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      Needs and Experiences of Children and Adolescents with Pediatric Multiple Sclerosis and Their Caregivers: A Systematic Review

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          Abstract

          In the present study we conduct a systematic review to evaluate the needs and experience of people with pediatric multiple sclerosis (MS) and their caregivers. The literature search was conducted across 10 academic databases, adhering to PRISMA-P guidelines. Quality appraisal was conducted using the mixed method appraisal test for individual studies, and GRADE-CERQual to establish overall confidence of findings. Results were analyzed using a process of narrative synthesis. We identified 26 studies which included 2253 children/adolescents with MS (CAMS) and 1608 caregivers. MS was reported to negatively impact experiences for CAMS in domains such as of school performance, social relationships, mental health, and overall physical functioning. Specifically, fatigue and social support were reported as the most important barriers and facilitators for CAMS, respectively. In terms of caregiver experience, negative impacts were reported on social functioning, mental health, and quality of life. Additionally, lack of awareness concerning MS was one of the biggest challenges reported. Caregivers expressed needs for psychological and social support. This study provides the first evidence regarding the needs and experiences of CAMS and their caregivers. Findings can be used to address policy gaps for supporting families affected by pediatric MS.

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          Beyond PICO: the SPIDER tool for qualitative evidence synthesis.

          Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.
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            Multiple sclerosis--the plaque and its pathogenesis.

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              Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series

              The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners. Electronic supplementary material The online version of this article (10.1186/s13012-017-0688-3) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Children (Basel)
                Children (Basel)
                children
                Children
                MDPI
                2227-9067
                25 May 2021
                June 2021
                : 8
                : 6
                : 445
                Affiliations
                [1 ]School of Physical and Occupational Therapy, McGill University, Montréal, QC H3G 1Y5, Canada
                [2 ]Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital—CISSS Laval, a Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada
                [3 ]Department of Family Medicine, McGill University, Montréal, QC GRM MDI, Canada
                [4 ]European Multiple Sclerosis Platform, 1030 Brussels, Belgium; elisabeth.kasilingam@ 123456emsp.org
                [5 ]Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80138 Naples, Italy; robertalanzillo@ 123456libero.it (R.L.); carotenuto.antonio87@ 123456gmail.com (A.C.)
                [6 ]Department of Child Neurology, Associated Member of the ERN EpiCARE, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia; malenicamasa96@ 123456gmail.com
                [7 ]Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium; vincent.vanpesch@ 123456uclouvain.be
                [8 ]Department of Psychology, Maynooth University, Maynooth W23 F2K8, Ireland; niamh.burke.2019@ 123456mumail.ie (N.C.B.); rebecca.maguire@ 123456mu.ie (R.M.)
                Author notes
                Author information
                https://orcid.org/0000-0002-8779-7408
                https://orcid.org/0000-0001-6388-8180
                https://orcid.org/0000-0003-4950-9038
                https://orcid.org/0000-0003-2885-9004
                https://orcid.org/0000-0002-1574-9693
                https://orcid.org/0000-0002-0368-4626
                Article
                children-08-00445
                10.3390/children8060445
                8226634
                34070298
                1aa40255-d24b-431b-ac8a-58613c47ae0f
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 29 April 2021
                : 23 May 2021
                Categories
                Review

                pediatric multiple sclerosis,caregivers,burden,social support,quality of life

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