Aim The aim of the study was to explore how specialist nursing affected the experience of fatigue for people with multiple sclerosis. Methodology This mixed method case study is a single embedded revelatory approach designed to investigate specialist nurse interaction with patients with multiple sclerosis who experience fatigue. The convenience sample of one nurse and two patients constitutes the case. The case is bounded by purposively sampling data which were collected by the use of: interview, observation, reflective diaries. Assessment tools were also used for fatigue, depression, disability and the impact of MS, and actigraphy recording of patient activity. Participants completed key measurements and interview at three monthly intervals during the one year study period. Other data collection was organised to reflect the frequency of nurse patient consultations. The critical social theory of Jurgen Habermas and specifically his theories of moral consciousness and communicative action were used to aid interpretation of data. Conclusions Actigraphy demonstrated that overall level of physical activity for both patients was similar despite differences in fatigue experience. Differences occurred in how patients: (i) Chose to utilise the level of physical activity available to them; (ii) The sense of meaning that they constructed around their experience of fatigue and (iii) The adoption of self management techniques.

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Improved understanding of health service provision for people with Multiple Sclerosis (MS) in relation to their perspectives provides vital information guiding efforts to meet their ongoing needs. This thesis presents a qualitative study of service provision for people with MS in one health authority in the UK. The philosophical/theoretical underpinnings of the study were social realism and symbolic interactionism. The study explored three key questions appertaining to service provision: how do people with MS utilise health services in this authority?; what problems occur in daily interactions between service users and providers that affect how needs are met for people with MS?; and how does the structure of current health services in this authority affect people with MS? The study was carried out in four stages incorporating: initial exploration; analysis of initial data with design and implementation of required pilot studies; a retrospective examination of cases of people newly diagnosed with MS; and a prospective examination of service use which involved monitoring how people with clinically confirmed MS used services over a 10-month period. Three main themes arose from the study: trust in the relationship between health professionals and people with MS; how health professionals and people with MS express their knowledge of MS; and service planning and design factors that influence whether and how the needs of people with MS are met. It was concluded that better understanding and improved promotion of trust between health and social care professionals and people with MS are critical to increasing the satisfaction of the latter with service provision. The findings are discussed in relation to an analysis of individual and collective factors which promote and impede the development of trust.

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The epidemiology of multiple sclerosis has informed us about the unique distribution of the disease worldwide and has helped to generate important hypotheses in order to understand more about the aetiology of the disease. Studies of the prevalence and the incidence of MS in the United Kingdom have contributed to this body of research. The aim of this study was to examine the epidemiology of MS in the multiethnic population in the Bradford Health Authority in West Yorkshire/UK and to investigate the phenotype of MS in the South Asian population. This population based study identified 344 people with MS on prevalence day 1st July 2008. The crude prevalence was 112.3/10. The prevalence in the non-South Asian population was 135.5/10 using the non-South Asian population as the denominator. The prevalence of multiple sclerosis in the South Asian population was 46/10 using the South Asian population as the denominator. Using the 1961 population of Northern Ireland as the reference population the standardised prevalence was 121/10 (CI 108-134). When age-adjusted to the European and World Standard population, the prevalence was 123.7/10 (CI 110-137) and 111.1/10 (CI 99- 123) respectively. Thirty-seven people with MS of South Asian origin were clinically assessed and their Expanded Disability Status Scale scores and Multiple Sclerosis Severity Score recorded. The overall severity of MS in this cohort appeared to be similar to that of the severity of MS in the UK. However, a significant number of patients experienced a rapid disease progression at a young age. Our observations indicate a potentially more severe clinical course in the South Asian population with MS suggesting the need for future well-designed studies in order to confirm or refute these results.

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This thesis consists of a literature review and a research project investigating fitness to drive in people with multiple sclerosis (MS). Driving ability is often affected in individuals with neurological conditions, but assessment methods for determining safety to drive are inconsistent and lack evidence-base. The literature review explored a range of factors that may be related to driving ability in individuals with MS. Studies have mostly emphasised the importance of cognitive abilities when assessing fitness to drive in this population. Findings were presented according to a comprehensive model of driving and clinical implications were summarised. Suggestions for future research in this area were formulated. The research report presented a study examining the concurrent validity of two neuropsychological batteries that have been previously validated against an on-road test. The MS-Driver’s Screening Assessment (MSDSA) has been specifically developed for people with MS, whereas the Rookwood Driving Battery (RDB) has been developed for all neurological conditions and it is widely used in clinical practice. This study also explored whether individual subtests of each battery could predict either pass/fail classifications or overall scores. Twenty-nine individuals with MS were recruited via their clinicians and completed both batteries. There was moderate agreement between MSDSA and RDB for pass/fail classifications. The MSDSA could better identify individuals who may be unsafe to drive compared to the RDB. It was established that attention, visuospatial and executive abilities are predictive of driving ability in this population. Methodological limitations were presented and a larger study was recommended to compare discrepancies between the two batteries against an on-road test.

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