A test of the relationship between health locus of control and the course of multiple sclerosis

Internal Versus External Frame of Reference in Functional Movement Disorders

OBJECTIVE

The purpose of this study was to determine whether patients with functional movement disorders (FMDs) differ in their internal versus external locus of control (LOC) and whether LOC in these patients affected disease severity, quality of life, and functional impairment compared with control subjects with degenerative (Parkinson's disease) and nondegenerative (focal dystonia) neurological conditions.

METHODS

A total of 156 patients with FMD (N=45), Parkinson's disease (N=64), and focal dystonia (N=47) were recruited between June 2015 and August 2017. The authors administered the general Levenson Multidimensional LOC (LOC-G) and health-specific Multidimensional Health LOC (LOC-H) scales. An internal LOC was represented similarly in both scales: the external LOC included "chance" and "powerful others" in the LOC-G measure and chance, "other people," and "doctors" in the LOC-H measure. Quality of life, functional impairment, and FMD severity were assessed. One-way analysis of variance and adjusted logistic regressions were used, as well as ordinary least-squares between and within groups, respectively.

RESULTS

Patients with FMD had lower external chance LOC-G scores compared with patients in the Parkinson's disease group (odds ratio=0.90, p=0.03) and higher internal (odds ratio=1.22, p=0.01) and lower external (odds ratio=0.77, p=0.02) doctors LOC-H scores compared with patients in the focal dystonia group. External powerful others LOC-G score was associated with functional impairment (regression coefficient=-0.04, p=0.02). There were no effects of LOC on quality of life or disease severity.

CONCLUSIONS

Patients with FMD exhibited high "within our control" internal general and health-specific frame of reference. LOC had no influence on quality of life or disease severity in this patient population.

Psychological factors associated with self-management in multiple sclerosis

OBJECTIVE

Patient's engagement in their own treatment has been shown to improve clinical outcomes. A better understanding of the association between self-management in multiple sclerosis (MS) and potentially modifiable psychological factors may provide clinicians with strategies to design and stimulate better patient activation for self-managing health. Therefore, in this study, we examined whether cognitive factors, namely self-efficacy, acceptance of illness, optimism, and health locus of control (HLC), are associated with self-management in MS.

METHODS

This is a cross-sectional study. A total of 382 patients with MS who completed the MS Self-Management Scale-Revised and the questionnaires that measure self-efficacy, optimism, illness acceptance, and HLC were included in the study.

RESULTS

A hierarchical multiple regression revealed that power of others' HLC (b = 0.42, P ≤ .001), optimism (b = 0.27, P ≤ .01), internal HLC (b = -0.11, P = .017), and self-efficacy (b = 0.11, P = .031), together with control variables (longer disease duration and higher disability), explained 30% of the variance in the dependent variable.

CONCLUSIONS

In the case of MS, self-management is associated with patient's perception that healthcare professionals control their health, higher self-efficacy, optimism, and, surprisingly, lower internal HLC. The results of this study indicate the vital role of the healthcare staff in encouraging the patients with MS toward activities related to self-management and provide new insights on the psychological intervention aimed at improving self-management by patients.

Perspectives of individuals with multiple sclerosis on discontinuation of disease-modifying therapies

BACKGROUND

Therapeutic research in multiple sclerosis (MS) has focused on the development of treatments with little investigation regarding the possibility of discontinuation of disease-modifying therapies (DMTs).

OBJECTIVE

To understand the opinion of individuals with MS concerning stopping DMTs and the factors that influence the decision-making process.

METHODS

A mixed method approach was used starting with three focus groups from which a survey was developed. This survey was sent to 1000 participants in the North American Research Committee on Multiple Sclerosis registry who met inclusion criteria (age ⩾45 years; on most recent DMT for ⩾5 years). Descriptive analysis and structural equation modeling were used.

RESULTS

Of 1000 participants receiving the survey, 377 provided complete responses and met inclusion criteria. Only 11.9% of participants reported that if their disease was considered stable, they would consider coming off medications. A high level of external locus of control in influential others such as physicians significantly decreased the likelihood of considering discontinuation.

CONCLUSIONS

Most individuals with MS report being unlikely to consider stopping MS therapy if their disease was considered "non-active." As the results of studies concerning DMT discontinuation are obtained, information from providers will be an important part of individuals' decision-making process.

Quality of life and psychological well-being in the early stages of multiple sclerosis (MS): Importance of adopting a biopsychosocial model

BACKGROUND

Reductions in quality of life (QOL) exist among individuals with multiple sclerosis (MS).

