15 May 2010
Paula Viscomi, Janet Jeffrey
Multiple system atrophy (MSA) is a progressive, neurodegenerative
disorder. Among its range of multisystem dysfunctions, manifestation of
highly unstable blood pressure (BP) is often a primary clinical concern
for practitioners and patients.
The ability to manage BP instability has
important implications ranging from patient comfort, safety, and choice
of treatments to the incidental demands placed on a strained health
care system. Many conditions require that patients monitor their BP, yet
no guidelines are available for patients with MSA who have similar
needs.
Utilization of a self-care protocol could assist in planning more
effective care regimens. Additionally, benefits to the patient and the
health care system may also result from using evidence-based clinical
practice guidelines (CPGs) to make patient care decisions.
This paper
describes the process of developing CPGs for patient self-management of
BP instability secondary to MSA. It was guided by theoretical and
practical frameworks such as those developed by the Registered Nurses
Association of Ontario (RNAO). Recommendations include the adoption of
these CPGs for the care of patients coping with orthostatic hypotension
secondary to MSA, Parkinson's disease, and other neurological
conditions.
The paper concludes with additional recommendations for
research, health policy, and clinical practice.
