Self-report versus performance measure in gauging level of function with multiple sclerosis

Resilience Indirectly Affects Functional Capabilities Through Physical Activity Engagement in Individuals With Multiple Sclerosis

BACKGROUND

The role of resilience on functional outcomes in multiple sclerosis (MS) has been debated. One theorized pathway is that healthy lifestyle behaviors contribute to better functioning capabilities, which resilient individuals with MS tend to engage in more. This study aimed to explore whether resilience might influence functioning in individuals with MS indirectly through specific lifestyle behaviors.

METHODS

Participants (N = 64) were individuals with MS who completed measures assessing resilience (Multiple Sclerosis Resiliency Scale; MSRS), lifestyle behaviors (Simple Lifestyle Indicator Questionnaire and Alcohol Use Disorders Identification Test), and functional capabilities (PROMIS Physical Function-Short Form 20a; PROMIS-PF). Mediation models were constructed with the MSRS as the independent variable and significant individual lifestyle behaviors as the mediators, and PROMIS-PF as the dependent variable, with demographics and disease-related factors as covariates.

RESULTS

Physical activity was the only lifestyle behavior associated with functioning capabilities (ρ = 0.43, P < .001). Resilience had a significant indirect effect on functioning through physical activity (b = 0.16; 95% CI, 0.04-0.32). Its corresponding direct effect was not significant (b = -0.02, P = .860).

CONCLUSIONS

These findings suggest that resilience indirectly influences functioning through engagement in physical activity. The results highlight the important role of resilience in promoting well-being among individuals with MS.

A brief report on the iterative development and content validation of the myAccessibleHome app for home safety screening and interventions

myAccessibleHome is a home safety screening and intervention app developed to be used by PwD, aging adults, support persons, and stakeholders vested in facilitating improved community living outcomes in home-dwellers desiring to age-in-place. This study describes the iterative development process and content validation of myAccessibleHome. App development involved participatory action research (PAR) methodology and engaged PwD, caregivers, and contractors (N = 6) as part of the core research and development team. For content validity, an expert panel (N = 7) and target population end-users (N = 15) completed a web-based survey which evaluated relevance and clarity. Item and scale content validity (I-CVI, S-CVI) indices were calculated. The PAR team and content validation process contributed to iterative and ongoing refinement of content, design, and features of myAccessibleHome. For the expert panel, mean I-CVI was 0.96 [0.57-1.00] for relevance and 0.89 [0.29-1.00] for clarity. The S-CVI was 0.93. For target population end-users, mean I-CVI was 0.64 [0.40-0.87] for relevance and 0.82 [0.53-0.93] for clarity. Items were removed and revised based on respondent feedback. Engaging potential end-users in PAR and content validation studies contributed to myAccessibleHome matching wants and needs of targeted end-users.

Relationships Between Resilience and Health, Health Promotion, and Quality of Life Among Community-Dwelling Older Adults With Long-Standing Multiple Sclerosis

PURPOSE

As people with long-standing disabling conditions age, the interplay between pre-existing conditions and new comorbidities can present unique challenges. Therefore, the current study explored relationships between resilience and health, health promotion, and quality of life among older adults living with multiple sclerosis (MS).

METHOD

Adults recruited from National MS Society chapters completed a mailed survey about their health, health promotion, and well-being.

RESULTS

The 147 respondents (mean age = 72 years) reported an average of three additional comorbidities and had been diagnosed with MS for 35 years on average. Resilience scores were most highly correlated with depressive symptoms, spiritual growth, social support, incapacity status, and quality of life. Resilience scores significantly improved prediction of emotional health, after controlling for other functional and psychosocial variables.

CONCLUSION

Nurses can help patients with chronic conditions, such as MS, develop strategies for regulating their emotional health to adapt to new health challenges. [Journal of Gerontological Nursing, 51(1), 15-23.].

