Amyotrophic Lateral Sclerosis and Its Management during the COVID-19 Pandemic: A Qualitative Study with Thematic Analysis of Patients and Caregivers Who Participated in Self-Help Groups
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design
2.2. Participants
3. Results
3.1. The ALS Patients
3.1.1. The Impact of the Pandemic
3.1.2. Dealing with ALS
3.1.3. Online Support
3.2. The Family Carers
3.2.1. The Impact of the Pandemic
3.2.2. The Burden of Care
3.2.3. Online Support
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Morris, J. Amyotrophic lateral sclerosis (ALS) and related motor neuron diseases: An overview. Neurodiagn. J. 2015, 55, 180–194. [Google Scholar] [CrossRef] [PubMed]
- Hardiman, O.; van den Berg, L.H.; Kiernan, M.C. Clinical diagnosis and management of amyotrophic lateral sclerosis. Nat. Rev. Neurol. 2011, 7, 639–649. [Google Scholar] [CrossRef]
- Burke, T.; Wilson O’Raghallaigh, J.; Maguire, S.; Galvin, M.; Heverin, M.; Hardiman, O.; Pender, N. Group interventions for amyotrophic lateral sclerosis caregivers in Ireland: A randomised controlled trial protocol. BMJ Open 2019, 9, e030684. [Google Scholar] [CrossRef] [PubMed]
- Zarei, S.; Carr, K.; Reiley, L.; Diaz, K.; Guerra, O.; Altamirano, P.F.; Pagani, W.; Lodin, D.; Orozco, G.; Chinea, A. A comprehensive review of amyotrophic lateral sclerosis. Surg. Neurol. Int. 2015, 6, 171. [Google Scholar] [PubMed]
- Oh, J.; Kim, J.-A.; Chu, M.S. Family caregiver suffering in caring for patients with amyotrophic lateral sclerosis in Korea. Int. J. Environ. Res. Public Health 2021, 18, 4937. [Google Scholar] [CrossRef]
- Gunton, A.; Hansen, G.; Schellenberg, K.L. Photovoice as a participatory research tool in amyotrophic lateral sclerosis. J. Neuromuscul. Dis. 2021, 8, 91–99. [Google Scholar] [CrossRef] [PubMed]
- Pinto, C.; Geraghty, A.W.A.; Yardley, L.; Dennison, L. Emotional distress and well-being among people with motor neurone disease (MND) and their family caregivers: A qualitative interview study. BMJ Open 2021, 11, e044724. [Google Scholar] [CrossRef] [PubMed]
- Ozanne, A.O.; Graneheim, U.H.; Strang, S. Finding meaning despite anxiety over life and death in amyotrophic lateral sclerosis patients. J. Clin. Nurs. 2013, 22, 2141–2149. [Google Scholar] [CrossRef]
- Yuan, M.-M.; Peng, X.; Zeng, T.-Y.; Wu, M.-L.-Y.; Chen, Y.; Zhang, K.; Wang, X.Y. The illness experience for people with amyotrophic lateral sclerosis: A qualitative study. J. Clin. Nurs. 2021, 30, 1455–1463. [Google Scholar] [CrossRef]
- Galvin, M.; Gaffney, R.; Corr, B.; Mays, I.; Hardiman, O. From first symptoms to diagnosis of amyotrophic lateral sclerosis: Perspectives of an Irish informal caregiver cohort—A thematic analysis. BMJ Open 2017, 7, e014985. [Google Scholar] [CrossRef]
- Harris, M.; Thomas, G.; Thomas, M.; Cafarella, P.; Stocks, A.; Greig, J.; McEvoy, R.D. Supporting wellbeing in motor neurone disease for patients, carers, social networks, and health professionals: A scoping review and synthesis. Palliat. Support. Care 2018, 16, 228–327. [Google Scholar] [CrossRef]
- Oh, J.; Kim, J.A. Supportive care needs of patients with amyotrophic lateral sclerosis/motor neuron disease and their caregivers: A scoping review. J. Clin. Nurs. 2017, 26, 4129–4152. [Google Scholar] [CrossRef]
- Gladman, M.; Zinman, L. The economic impact of amyotrophic lateral sclerosis: A systematic review. Expert Rev. Pharmacoecon. Outcomes Res. 2015, 15, 439–450. [Google Scholar] [CrossRef]
