Living with myotonic dystrophy; what can be learned from couples? a qualitative study
- Equal contributors
1 Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation/Occupational Therapy 898, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
2 Leusdenhof 100, 1108 CZ Amsterdam, the Netherlands
3 Department of Occupational Therapy and European Masters of Science in Occupational Therapy, HAN University of Applied Sciences, c/o Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
4 Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation/Physical Therapy 898, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
5 Groot Klimmendaal Arnhem, P.O. Box 9044, 6800 GG Arnhem, the Netherlands
6 Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, 114, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
7 Nijmegen Centre for Evidence Based Practice, Department of Epidemiology, Biostatistics and HTA 133, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
8 Department of Neurology 935, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Citation and License
BMC Neurology 2011, 11:86 doi:10.1186/1471-2377-11-86Published: 13 July 2011
Myotonic dystrophy type 1 (MD1) is one of the most prevalent neuromuscular diseases, yet very little is known about how MD1 affects the lives of couples and how they themselves manage individually and together. To better match health care to their problems, concerns and needs, it is important to understand their perspective of living with this hereditary, systemic disease.
A qualitative study was carried out with a purposive sample of five middle-aged couples, including three men and two women with MD1 and their partners. Fifteen in-depth interviews with persons with MD1, with their partners and with both of them as a couple took place in the homes of the couples in two cities and three villages in the Netherlands in 2009.
People with MD1 associate this progressive, neuromuscular condition with decreasing abilities, describing physical, cognitive and psychosocial barriers to everyday activities and social participation. Partners highlighted the increasing care giving burden, giving directions and using reminders to compensate for the lack of initiative and avoidant behaviour due to MD1. Couples portrayed the dilemmas and frustrations of renegotiating roles and responsibilities; stressing the importance of achieving a balance between individual and shared activities. All participants experienced a lack of understanding from relatives, friends, and society, including health care, leading to withdrawal and isolation. Health care was perceived as fragmentary, with specialists focusing on specific aspects of the disease rather than seeking to understand the implications of the systemic disorder on daily life.
Learning from these couples has resulted in recommendations that challenge the tendency to treat MD1 as a condition with primarily physical impairments. It is vital to listen to couples, to elicit the impact of MD1, as a multisystem disorder that influences every aspect of their life together. Couple management, supporting the self-management skills of both partners is proposed as a way of reducing the mismatch between health services and health needs.