A Systematic Review of the Effects of Second-Eye Cataract Surgery on Motor Function

Cataract removal surgery is one of the most commonly performed surgical procedure in developed countries. The financial and staff resource cost that first-eye cataract surgery incurs, leads to restricted access to second-eye cataract surgery (SES) in some areas, including the United Kingdom. These restrictions have been imposed despite a lack of knowledge about the impact of not performing SES on visuo-motor function. To this end, a systematic literature review was carried out, with the aim of synthesising our present understanding of the effects of SES on motor function. Key terms were searched across four databases, PsycINFO, Medline, Web of Science, and CINAHL. Of the screened studies (K = 499) 13 met the eligibility criteria. The homogeneity between participants, study-design and outcome measures across these studies was not sufficient for meta-analyses and a narrative synthesis was carried out. The evidence from objective sources indicates a positive effect of SES on both mobility and fall rates, however, when considering self-report measures, the reduction in falls associated with SES becomes negligible. The evidence for any positive effect of SES on driving is also mixed, whereby SES was associated with improvements in simulated driving performance but was not associated with changes in driving behaviours measured through in vehicle monitoring. Self-report measures of driving performance also returned inconsistent results. Whilst SES appears to be associated with a general trend towards improved motor function, more evidence is needed to reach any firm conclusions and to best advise policy regarding access to SES in an ageing population. Systematic Review Registration: https://osf.io/7hne6/, identifier INPLASY2020100042.

Development and testing of a biobanking acceptability scale: A multistage effort to add a biobank to an existing longitudinal study

BACKGROUND

More biobanks linked to demographic, phenotypic, and clinical data are needed to advance multiple sclerosis (MS) research; however, little is known about biobanking attitudes among persons with MS, broadly, as well as willingness of participants in an existing longitudinal study to donate biospecimens, specifically.

METHODS

To assess biobanking attitudes in a cohort of MS patients in an ongoing longitudinal study, a new Biobanking Acceptability Scale (BAS) was developed, its reliability and predictive validity tested, and factors that influenced biobanking intent as well as behavior were explored. Analysis included descriptive statistics, factor analysis, Cronbach's α, and Pearson's bivariate correlation coefficients.

RESULTS

In 2018, 227 participants completed the 10-item BAS. Biobanking attitudes were generally positive (BAS total score, M = 38.8 out of 50; SD = 6.7), and most participants expressed willingness to donate hair (87%), saliva (85%), and/or blood (72%). In 2019, 143 participants consented to biobanking and were mailed supplies; 110 individuals provided at least one biospecimen, resulting in 110 saliva samples and 89 hair samples. The 10-item BAS displayed good internal consistency (α = 0.81). Demographic and clinical variables were not significantly associated with BAS score nor actual donation. Total BAS score was related to consent (r = 0.36, p < .001) and to actual donation of hair or saliva samples (r = 0.24, p < .01).

CONCLUSION

Overall, the participants had positive attitudes toward biobanking; the scale should be assessed in more diverse samples. The BAS predicted biobanking consent, and thus may be a useful measure to identify individuals most likely to donate biospecimens and/or identify potential barriers to biobanking that can be addressed through study design.

Health Promotion, Functional Abilities, and Quality of Life Before and During COVID-19 in People with Multiple Sclerosis

BACKGROUND

Because multiple sclerosis (MS) is an autoimmune disease, and many individuals with MS take disease-modifying drugs that suppress immune response, serious concerns have been expressed about the potential effct of COVID-19 on those with this chronic condition.

OBJECTIVES

The purpose of this research was to utilize the most recent 5 years of data from an ongoing longitudinal study of health promotion and quality of life (QoL) among people with long-standing MS to investigate changes across time in functional limitations, health promotion, and health-related QoL.

METHODS

Participants are mailed an annual survey to complete about their health promotion, depressive symptoms, health status, social support, MS-related functional limitations, and QoL. Differences across time were analyzed with repeated measures of analysis of variances and planned contrasts.

RESULTS

In 2021, the 141 participants had a mean age of 69 years and had been diagnosed with MS for 34 years on average. Most had attended college, were married/partnered females, and reported adequate economic resources. Thirty-seven percent reported they were in poor to fair health. Physical activity and health responsibility scores decreased significantly during 2020-2021 compared with 2017-2019. Significant changes in depressive symptoms, social support, and functional limitations scores followed a different pattern with the largest changes occurring between 2018 and 2019. QoL and other health promotion scores did not change significantly across time.

