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Impact of environmental factors and physical activity on disability and quality of life in CIDP

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Abstract

A few observational studies and randomized trials suggest that exercise and rehabilitation may improve activity limitation and quality of life (QoL) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but the impact of other modifiable factors on the severity of the disease is not well understood. Using a structured questionnaire, we collected data on lifestyle and dietary habits of the patients included in the Italian CIDP database to investigate the possible influence of modifiable lifestyle factors on disability and QoL. Questionnaire data were available for 323 patients. The effect of lifestyle and dietary exposures on impairment, disability and QoL was evaluated using logistic regression models, adjusting for age, sex, disease duration, physical activity and smoking. Physical activity was associated with lower sensory impairment by the ISS scale, less disability by the INCAT and RODS scale and a better QoL in all the domains of EURO-QoL scale with the exception of anxiety/depression. None of the other parameters had an impact on these scales. This study adds evidence to the possible role of physical activity in improving symptom severity, disability and QoL in patients with CIDP. None of the other environmental factors investigated appeared to have an impact on the severity and health perception of CIDP.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon request.

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Acknowledgements

Italian CIDP Database study group: Pietro Emiliano Doneddu, Giuseppe Liberatore, Francesca Gallia, and Eduardo Nobile-Orazio from the Department of Medical Biotechnology and Translational Medicine, Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Institute, Milan University, Rozzano, Milan, Italy; Erdita Peci and Dario Cocito from the Department of Neuroscience, University of Turin, Turin, Italy. Daniele Velardo, Stefano Tronci and Raffaella Fazio from the Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy; Fiore Manganelli, Emanuele Spina, Antonietta Topa and Lucio Santoro from the Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples ‘Federico II’, Naples, Italy; Marta Ruiz and Chiara Briani from the Neurology Unit, Department of Neuroscience, University of Padua, Padua, Italy. Stefano Cotti Piccinelli, Alice Todeschini and Massimiliano Filosto from the Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology ASST ‘Spedali Civili’, University of Brescia, Brescia, Italy; Corrado Cabona, Angela Zuppa and Luana Benedetti from the IRCCS Ospedale Policlinico San Martino, Genova, Italy; Antonio Toscano, Luca Gentile and Anna Mazzeo from the Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy; Giorgia Mataluni and Girolama Alessandra Marfia from the Disimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy; Giuseppe Cosentino, Laura Piccolo, Ilaria Callegari and Andrea Cortese from the University of Pavia, IRCCS Foundation C. Mondino, Pavia, Italy; Elena Pinuccia Verrengia and Stefano Jann from the Department of Neuroscience, Niguarda Ca’ Granda Hospital, Milan, Italy; Elisa Bianchi and Ettore Beghi from the Laboratorio di Malattie Neurologiche, IRCCS-Istituto Mario Negri, Milan, Italy; Angelo Maurizio Clerici from the Neurology Unit, Circolo and Macchi Foundation Hospital, Insubria University, DBSV, Varese, Italy; Federica Scrascia and Marinella Carpo from the ASST Bergamo Ovest-Ospedale Treviglio, Treviglio, Italy; Martina Garnero and Angelo Schenone from the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy; Marco Luigetti from Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Universita’ Cattolica del Sacro Cuore, Roma, Italy; Mario Sabatelli from Centro Clinico NEMO Adulti, Universita’ Cattolica del Sacro Cuore, Roma, Italy; Patrizia Dacci and Giuseppe Lauria from the Unit of Neuroalgology, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy; Luca Leonardi and Giovanni Antonini from the Unit of Neuromuscular Diseases, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Sant’Andrea Hospital, Rome, Italy; Tiziana Rosso from the Azienda UL.SS. 8 Asolo, Castelfranco Veneto, Italy; Erika Schirinzi and Gabriele Siciliano from the Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Claudia Balducci and Guido Cavaletti from the School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.

Funding

The study was supported by a grant from Regione Lombardia, Italy, for patients from this region and subsequently extended to other Italian centers. The study was also supported by unrestricted grants from Kedrion Biopharma (Italy), CSL Behring (Italy), Humanitas Clinical and Research Institute (Milan, Italy), and GBS-CIDP Foundation International (USA). The funders had no role in study design, data collection and analysis, decision to publish, or in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy

    Pietro Emiliano Doneddu, Giuseppe Liberatore & Eduardo Nobile-Orazio

  2. Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Elisa Bianchi & Ettore Beghi

  3. Istituti Clinici Scientifici Maugeri, Turin, Italy

    Dario Cocito

  4. Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples ‘Federico II’, Naples, Italy