- Tang, S.; Li, L.; Xue, H.; Cao, S.; Li, C.; Han, K.; Wang, B. Caregiver burden and associated factors among primary caregivers of patients with ALS in home care: A cross-sectional survey study. BMJ Open 2021, 11, e050185. [Google Scholar] [CrossRef]
- Conroy, É.; Kennedy, P.; Heverin, M.; Leroi, I.; Mayberry, E.; Beelen, A.; Stavroulakis, T.; van den Berg, L.H.; McDermott, C.J.; Hardiman, O.; et al. Informal caregivers in amyotrophic lateral sclerosis: A multi-centre, exploratory study of burden and difficulties. Brain Sci. 2021, 11, 1094. [Google Scholar] [CrossRef]
- Giusiano, S.; Peotta, L.; Iazzolino, B.; Mastro, E.; Arcari, M.; Palumbo, F.; Torrieri, M.C.; Bombaci, A.; Grassano, M.; Cabras, S.; et al. Amyotrophic lateral sclerosis caregiver burden and patients’ quality of life during COVID-19 pandemic. Amyotroph. Lateral Scler. Front. Degener. 2021, 23, 146–148. [Google Scholar] [CrossRef] [PubMed]
- Lacey, R.E.; McMunn, A.; Webb, E.A. Informal caregiving and metabolic markers in the UK Household Longitudinal Study. Maturitas 2018, 109, 97–103. [Google Scholar] [CrossRef] [PubMed]
- Pagnini, F.; Rossi, G.; Lunetta, C.; Banfi, P.; Castelnuovo, G.; Corbo, M.; Molinari, E. Burden, depression, and anxiety in caregivers of people with amyotrophic lateral sclerosis. Psychol. Health Med. 2010, 15, 685–693. [Google Scholar] [CrossRef]
- Toze, M.; Ray, M.; George, T.; Sisson, K.; Nelson, D. End of life care for long-term neurological conditions: A meta-ethnographic review of the experiences of informal carers. Palliat. Med. 2021, 35, 335–354. [Google Scholar] [CrossRef]
- Schischlevskij, P.; Cordts, I.; Günther, R.; Stolte, B.; Zeller, D.; Schröter, C.; Weyen, U.; Regensburger, M.; Wolf, J.; Schneider, I.; et al. Informal caregiving in amyotrophic lateral sclerosis (ALS): A high caregiver burden and drastic consequences on caregivers’ lives. Brain Sci. 2021, 11, 748. [Google Scholar] [CrossRef] [PubMed]
- D’Alvano, G.; Buonanno, D.; Passaniti, C.; De Stefano, M.; Lavorgna, L.; Tedeschi, G.; Siciliano, M.; Trojsi, F. Support needs and interventions for family caregivers of patients with amyotrophic lateral sclerosis (ALS): A narrative review with report of telemedicine experiences at the time of COVID-19 pandemic. Brain Sci. 2021, 12, 49. [Google Scholar] [CrossRef] [PubMed]
- Gentili, D.; Deiana, G.; Chessa, V.; Calabretta, A.; Marras, E.; Solinas, C.; Gugliotta, C.; Azara, A. Quality of Life in Amyotrophic Lateral Sclerosis Patients and Care Burden of Caregivers in Sardinia during COVID-19 Pandemic. Healthcare 2023, 11, 1641. [Google Scholar] [CrossRef]
- Onyeaka, H.; Anumudu, C.K.; Al-Sharify, Z.T.; Egele-Godswill, E.; Mbaegbu, P. COVID-19 pandemic: A review of the global lockdown and its far-reaching effects. Sci. Prog. 2021, 104, 368504211019854. [Google Scholar] [CrossRef] [PubMed]
- Ahmed, S.T.; Singh, D.K.; Basha, S.M.; Abouel Nasr, E.; Kamrani, A.K.; Aboudaif, M.K. Neural network based mental depression identification and sentiments classification technique from speech signals: A COVID-19 Focused Pandemic Study. Front. Public Health 2021, 9, 781827. [Google Scholar] [CrossRef] [PubMed]
- Consonni, M.; Telesca, A.; Dalla Bella, E.; Bersano, E.; Lauria, G. Amyotrophic lateral sclerosis patients’ and caregivers’ distress and loneliness during COVID-19 lockdown. J. Neurol. 2021, 268, 420–423. [Google Scholar] [CrossRef] [PubMed]
