a sampling frame to create a representation of all the elements of the population of interest.

In this study, one in every ten students will be chosen to form a list sample frame. The sampling strategy and the sampling frames give a total of three group samples/ lists for the study.

Allocation of Treatment Arms

The three groups are then subjected to the three different methods of intervention. Each is allocated a different method from the previous. The purpose of different allocation is to verify/ compare the efficiency of each of the three intervention techniques to Multiple Sclerosis. The first group marked as I, is subjected to medical intervention. The second group, marked as II, is subjected to the behavioral intervention. The third group is subjected to intervention by use of therapy; this group is christened group III.

The study variables

There are three variables for a research study. These are the dependent, independent and the confounding variables. The validity and reliability of a research study are increased when the variables are controlled by ensuring that the causal effects are eliminated. It is also known as isolation of the independent variable. The process of isolating the independent variable involves changing the other variables into consonants (Martin & Bridgmon, 2012). Eradication of the research variables involves employing scientific measurements to negate or nullify them.

The research study on Multiple Sclerosis will have two variables that will govern the style of research after the conversion of the variables of research into constants. They include the independent and dependent variables. The independent variable of the study is physical therapy whilst the dependent variable is the falls in people with multiple sclerosis. This study does not bear a confounding variable.

Methods of Data Collection

There are several method of data collection. These include the use of documents, observations, survey, and experimental analysis and among other fields like the nominal group technique (Creswel, 2014). Use of documents identifies trends in leisure research and practice. The participants carry diaries and journals. The method is detailed into historical, literature review, Meta and content analysis and mining of secondary data. Observations are detailed into interpretive, ethnographic, case study and observations of the participants. It evolves around the behavior and interaction of people in open and public places. The observation is meant to be systematic (Lodico, Spaulding & Voegtle, 2010). Survey involves use of questionnaires, interviews and standardized scales/ instruments. It aims at identifying the relationships between motivation and satisfaction.

The other are experimental that involves the use of true and quasi-designs and the multi-methods approach that is a combination of all the methods shown above. The experimental method aims at obtaining information under controlled conditions.

Though a part of the research will be observational, most of the data collection is conducted through survey. Methods like the use of questionnaires and interviews are employed. The reason for the survey is to improve the level of communication with the respondents to get even their personal information. Survey improves precision and clarity of information as no research content is based upon assumptions (Lodico, Spaulding & Voegtle, 2010). Questionnaires are distributed to the respondents/ members of the sample frames/ groups. The best response is then picked from the questionnaires once they have been submitted by the respondents. The respondent who filled the questionnaire is visited for an interview. The process is tedious but very effective.

Data Management

Data management is the manner in which data collected from the study is handled to serve the purposes of the study and also serve as a base of reference for future studies (Andrew, Paul & Chad, 2011). When done effectively, data management helps in achieving clarity and cohesion of a research and study and intended future studies as well. There are set procedural and order/ steps and guidelines for Data Management. The first is data collection from the recipients, then Data maintenance, storage, validation/ correction and manipulation. The steps before precede data views, access, security and documentation. To achieve a high level of efficiency, this research study aims to follow the data management protocol.

Data management will be conducted is described in the paragraph herein. The recipients mail back their responses/ questionnaires. The questionnaires are then filed according to the samples/ groups that had earlier been set and marked as I, II and III respectively. The collected data is then validated and corrected to comply with the scientifically facts. Responses based on mythical theories without a scientific support are cancelled. The data is then extracted and changed into essays. The process of extraction is also known as Data Manipulation and Reporting.

The views and responses of the data must be clearly outlined in the essay. Relevant explanations are given where necessary to give clarity and make observational references. The data of these research findings should be made accessible to researchers and victims for future references. To make this easier, there should be hardcopies of the findings in the order of educational journals. A report on the data is also made as part of the documentation procedures.