    Fiore Manganelli, Emanuele Spina & Lucio Santoro

  5. Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy

    Raffaella Fazio & Stefano Tronci

  6. Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST ‘Spedali Civili’, University of Brescia, Brescia, Italy

    Massimiliano Filosto & Stefano Cotti Piccinelli

  7. Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy

    Anna Mazzeo, Antonio Toscano & Luca Gentile

  8. University of Pavia, Pavia, Italy

    Giuseppe Cosentino, Andrea Cortese & Laura Piccolo

  9. IRCCS Mondino Foundation, Pavia, Italy

    Giuseppe Cosentino, Andrea Cortese & Laura Piccolo

  10. Department of Neuroscience, Niguarda Ca’ Granda Hospital, Milan, Italy

    Stefano Jann

  11. Neurology Unit, Circolo and Macchi Foundation Hospital, DBSV, Insubria University, Varese, Italy

    Angelo Maurizio Clerici

  12. Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Unit of Neuromuscular Diseases, ‘Sapienza’ University of Rome, Sant’Andrea Hospital, Rome, Italy

    Giovanni Antonini & Luca Leonardi

  13. Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy

    Gabriele Siciliano

  14. Department of Systems Medicine, Dysimmune Neuropathies Unit, Tor Vergata University of Rome, Rome, Italy

    Girolama Alessandra Marfia & Giorgia Mataluni

  15. Department of Neuroscience, Neurology Unit, University of Padua, Padua, Italy

    Chiara Briani & Marta Ruiz

  16. Unit of Neuroalgology, IRCCS Foundation ‘Carlo Besta’ Neurological Institute, Milan, Italy

    Giuseppe Lauria

  17. Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy

    Giuseppe Lauria

  18. ULSS2 Marca Trevigiana, UOC Neurologia-Castelfranco Veneto, Treviso, Italy

    Tiziana Rosso

  19. School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy

    Guido Cavaletti

  20. ASST Bergamo Ovest-Ospedale Treviglio, Treviglio, Italy

    Marinella Carpo

  21. IRCCS Ospedale Policlinico San Martino Genova, Genoa, Italy

    Luana Benedetti

  22. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy

    Angelo Schenone

  23. Department of Neuroscience, University of Turin, Turin, Italy

    Erdita Peci

  24. Università Cattolica del Sacro Cuore. Sede di Roma, Rome, Italy

    Mario Sabatelli

  25. Centro Clinico NEMO Adulti, Rome, Italy

    Mario Sabatelli

  26. Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Milan University, Milan, Italy

    Eduardo Nobile-Orazio

Authors
  1. Pietro Emiliano Doneddu
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  2. Elisa Bianchi
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  3. Dario Cocito
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  4. Fiore Manganelli
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  5. Raffaella Fazio
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  6. Massimiliano Filosto
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  7. Ettore Beghi
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  8. Anna Mazzeo
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  9. Giuseppe Cosentino
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  10. Andrea Cortese
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  11. Stefano Jann
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  12. Angelo Maurizio Clerici
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  13. Giovanni Antonini
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  14. Gabriele Siciliano
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  15. Girolama Alessandra Marfia
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  16. Chiara Briani
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  17. Giuseppe Lauria
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  18. Tiziana Rosso
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  19. Guido Cavaletti
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  20. Marinella Carpo
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  21. Luana Benedetti
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  22. Angelo Schenone
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  23. Giuseppe Liberatore
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  24. Erdita Peci
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  25. Emanuele Spina
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  26. Stefano Tronci
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  27. Stefano Cotti Piccinelli
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  28. Antonio Toscano
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  29. Luca Gentile
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  30. Laura Piccolo
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  31. Luca Leonardi
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  32. Giorgia Mataluni
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  33. Marta Ruiz
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  34. Mario Sabatelli
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  35. Lucio Santoro
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  36. Eduardo Nobile-Orazio
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Consortia