- Testoni, I.; Palazzo, L.; Pompele, S.; De Vincenzo, C.; Perardi, M.; Ronconi, L. Coping and managing ALS disease in the family during COVID-19: Caregivers’ perspective. OBM Neurobiol. 2023, 7, 165. [Google Scholar] [CrossRef]
- Esselin, F.; De La Cruz, E.; Pageot, N.; Juntas-Moralès, R.; Alphandéry, S.; Camu, W. Increased worsening of amyotrophic lateral sclerosis patients during COVID-19-related lockdown in France. Amyotroph. Lateral Scler. Front. Degener. 2021, 22, 505–507. [Google Scholar] [CrossRef]
- Bacanoiu, M.; Danoiu, M.; Marin, M.; Rusu, M.R.; Rusu, L. New recovery strategies in motor and cognitive functions, before, during and after home-confinement COVID-19, for healthy adults and patients with neurodegenerative diseases: Review. J. Clin. Med. 2022, 11, 597. [Google Scholar] [CrossRef]
- Grande, A.J.; Keogh, J.; Silva, V.; Scott, A.M. Exercise versus no exercise for the occurrence, severity, and duration of acute respiratory infections. Cochrane Database Syst. Rev. 2020, 4, CD010596. [Google Scholar] [CrossRef] [PubMed]
- Ammar, A.; Boukhris, O.; Halfpaap, N.; Labott, B.K.; Langhans, C.; Herold, F.; Grässler, B.; Müller, P.; Trabelsi, K.; Chtourou, H.; et al. Four weeks of detraining induced by COVID-19 reverse cardiac improvements from eight weeks of Fitness-Dance training in older adults with mild cognitive impairment. Int. J. Environ. Res. Public Health 2021, 18, 5930. [Google Scholar] [CrossRef]
- De Marchi, F.; Gallo, C.; Sarnelli, M.F.; De Marchi, I.; Saraceno, M.; Cantello, R.; Mazzini, L. Accelerated early progression of amyotrophic lateral sclerosis over the COVID-19 pandemic. Brain Sci. 2021, 11, 1291. [Google Scholar] [CrossRef] [PubMed]
- Vasta, R.; Moglia, C.; D’Ovidio, F.; Di Pede, F.; De Mattei, F.; Cabras, S.; Peotta, L.; Iazzolino, B.; Giusiano, S.; Manera, U.; et al. Telemedicine for patients with amyotrophic lateral sclerosis during COVID-19 pandemic: An Italian ALS referral center experience. Amyotroph. Lateral Scler. Front. Degener. 2021, 22, 308–311. [Google Scholar] [CrossRef]
- Bombaci, A.; Abbadessa, G.; Trojsi, F.; Leocani, L.; Bonavita, S.; Lavorgna, L. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail. Neurol. Sci. 2021, 42, 9–13. [Google Scholar] [CrossRef] [PubMed]
- Capozzo, R.; Zoccolella, S.; Musio, M.; Barone, R.; Accogli, M.; Logroscino, G. Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: Results from Southern Italy. Amyotroph. Lateral Scler. Front. Degener. 2020, 21, 542–548. [Google Scholar] [CrossRef] [PubMed]
- Camic, P.M.; Rhodes, J.E.; Yardley, L. Qualitative Research in Psychology: Expanding Perspectives in Methodology and Design, 1st ed.; American Psychological Association: Washington, DC, USA, 2003. [Google Scholar]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef]
- Boyatzis, R.E. Transforming Qualitative Information: Thematic Analysis and Code Development; SAGE Publications: Thousand Oaks, CA, USA, 1998. [Google Scholar]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Clarke, V.; Braun, V.; Hayfield, N. Thematic analysis. In Qualitative Psychology: A Practical Guide to Research Methods; Smith, J.A., Ed.; SAGE Publications: London, UK, 2015; pp. 222–248. [Google Scholar]
- Gibbs, G.R. Media review: Atlas. Ti software to assist with the qualitative analysis of data. J. Mix. Methods Res. 2007, 1, 103–104. [Google Scholar] [CrossRef]
