Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis
Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effectiv...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-08-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.00464/full |
| _version_ | 1819209659891843072 |
|---|---|
| author | Nevena Zubcevik Nevena Zubcevik Nevena Zubcevik Charlotte Mao Charlotte Mao Qing Mei Wang Qing Mei Wang Eliezer L. Bose Rose Nadlyne Octavien David Crandell Lisa J. Wood Lisa J. Wood |
| author_facet | Nevena Zubcevik Nevena Zubcevik Nevena Zubcevik Charlotte Mao Charlotte Mao Qing Mei Wang Qing Mei Wang Eliezer L. Bose Rose Nadlyne Octavien David Crandell Lisa J. Wood Lisa J. Wood |
| author_sort | Nevena Zubcevik |
| collection | DOAJ |
| description | Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking.Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability.Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters.Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001).Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies.Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migraine-like, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology. |
| first_indexed | 2024-12-23T05:58:48Z |
| format | Article |
| id | doaj.art-5210ddfe9c2d4584b86f36a70376c784 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-23T05:58:48Z |
| publishDate | 2020-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-5210ddfe9c2d4584b86f36a70376c7842022-12-21T17:57:44ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-08-01710.3389/fmed.2020.00464534202Symptom Clusters and Functional Impairment in Individuals Treated for Lyme BorreliosisNevena Zubcevik0Nevena Zubcevik1Nevena Zubcevik2Charlotte Mao3Charlotte Mao4Qing Mei Wang5Qing Mei Wang6Eliezer L. Bose7Rose Nadlyne Octavien8David Crandell9Lisa J. Wood10Lisa J. Wood11Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United StatesThe Dean Center for Tickborne Illness, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesInvisible International, Cambridge, MA, United StatesThe Dean Center for Tickborne Illness, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesMassachusetts General Hospital, Department of Pediatric Infectious Diseases, Boston, MA, United StatesDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United StatesStroke Biological Recovery Laboratory, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesStroke Biological Recovery Laboratory, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesThe Dean Center for Tickborne Illness, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesThe Dean Center for Tickborne Illness, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United StatesMassachusetts General Hospital, Institute for Health Professions, School of Nursing, Charlestown, MA, United StatesWilliam F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United StatesContext: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking.Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability.Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters.Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001).Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies.Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migraine-like, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology.https://www.frontiersin.org/article/10.3389/fmed.2020.00464/fulllyme borreliosissymptom clusterdisabilityfatigueneurocognitive impairment |
| spellingShingle | Nevena Zubcevik Nevena Zubcevik Nevena Zubcevik Charlotte Mao Charlotte Mao Qing Mei Wang Qing Mei Wang Eliezer L. Bose Rose Nadlyne Octavien David Crandell Lisa J. Wood Lisa J. Wood Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis Frontiers in Medicine lyme borreliosis symptom cluster disability fatigue neurocognitive impairment |
| title | Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis |
| title_full | Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis |
| title_fullStr | Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis |
| title_full_unstemmed | Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis |
| title_short | Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis |
| title_sort | symptom clusters and functional impairment in individuals treated for lyme borreliosis |
| topic | lyme borreliosis symptom cluster disability fatigue neurocognitive impairment |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.00464/full |
| work_keys_str_mv | AT nevenazubcevik symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT nevenazubcevik symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT nevenazubcevik symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT charlottemao symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT charlottemao symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT qingmeiwang symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT qingmeiwang symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT eliezerlbose symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT rosenadlyneoctavien symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT davidcrandell symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT lisajwood symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis AT lisajwood symptomclustersandfunctionalimpairmentinindividualstreatedforlymeborreliosis |