OBJECTIVE

The present investigation aimed to adopt a biopsychosocial model in examining QOL in the early stages of MS.

METHODS

Individuals with MS (34 with average to low QOL and 35 with high QOL) were compared on measures of disease symptoms, psychological functioning, personality, self-efficacy, locus of control (LOC), social support, and coping to determine the most salient predictors of QOL.

RESULTS

Individuals were matched on disease course and duration. Individuals with lower QOL reported more fatigue, sleep problems, pain, depression, and anxiety (d = 0.83-1.49, p's < 0.001). They also reported lower levels of self-efficacy, LOC, and social support (d = 0.75-1.50 p's < 0.01). They indicated higher levels of neuroticism (d = 1.31, p < .001) and lower levels of extraversion (d = 1.21, p < .001) and reported greater levels of disengagement as a means of coping (d = 0.75, p = .002). Those with high QOL endorsed more use of adaptive coping (d = 0.52 - 0.86, p's < 0.05). When taken together, LOC and anxiety were the most significant predictors, accounting for 40% of the variance.

CONCLUSION

Even early on in the illness, there exists differing levels of QOL. Identifying the psychological and social variables as well as the disease related factors is important, and in this case, may make a much greater contribution. Efforts to assure routine assessment and effective intervention aimed at these factors are warranted, particularly as an early intervention to assure maintenance/improvement in QOL among individuals with MS.

A review of stress-relapse interactions in multiple sclerosis: important features and stress-mediating and -moderating variables

Studies do not provide a consensus opinion of the relationship between stress and relapse in relapsing=remitting multiple sclerosis (RRMS). Few studies have defined the critical features of these stressful situations, or examined the role of stress-mediating and -moderating variables. Available evidence indicates that the relationship between life stress and relapse is complex, and is likely to depend on factors such as stressor chronicity, frequency, severity and type, and individual patient characteristics such as depression, health locus of control and coping strategy use. Little is known about how these factors, individually or in combination, are related to MS disease activity. Viral infections are also likely to precipitate relapse in MS, and significant life-stress may further enhance this relationship. The nature and strength of these interrelationships have strong clinical implications. MS patients are particularly vulnerable to a deteriorating cycle of stressful life events, illness episodes and disability. Timely multidisciplinary care interventions aimed at both minimizing psychological distress and physical symptoms may halt this downward reciprocal cycle. Little is known of the pathogenesis of these putative stress-induced changes in disease activity, and almost all stressor studies suffer from some biases or limitations.

How fatigue influences exercise participation in men with multiple sclerosis

Researchers have suggested that men with multiple sclerosis (MS) experience lower self-efficacy than women with MS and have linked women's self-efficacy with a sense of perceived control over symptoms and activities. Self-efficacy—the belief in one's own ability to achieve an outcome—has also been linked to engagement in healthy behaviors such as exercise. We sampled men with MS to better understand how MS-related fatigue influences exercise participation. Guided by the interpretive description method, we interviewed 18 men about their fatigue and exercise experiences. One overarching theme and three subthemes were developed through multiple readings, author comparisons, and participant reflections. The men described a process of goal readjustment with regard to exercise that helped them stay engaged in meaningful physical activity despite fatigue. Health care professionals might consider introducing goal readjustment strategies to help men with MS-related fatigue retain perceived control over exercise engagement and achieve greater self-efficacy.

Employment status in multiple sclerosis: impact of disease-specific and non-disease-specific factors

Background:

Multiple sclerosis (MS) is associated with high rates of early retirement (ER).

Objectives:

A German cohort of MS patients and healthy control subjects (HCs) were compared cross-sectionally to investigate disease- and non-disease-specific factors that are associated with employment status (ES) in MS and to identify predictors of ES in MS.

Methods:

A total of 39 ER MS patients, 48 employed MS patients, and 37 HCs completed a brief neuropsychological battery and questionnaires related to depressive symptoms, fatigue, health-related quality of life (HrQoL) and health locus of control (HLC). Neurological disability was assessed by the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC).

Results:

ER compared with employed MS patients scored significantly higher in neurological disability, depressive symptoms and fatigue and significantly lower in cognitive functioning and HrQoL. Further, both groups differed with regard to age, education, disease course and duration but not in HLC. Neurological disability, age and fatigue were identified as significant predictors of ES in MS.

Conclusions:

ES in MS was associated with demographic aspects, neurological and cognitive status, depressive symptoms, fatigue and HrQoL but was not associated with HLC. Findings confirm neurological disability, age and fatigue as independent predictors of ES in MS.