- Musson, L.S.; Collins, A.; Opie-Martin, S.; Bredin, A.; Hobson, E.V.; Barkhouse, E.; Coulson, M.C.; Stavroulakis, T.; Gould, R.L.; Al-Chalabi, A.; et al. Impact of the COVID-19 pandemic on amyotrophic lateral sclerosis care in the UK. Amyotroph. Lateral Scler. Front. Degener. 2022, 24, 91–99. [Google Scholar] [CrossRef] [PubMed]
- Andrews, J.A.; Berry, J.D.; Baloh, R.H.; Carberry, N.; Cudkowicz, M.E.; Dedi, B.; Glass, J.; Maragakis, N.J.; Miller, T.M.; Paganoni, S.; et al. Amyotrophic lateral sclerosis care and research in the United States during the COVID-19 pandemic: Challenges and opportunities. Muscle Nerve 2020, 62, 182–186. [Google Scholar] [CrossRef]
- Pinto, S.; Quintarelli, S.; Silani, V. New technologies and amyotrophic lateral sclerosis—Which step forward rushed by the COVID-19 pandemic? J. Neurol. Sci. 2020, 418, 117081. [Google Scholar] [CrossRef]
- Burke, T.; Hardiman, O.; Pinto-Grau, M.; Lonergan, K.; Heverin, M.; Tobin, K.; Staines, A.; Galvin, M.; Pender, N. Longitudinal predictors of caregiver burden in amyotrophic lateral sclerosis: A population-based cohort of patient-caregiver dyads. J. Neurol. 2018, 265, 793–808. [Google Scholar] [CrossRef]
- Petrini, M.; Cirulli, F.; D’Amore, A.; Masella, R.; Venerosi, A.; Carè, A. Health issues and informal caregiving in Europe and Italy. Ann. Ist. Super. Sanitą 2019, 55, 41–50. [Google Scholar]
- De Wit, J.; Bakker, L.A.; van Groenestijn, A.C.; van den Berg, L.H.; Schröder, C.D.; Visser-Meily, J.M.; Beelen, A. Caregiver burden in amyotrophic lateral sclerosis: A systematic review. Palliat. Med. 2018, 32, 231–245. [Google Scholar] [CrossRef]
- Ammar, A.; Chtourou, H.; Boukhris, O.; Trabelsi, K.; Masmoudi, L.; Brach, M.; Bouaziz, B.; Bentlage, E.; How, D.; Ahmed, M.; et al. COVID-19 home confinement negatively impacts social participation and life satisfaction: A worldwide multicenter study. Int. J. Environ. Res. Public Health 2020, 17, 6237. [Google Scholar] [CrossRef]
- Testoni, I.; Palazzo, L.; Tosatto, T.; Sani, L.; Rossi, G.; Ferizoviku, J. Facing amyotrophic lateral sclerosis under lockdown: The experiences of minors. In Facing Death: Familial Responses to Illness and Death; Emerald Publishing: Bingley, UK, 2022; pp. 19–36. [Google Scholar]
- Cabona, C.; Ferraro, P.M.; Meo, G.; Roccatagliata, L.; Schenone, A.; Inglese, M.; Villano, F.; Caponnetto, C. Predictors of self-perceived health worsening over COVID-19 emergency in ALS. Neurol. Sci. 2021, 42, 1231–1236. [Google Scholar] [CrossRef] [PubMed]
- Edgar, S.; Abdul-Aziz, N.A.; Loh, E.C.; Capelle, D.; Goh, K.; Latif, L.A.; Shahrizaila, N.; Ahmad-Annuar, A. A survey on patients’ disease perception and the impact of the COVID-19 pandemic on persons living with amyotrophic lateral sclerosis in Malaysia. Neurodegener. Dis. Manag. 2021, 11, 307–314. [Google Scholar] [CrossRef] [PubMed]
- Harris, D.A.; Jack, K.; Wibberley, C. The meaning of living with uncertainty for people with motor neurone disease. J. Clin. Nurs. 2018, 27, 2062–2071. [Google Scholar] [CrossRef] [PubMed]
- Van Dyke, B.; Kim, M.; Thorn, B. Longitudinal relationships between perceived social support and quality-of-life among patients with chronic pain. J. Pain 2018, 19, S39. [Google Scholar] [CrossRef]
- Testoni, I.; Palazzo, L.; Pamini, S.; Ferizoviku, J.; Boros, A.; Calvo, V. Amyotrophic lateral sclerosis (ALS) impact on minors’ life: A qualitative study with children of ALS patients in Italy. J. Loss Trauma 2023, 28, 472–483. [Google Scholar] [CrossRef]