the Italian CIDP Database Study Group

  • Pietro Emiliano Doneddu
  • , Giuseppe Liberatore
  • , Francesca Gallia
  • , Eduardo Nobile-Orazio
  • , Erdita Peci
  • , Dario Cocito
  • , Daniele Velardo
  • , Stefano Tronci
  • , Raffaella Fazio
  • , Fiore Manganelli
  • , Emanuele Spina
  • , Antonietta Topa
  • , Lucio Santoro
  • , Marta Ruiz
  • , Chiara Briani
  • , Stefano Cotti-Piccinelli
  • , Alice Todeschini
  • , Massimiliano Filosto
  • , Corrado Cabona
  • , Angela Zuppa
  • , Luana Benedetti
  • , Antonio Toscano
  • , Luca Gentile
  • , Anna Mazzeo
  • , Giorgia Mataluni
  • , Girolama Alessandra Marfia
  • , Giuseppe Cosentino
  • , Laura Piccolo
  • , Ilaria Callegari
  • , Andrea Cortese
  • , Elena Pinuccia Verrengia
  • , Stefano Jann
  • , Elisa Bianchi
  • , Ettore Beghi
  • , Angelo Maurizio Clerici
  • , Federica Scrascia
  • , Marinella Carpo
  • , Martina Garnero
  • , Angelo Schenone
  • , Marco Luigetti
  • , Mario Sabatelli
  • , Patrizia Dacci
  • , Giuseppe Lauria
  • , Luca Leonardi
  • , Giovanni Antonini
  • , Tiziana Rosso
  • , Erika Schirinzi
  • , Gabriele Siciliano
  • , Claudia Balducci
  •  & Guido Cavaletti

Contributions

PED designed and conceptualized the study, had a major role in the acquisition of data, analyzed the data, and wrote the first draft of the manuscript. EBianchi designed and executed the statistical analysis, contributed to the conception, organization, and execution of the research project, and reviewed and commented on the statistical analysis and the report. DC, FM, RF, MF, EBeghi, AM, GC, AC, SJ, AMC, GA, GS, GAM, CB, GL, TR, GC, MC, LB, AS, GL, EP, ES, ST, SCP, AT, LG, LP, EPV, LL, ES, GM, MR, MS and LS contributed to the study conception and design, had a major role inacquisition and interpretation of data and revised the manuscript for intellectual content. ENO conceived, organized and designed the study, reviewed and commented on the statistical analysis and reviewed the report.

Corresponding author

Correspondence to Eduardo Nobile-Orazio.

Ethics declarations

Conflicts of interest

Pietro Emiliano Doneddu has received travel grants to attend scientific meetings from CSL Behring and Kedrion. Dario Cocito has received honoraria for lecturing fromShire, CSL Behring, and Kedrion and travel grants to attend scientific meeting from Shire, Kedrion, and CSL Behring. Fiore Manganelli reports personal fees for scientific events from CSL Behring and has received travel grants to attend scientific meetings from CSL Behring and Kedrion. Raffaella Fazio has served on scientific advisory boards for CSL Behring and has received travel grants from Kedrion and CSL Behring to attend scientific meeting. Chiara Briani has served on scientific advisory boards for Pfizer, Alnylam, and Akcea, and has received travel grants from Kedrion and CSL Behring to attend scientific meeting. Massimiliano Filosto has served on scientific advisory boards for CSL Behring and has received travel grants from Kedrion, Baxter and CSL Behring to attend scientific meeting. Stefano Jann has received research grants from Grifols, outside this work, and travel grants from Grifols and Kedrion. Anna Mazzeo has received travel grants from Kedrion and CSL Behring to attend scientific meeting. Giuseppe Cosentino has received travel grants to attend scientific meetings from CSL Behring and Kedrion. Andrea Cortese has received travel grants to attend scientific meetings from Kedrion. Marinella Carpo has received travel grants to attend scientific meetings from Kedrion. Guido Cavaletti has received honoraria for lecturing and travel grants to attend scientific meetings from Kedrion. Ettore Beghi reports grants from UCB-Pharma, grants from Shire, grants from EISAI, personal fees from Viropharma, grants from Italian Ministry of Health, grants from Fondazione Borgonovo, grants from Associazione IDIC 15 and grants from European Union, outside the submitted work. Giuseppe Liberatore has received travel grants to attend scientific meetings from CSL Behring and Kedrion. Lucio Santoro reports personal fees for scientific events from CSL Behring and has received travel grants to attend scientific meetings from CSL Behring and Kedrion. Erdita Peci has received travel grants to attend scientific meetings from CSL Behring. Eduardo Nobile Orazio reports personal fees for Advisory or Scientific Board from Kedrion, Italy, Baxter, Italy, Novartis, Switzerland, CSL-Behring, Italy, Astellas, the Netherlands, outside the submitted work and travel grants to attend Scientific Meeting from Baxter, Grifols, Kedrion, and Novartis, Italy. The other authors declare no conflict of interest.

Ethics approval

The study was approved by the Ethical Committee of each participating center.

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Written informed consent was obtained from all participants at enrollment.

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Doneddu, P.E., Bianchi, E., Cocito, D. et al. Impact of environmental factors and physical activity on disability and quality of life in CIDP. J Neurol 267, 2683–2691 (2020). https://doi.org/10.1007/s00415-020-09916-y

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  • DOI: https://doi.org/10.1007/s00415-020-09916-y

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