The Gap in the Current Research on the Link between Health Locus of Control and Multiple Sclerosis: Lessons and Insights from a Systematic Review

Multiple sclerosis (MS) is a chronic neurological disease whose etiology has not been fully understood yet in detail. Empirical findings show how psychosocial symptoms are very important features of the clinical presentation of MS, having a deep impact on patient's quality of life, and thus psychological coping strategies may play a central role in reducing the burden of the disease and improving patient's satisfaction of life. MS progression and relapses/exacerbations are unpredictable and may depend on factors such as stressor chronicity, frequency, severity, type, and individual patient characteristics such as depression, personality, locus of control (LOC), optimism, and perceived social support. Due to its importance for health-care delivery, rehabilitation, and nursing, here, we make a systematic review on the current state-of-the-art studies concerning the relationship between LOC and MS, according to the PRISMA guidelines, and we assess the quality and the completeness of the studies using the CONSORT instrument, underpinning their limitations, and suggesting how to fill the gap in this research field.

Factors affecting anxiety in multiple sclerosis

PURPOSE

Anxiety is common in people with multiple sclerosis (MS). Little is known about the factors related to anxiety. The aim was to identify factors associated with the presence of anxiety.

METHODS

This was a cohort study. Participants were sent questionnaires to measure factors potentially related to anxiety. The factors included disability, depression, self-efficacy, locus of control, general stress, psychological distress and factors specific to MS. Participants with significant levels of anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS), were compared to those who were not anxious.

RESULTS

Of the 157 participants who took part, 89 (57%) were clinically anxious. Participants who were anxious had a lower level of self-efficacy (p < 0.001), higher level of disability (p < 0.001), higher level of depression (p < 0.001) and higher level of stress (p < 0.001). The regression analysis showed that experiencing depression (χ(2) = 5.05, OR = 1.32, p < 0.05) was the only factor that significantly predicted whether someone was anxious or not, accounting for 46% of the variance.

CONCLUSION

There was a high prevalence of anxiety in people with MS. Depression, low levels of self-efficacy, disability and stress increased the likelihood of experiencing anxiety.

How does exercise influence fatigue in people with multiple sclerosis?

PURPOSE

This study explored the influence of an 8-week exercise programme on fatigue perceptions in people with multiple sclerosis (MS).

METHOD

Eight women and two men with a confirmed diagnosis of MS participated three times a week in an 8-week exercise programme at a physiotherapy gymnasium. Participants were interviewed at three defined time points. Interviews were transcribed, analysed, and emergent categories were subject to verification by three independent sources.

RESULTS

Five interrelated categories were identified from the data. The category, 'listening to your body' evolved from the participants' 'perceived control over fatigue', which subsequently defined the 'reaching the edge'; a critical point at which the 'nature of tiredness' perceived by participants following exercise was either healthy or unhealthy. This critical point consequently explained either perceived positive 'exercise outcomes' outcomes of physical improvement and wellbeing or perceived physical deterioration and negative feelings.

CONCLUSION

This study details the positive and negative influences of exercise on fatigue perceptions in people with MS. Healthcare professionals therefore, need to be cognisant of strategies which may enhance 'perceived control over fatigue' and promote 'listening to your body', in order to maximise the benefits of exercise intervention for individuals with MS-related fatigue.

Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis

OBJECTIVES

No longitudinal studies have concurrently evaluated predictors of anxiety, depression, and fatigue in people with multiple sclerosis (PwMS). This study determined factors that best predicted anxiety, depression, and fatigue in MS patients from a large pool of disease, cognitive, life-event stressor (LES), psychosocial, life-style, and demographic factors.

DESIGN

A 2-year prospective longitudinal study evaluated predictors of psychological distress and fatigue in PwMS.

METHODS

One hundred and one consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. LES, anxiety, depression, and fatigue were assessed at baseline and at 3-monthly intervals for 2-years. Disease, cognitive, demographic, psychosocial, and life-style factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.

RESULTS

Depression strongly predicted anxiety and fatigue, and anxiety and fatigue strongly predicted later depression. Psychological distress (i.e. anxiety, depression) was also predicted by a combination of unhealthy behaviours (e.g. drug use, smoking, no exercise, or relaxation) and psychological factors (e.g. low optimism, avoidance coping), similar to the results of community-based studies. However, state-anxiety and fatigue were also predicted by immunotherapy status, and fatigue was also predicted by LES and demographics.

CONCLUSIONS

These results suggest that similar factors might underpin psychological distress and fatigue in MS patients and community-well samples, although MS treatment factors may also be important. These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety, depression, or fatigue.