- Sharbafshaaer, M.; Buonanno, D.; Passaniti, C.; De Stefano, M.; Esposito, S.; Canale, F.; D’Alvano, G.; Silvestro, M.; Russo, A.; Tedeschi, G.; et al. Psychological support for family caregivers of patients with amyotrophic lateral sclerosis at the time of the Coronavirus disease 2019 pandemic: A pilot study using a telemedicine approach. Front. Psychiatry 2022, 13, 904841. [Google Scholar] [CrossRef] [PubMed]
- Aoun, S.M.; Connors, S.L.; Priddis, L.; Breen, L.J.; Colyer, S. Motor Neurone Disease family carers’ experiences of caring, palliative care and bereavement: An exploratory qualitative study. Palliat. Med. 2012, 26, 842–850. [Google Scholar] [CrossRef] [PubMed]
- Bentley, B.; O’Connor, M. The end-of-life experiences of people with motor neuron disease: Family carers’ perspectives. J. Palliat. Med. 2016, 19, 857–862. [Google Scholar] [CrossRef] [PubMed]
- Testoni, I.; Lazzarotto Simioni, J.; Di Lucia Sposito, D. Representation of death and social management of the limit of life: Between resilience and irrationalism. Nutr. Ther. Metab. 2013, 31, 192–198. [Google Scholar] [CrossRef]
- Testoni, I.; Sposito, D.D.; De Cataldo, L.; Ronconi, L. Life at all costs? Italian social representations of end-of-life decisions after president napolitano’s speech—Margin notes on withdrawing artificial nutrition and hydration. Nutr. Metab. 2014, 32, 121–135. [Google Scholar] [CrossRef]
- Testoni, I.; Antonellini, M.; Ronconi, L.; Biancalani, G.; Neimeyer, R.A. Spirituality and meaning-making in bereavement: The role of social validation. J. Loss Trauma 2022, 27, 351–366. [Google Scholar] [CrossRef]
- Ronconi, L.; Testoni, I.; Zamperini, A. Validation of the Italian version of the reasons for living inventory. TPM 2009, 16, 151–159. [Google Scholar]
- Flemming, K.; Turner, V.; Bolsher, S.; Hulme, B.; McHugh, E.; Watt, I. The experiences of, and need for, palliative care for people with motor neurone disease and their informal caregivers: A qualitative systematic review. Palliat. Med. 2020, 34, 708–730. [Google Scholar] [CrossRef] [PubMed]
- Cipolletta, S.; Amicucci, L. The family experience of living with a person with amyotrophic lateral sclerosis: A qualitative study: Family Experience in ALS. Int. J. Psychol. 2015, 50, 288–294. [Google Scholar] [CrossRef]
- Testoni, I.; Palazzo, L.; Calamarà, N.; Rossi, G.; Wieser, M.A. “Imagine You Have ALS”: Death Education to Prepare for Advance Treatment Directives. Behav. Sci. 2021, 11, 6. [Google Scholar] [CrossRef]
- Ray, R.A.; Brown, J.; Street, A.F. Dying with motor neurone disease, what can we learn from family caregivers. Health Expect. 2014, 17, 466–476. [Google Scholar] [CrossRef]
- O’Brien, M.R.; Clark, D. Spirituality and/or religious faith: A means for coping with the effects of amyotrophic lateral sclerosis/motor neuron disease? Palliat. Support. Care 2015, 13, 1603–1614. [Google Scholar] [CrossRef]
- Testoni, I.; Palazzo, L.; Ronconi, L.; Macelloni, T.; Calvo, V. Strengths and weaknesses of children witnessing relatives with amyotrophic lateral sclerosis. Children 2023, 10, 140. [Google Scholar] [CrossRef]
- Arslan, G.; Yıldırım, M. Meaning-based coping and spirituality during the COVID-19 pandemic: Mediating effects on subjective well-being. Front. Psychol. 2021, 12, 646572. [Google Scholar] [CrossRef]
- Do Nascimento, F.A.B.; da Silva, G.P.F.; Prudente, G.F.G.; Mesquita, R.; Pereira, E.D.B. Assessment of religious coping in patients with COPD. J. Bras. Pneumol. 2019, 46, e20180150. [Google Scholar] [CrossRef] [PubMed]