Data Analysis

The aims of this research are to determine the number and incidences of MS patients with fall incidences while analyzing the effects that the condition has on the patients’ life, work and education

The paper also examines the effectiveness of the PT and OT in slowing down the advancements of the disability and reducing the frequency of falls. There are two methods of data analysis (Ott & Longnecker, 2008) The General Practice Research Database and Hospital Episode Statistics data is the preferred method of data analysis for this study. The other method is the Hospital Episode Statistics (HES).Based on patient records and hospital intervention, the two methods will enable accurate compilation and analysis of data (Carlin & Louis, 2008).

a)General Practice Research Database (GPRD)

The calculations on the follow-up durations per patient are done annually to determine the fall incidences of patients per year and whether a diagnosis has occurred due to such falls (Carlin & Louis, 2008). The fall incidences will be estimated using passion regression models with logarithm (time at risk) as an offset variable. The gender analysis is done separately and year and age are used as the variables for the models (Phelps & Hassed, 2010).

b)Hospital Episode Statistics (HES)

The available HES data for the patient population will be analyzed. Estimates of fall incidences within the time duration will be made using the GPRD data. The fall incidence rates will then be calculated using extra diagnosis from HES. Age-specific rates of fall incidence will be estimated from inverse polynomials and fitted to ratio cases from GPRD and HES versus GPRD alone.

Dissemination of Research

Victims of Multiple Sclerosis are the main stakeholders in this research proposal. They are the focal point of the research. Because of their immediate contacts with the MS patients, the families and friends have the information on the effects of this disease. The information that is firsthand, especially on the falling incidences and they should be handled is vital to the research. For this reason, these family members will also be part of the processes of the research. Research institutions that include health facilities and professionals, schools and their staffs and members of the community also play a vital role as stakeholders in this research. The reason for this is that they are privy to information on research and challenges faced by the victims of MS.

There is a need and necessity to formulate Government policies galvanizing the education and employment of MS patients. The victims always get victimized and discriminated against because of their sluggish movements and mobility problems. For this reason, Government representatives will also take part in the research. The media will also take part as the issue of MS fall incidences is a serious issue that should attract public awareness. They not only come to create awareness on the fall cases and reasons for the fall, but also to de-campaign the discrimination against the MS patients. Lastly, the research will source for sponsors who will also become part of the project to evaluate its progress and look into matters of transparency and accountability.

Ethical Issues

Physicians assert that in cases of probable diagnosis, at the early stages before the second attack on the CNS, patients should not be informed of the contraction of the disease (Furney, 2008). They base this on the argument that a medic’s first role is not to create panic but to relieve patients of pain. Telling patients the truth, they argue, could trigger mental agony rather than give patients a piece of mind. Justification for this is that the early phases of MS do not exhibit serious falls. Moreover, it is hard to precisely predict future experiences. Most patients will not understand anything about such future experiences.

Respect for individuals calls for voluntary informed consent plus adequate patient information regarding the research aims, procedure, methods, potential risks and anticipated benefits. Patient autonomy is a very crucial principle – patients should be allowed freedom of expression, comment and adjustment as the research progresses. Moreover, when analyzing the benefits and risks of the research, they should be weighed critically based on the potential benefits of new interventions against the current ones. Lastly, justice should prevail when selecting the participants in the research. There should be no reasons other than ethical or scientific ones for including participants into the research.

The need to source for funding makes it necessary to seek IRB approval. The IB approval only comes when the validity of the research is clearly stated and emphasized. This research has its relevance steeped in the statements that follow. It articulates the woes and tribulations of the MS patients at school, work and even in their everyday life. Policy statements have been slow to capture the problems faced by the victims of MS. The key factor for this is that the research and reports made about this filed have not been sufficient. The research findings of this proposal, therefore, will serve to enhance policy development and create awareness concerning Multiple Sclerosis.

Secondly, assurances on the respondents/ participants ‘safety throughout the research have to be paramount. The research aims at participation of MS patients and other stakeholders at free will. During the research, measures to control and lessen any jeopardy/ risks of harm that might suffice during the research will be put in place. Moreover, there will be an efficient consent procedure whereby no participant feels compelled to take part in the research. In addition, withdrawal decisions will be honored. Lastly, before seeking IRB approval, the respondents’ perceptions on the research will be clarified.

References

Andrew, D P., Paul M. P, & Chad D. M. (2011). Research Methods and Design in Sport Management. Champaign, IL: Human Kinetics.

Babbie, E. R. (2013). The Practice of Social Research. Belmont, Calif: Wadsworth Cengage Learning.

Barceló, D. (1996). Applications of LC-MS in environmental chemistry. Amsterdam: Elsevier.

Bowling, A. (2014). Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative, and Conventional Medicine.