Rural and urban breast cancer patients: health locus of control and psychological adjustment

OBJECTIVE

This study examines the moderating influence of rural residence on the associations between health locus of control (HLC) beliefs and psychological well-being.

METHOD

Two hundred and twenty-four breast cancer patients were surveyed.

RESULTS

The results revealed that rurality interacted with HLC beliefs in predicting psychological adjustment. The pattern indicated that, whereas endorsing external forms of locus of control can be detrimental to the psychological well-being of urban breast cancer patients, the same is not true for rural breast cancer patients. For rural breast cancer patients, powerful others locus of control was beneficial for and chance locus of control was unrelated to well-being.

CONCLUSIONS

Implications for future research and medical care are discussed.

Relation between anxiety, depression and locus of control of patients with multiple sclerosis

This study was concerned with examining relation between anxiety, depression and locus of control (LC) in Croatian multiple sclerosis (MS) patients in order to determine an indication for psychotherapeutic intervention. The participants were 457 MS patients attending central state medical rehabilitation program at Varaždinske Toplice, asked to fill in the locus of control inventory and Crown-Crisp Experiential Index (CCEI) questioner of personality in the clinical setting. In order to determine whether locus of control changes along natural course of MS, patients were grouped according to the duration of the disease: less than five years, five to 10 years and more than 10 years. The results demonstrated that 405 (88.6%) MS patients exhibited external locus of control while 52 (11.4%) had internal locus of control. Moreover, as the disease progressed, locus of control shifted more to externality. Analysis of gathered data confirms connectivity of external locus of control with anxiety and depression. Results of anxiety and depression level on CCEI questionnaire show continuously increased values regardless on duration of illness. Croatian MS patients like other chronically ill externally oriented patients' show more maladaptive behaviour, which has been strongly linked to anxiety and depression and this, is indication for psychotherapeutic support. Multiple Sclerosis 2007; 13: 1065—1067. http://msj.sagepub.com

Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships

OBJECTIVE

The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors.

BACKGROUND

Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship.

METHODS

A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.

RESULTS

MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress relapse relationship.

CONCLUSIONS

The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.

Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients

The objectives of this study were to determine whether there are differences in emotional distress among spouses of recovering cardiac patients based on level of perceived control, and to determine whether perceived control can be enhanced by cardiopulmonary resuscitation (CPR) training. A total of 219 spouses of cardiac patients recovering from an acute cardiac event were enrolled and 196 completed the study. Spouses were assigned to either a no-treatment control group or one of two CPR training groups. Perceived control and emotional adjustment were measured at baseline and again 1 month after subjects received CPR training. Spouses with high perceived control were less anxious, less depressed, and less hostile at baseline. Perceived control increased significantly in spouses after both CPR training groups, but was unchanged in the control group. After a partner's cardiac event, perceived control is important for psychological recovery in spouses and can be increased by CPR training.

The relationship of rural persons' multidimensional health locus of control to knowledge of cancer, cancer myths, and cancer danger signs

The purpose of the study was to determine if a relationship exists between multidimensional health locus of control and knowledge of breast cancer, prostate cancer, cancer myths, and danger signs. A descriptive correlational design was used. A convenience sample of 78 rural men and 79 rural women participated in the study. Participants completed three questionnaires: (a) the Cancer Danger Signs Questionnaire, (b) the Cancer Myths Questionnaire, (c) the Prostate Cancer Knowledge Test (completed by the men) and the Breast Cancer Knowledge Test (completed by the women). Results indicated that an internal score on the Multidimensional Health Locus of Control (MHLOC) scale did not predict knowledge of breast cancer in women, prostate cancer in men, cancer myths, or danger signs. Women who scored high on the Powerful Others subscale of the MHLOC had statistically significant high scores on knowledge of breast cancer, but not on cancer myths and danger signs. The MHLOC and its subscales did not predict knowledge of prostate cancer, cancer myths, or cancer danger signs for the male participants. The implications of these results for rural nursing practice and their relationship to previous research are discussed.