- Biancalani, G.; Azzola, C.; Sassu, R.; Marogna, C.; Testoni, I. Spirituality for coping with the trauma of a loved one’s death during the COVID-19 pandemic: An Italian qualitative study. Pastoral. Psychol. 2022, 71, 173–185. [Google Scholar] [CrossRef] [PubMed]
- Marchica, B.; Rosellini, F.; Iacona, E.; Wieser, M.A.; Testoni, I. Spiritual counseling during the COVID-19 pandemic in Italy: A qualitative study. Pastoral. Psychol. 2022, 71, 233–244. [Google Scholar] [CrossRef] [PubMed]
Fictitious Name | Gender | Age | City of Residence | Degree | Employment | Family Relation with ALS Patient | Deceased Family Member |
---|---|---|---|---|---|---|---|
Floriana | F | 47 | Milan | Graduated | Employed | Spouse | |
Beatrice | F | 53 | Milan | High school diploma | Housewife | Mother | x |
Giorgia | F | 52 | Milan | Graduated | Self-employed | Spouse | |
Matteo | M | 68 | Pisa | Graduated | Company director | Spouse | x |
Giulia | F | 46 | Milan | Graduated | Teacher | Mother | x |
Roberta | F | 41 | Milan | Graduated | Manager | Father | x |
Marco | M | 76 | Milan | Graduated | Manager | Spouse | |
Angelica | F | 73 | Milan | High school diploma | Retired | Spouse | |
Chiara | F | 47 | Milan | Graduated | Nurse | Mother | x |
Lucia | F | 60 | Empoli | High school diploma | Employed | Father | |
Erica | F | 66 | Borgo S. Lorenzo (Florence) | High school diploma | Retired | Spouse | |
Sara | F | 58 | Empoli | High school diploma | Employed | Spouse | x |
Fictitious Name | Gender | Age | City of Residence | Degree | Employment | Stage of ALS | Time of Diagnosis |
---|---|---|---|---|---|---|---|
Massimo | M | 55 | Milan | Graduated | Lawyer | Advanced stage (Non-Invasive Ventilation h24) | October 2018 |
Lorenzo | M | 45 | Milan | Ph.D. | Researcher and University Professor | Initial stage (slow progression) | July 2019 |
Tommaso | M | 63 | Florence | High school diploma | Company director | Advanced stage (Palliative care activated) | June 2020 |
ALS Patients | Exemplars |
---|---|
Impact of the pandemic |
|
ALS management |
|
Online support |
|
Family Carers | Exemplars |
---|---|
Impact of the pandemic |
|
Burden of care |
|
Online support |
|
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Palazzo, L.; Pizzolato, L.; Rigo, M.; Bondì, G. Amyotrophic Lateral Sclerosis and Its Management during the COVID-19 Pandemic: A Qualitative Study with Thematic Analysis of Patients and Caregivers Who Participated in Self-Help Groups. Behav. Sci. 2023, 13, 822. https://doi.org/10.3390/bs13100822
Palazzo L, Pizzolato L, Rigo M, Bondì G. Amyotrophic Lateral Sclerosis and Its Management during the COVID-19 Pandemic: A Qualitative Study with Thematic Analysis of Patients and Caregivers Who Participated in Self-Help Groups. Behavioral Sciences. 2023; 13(10):822. https://doi.org/10.3390/bs13100822
Chicago/Turabian StylePalazzo, Lorenza, Laura Pizzolato, Matteo Rigo, and Giuseppina Bondì. 2023. "Amyotrophic Lateral Sclerosis and Its Management during the COVID-19 Pandemic: A Qualitative Study with Thematic Analysis of Patients and Caregivers Who Participated in Self-Help Groups" Behavioral Sciences 13, no. 10: 822. https://doi.org/10.3390/bs13100822
APA StylePalazzo, L., Pizzolato, L., Rigo, M., & Bondì, G. (2023). Amyotrophic Lateral Sclerosis and Its Management during the COVID-19 Pandemic: A Qualitative Study with Thematic Analysis of Patients and Caregivers Who Participated in Self-Help Groups. Behavioral Sciences, 13(10), 822. https://doi.org/10.3390/bs13100822