Learning from unreliability: the importance of inconsistency in coping dynamics

The role of response stability in the measurement of coping is examined with a focus on the unique information that can be gleaned from low test retest reliability ('inconsistency'). Data from two studies are presented in which a card sort measure of coping flexibility was used on people with three different chronic diseases and the elderly (n = 219). We begin by testing the hypothesis that the low stability reflects unreliability due to measurement artifacts, such as random error, low ecological validity, long test retest interval, surrogate assistance, or error due to completing the questionnaire in multiple sittings. Our findings suggest that surrogate assistance in completing questionnaires was the only measurement artifact associated with low stability. We then tested the proposition that low stability reflects a genuine behavior pattern (i.e. inconsistency). Hierarchical modeling revealed that measurement artifact accounted for less than one percent of the variance in inconsistency in reported coping behavior and that an additional 21% of the variance could be explained by the behavioral factors, including neuropsychological problems (9%), psychological morbidity (4%), locus of control (3%) and eudaimonistic well-being (5%). Thus inconsistency in reported coping behavior was better explained by behavioral and psychosocial factors than by the tested measurement artifacts. We conclude that inconsistency in reported coping behavior does indeed reflect a meaningful behavior pattern, rather than simply measurement artifact.

Patient perception of quality of care provided by specialists and generalists

Efforts to control medical care costs have focused on reducing the number of specialists directing patient care. This cross-sectional survey evaluated multiple sclerosis patient perceptions of the quality of care across three patterns of care: primary care (n = 156), single specialty care (n = 338), and comprehensive care (n = 75). The pattern of medical care received by the patient was defined by: (1) whether the MS provider was a primary care physician or (2) a neurologist; (3) whether the patient reported using other specialty services, such as psychological, rehabilitation, or social work services. Process indicators of quality of care were measured by subscales for interpersonal aspects of care, access to care, and perceived action plan. The MSQOL-54 was used to measure health-related quality of life. Pattern of care was not related to the Interpersonal or Access dimensions of care, after adjusting for health status and sociodemographic characteristics. Patients in the Single Specialty and Comprehensive Care patterns of care were, however, more likely to report their MS provider having and implementing an action plan. We conclude that MS patients who receive Single Specialty and Comprehensive Care are more likely to get diagnostic and treatment-related tests, as well as immunotherapeutic and experimental treatments.

Providing a neuropsychology service for people with multiple sclerosis in an interdisciplinary rehabilitation unit

Multiple sclerosis (MS) is a chronic progressive disease with symptoms that are often difficult to interpret and distinguish from other neurological disorders. These symptoms are discussed together with psychological interventions, physical management and occupational therapies. A review of studies is presented as well as concepts for service provision for MS patients in the NHS. Finally, current practice in an interdisciplinary rehabilitation unit is discussed, and some recent advances in MS treatment are noted.

Psychosocial recovery from a cardiac event: the influence of perceived control

OBJECTIVE

To determine the relationship between patients' feelings of control at baseline and psychosocial recovery 6 months after their cardiac event.

PATIENTS

One hundred seventy-six patients who had had myocardial infarction, had undergone coronary artery bypass or both.

DESIGN

In this longitudinal, comparative survey patients with high perceptions of control were compared with those with low perceptions of control at baseline to determine differences in psychosocial recovery 6 months later.

OUTCOME MEASURES

Psychosocial recovery was operationalized as anxiety, depression, and hostility (measured by Multiple Affect Adjective Checklist) and overall psychosocial adjustment to illness (measured by Psychosocial Adjustment to Illness Scale).

RESULTS

Significant differences were seen in psychosocial recovery between patients with feelings of high control versus those with feelings of low control (p = 0.006). Patients with feelings of high control at baseline were less anxious (p = 0.002), less depressed (p = 0.001), less hostile (p = 0.02), and had better psychosocial adjustment (p = 0.009) at a 6-month follow-up than those with feelings of low control.

CONCLUSION

Feelings of perceived control are important for psychosocial recovery after a cardiac event.

Who says yes? Identifying selection biases in a psychosocial intervention study of multiple sclerosis

The purpose of this work is to examine whether patients' sociodemographic and medical characteristics are associated with participation in a randomized controlled trial of two psychosocial interventions. After elimination of basic ineligibles from a registry of multiple sclerosis patients, 325 patients were sent a letter inviting participation in the randomized trial. Among those invited, 29% expressed an interest in participating, 19% scheduled an intake interview and 13% were actually randomized. chi 2 and logistic regression analyses were used to determine what factors were associated with successive stages of participation or non-participation in the study. Differential referral and participation rates could be traced in part to physician factors. With respect to patient factors, people were more likely to participate in the successive stages of recruitment if they had a higher median family income, lived a moderate distance from the hospital, and were disabled from working. Multivariate analyses of patient factors revealed that having a higher income and being disabled from work were the strongest predictors of participation, after adjusting for the effects of course of disease, disability status, and other sociodemographic predictors. Implications of these findings are discussed in terms of potential sources of bias in the selection of eligible patients, as well as the role the investigator may play in highlighting or underplaying this selection bias. Suggestions are made to minimize the bias-generating barriers.