DISCUSSION

The relatively small changes in health indicators revealed here suggest that older people with long-standing MS may have generally been able to maintain their health promotion, functional abilities, and QoL from before to during the COVID-19 pandemic. However, nurses and other providers should support them to resume their physical activity and regular provider contact as COVID-19 restrictions are eased. The patterns observed here demonstrate the importance of examining changes across an extended period, rather than simply looking at 1 year before and 1 year after a major event, such as COVID-19. These findings can help nurses understand how to help their patients with chronic health conditions maximize their health as they move forward.

Sleep and functional capacity in adults: Cross-sectional associations among self-report and objective assessments

OBJECTIVES

This study examined the relationship between self-reported and objectively measured sleep and functional capacity in adults.

DESIGN

Cross-sectional.

PARTICIPANTS

Data were from the Midlife in the United States study. The sample consisted of men and women (n = 664) aged 25-83 who completed telephone interviews, questionnaires, and an overnight clinic stay.

MEASUREMENTS

Sleep was assessed by self-report (Pittsburgh Sleep Quality Index [PSQI]) and by objective measures (sleep latency, duration, wake after sleep onset [WASO], and midpoint/midpoint variability) from 7 consecutive days of actigraphy. Functional capacity was assessed by self-report of limitations and measured gait speed, grip strength, and chair stands.

RESULTS

In linear regression models adjusting for demographic and health factors, better self-reported sleep quality predicted fewer reported limitations, stronger grip, quicker gait, and faster chair stands (all P< .01). Greater WASO predicted more self-report limitations and slower gait speed (P< .05). Long (>8 hours) sleep duration and a more variable sleep schedule predicted lower grip strength (p < .05). Finally, after adjustment for objective sleep measures, PSQI remained a significant predictor of functional measures (P< .05) and explained a significant amount of additional variance (change in R²: 0.01-0.05).

CONCLUSIONS

The present results suggest that subjective and objective sleep measures capture distinct aspects of sleep that are independently related to functional capacity. The variance in functional measures explained by sleep variables, though small, was comparable to other risk factors for functional impairment (eg, obesity), underscoring the importance of associations between sleep and optimal function in adults.

Profiling serum neurofilament light chain and glial fibrillary acidic protein in primary progressive multiple sclerosis

This study examined the utility of serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) as biomarkers in primary progressive multiple sclerosis in context with clinical severity, progression, and treatment. Using a single-molecule array (Quanterix), serum protein concentrations were measured from twenty-five participants semiannually for five years. There was no association between levels of either biomarker and disease severity, disease duration, or treatment group. Enrollment sNfL level was not associated with future clinical worsening. Precedent clinical worsening was not associated with last sGFAP measurement. These results suggest a limited role for these biomarkers in primary progressive disease management.

Comparison Between Common Performance-Based Tests and Self-Reports of Physical Function in People With Multiple Sclerosis: Does Sex or Gender Matter?

OBJECTIVE

To estimate the extent to which sex or gender differences affect the relations between tests of physical performance and self-reports about function in everyday life activities. Ecological validity is an important psychometric property when choosing tests of physical function, because they need to relate to everyday function. In multiple sclerosis (MS), the EQUI scale, modified Canadian Aerobic Fitness Test, grip strength, vertical jump, push-up, partial curl-up, gait speed (comfortable or fast), 6-minute walk test, and 9-hole peg test are commonly used but the extent to which they relate to everyday function is understudied and the extent to which ecological validity of these tests differ between women and men is unknown.

DESIGN

A cross-sectional analysis was conducted on a random sample of men and women recruited for a study on the life effect of MS. Correlations between pairs of performance outcome (PerfO) and self-reported outcome (SRO) items pairs of variables with theoretical coherence were calculated and gender effects identified using linear regression.

SETTING

Participants were recruited from MS clinic at Montreal Neurological Hospital.

PARTICIPANTS

The sample (N=188) consisted of 140 women and 48 men with MS.

INTERVENTIONS

Not applicable.

RESULTS

The mean age ± SD of the participants was 43±10. Sixty PerfO and SRO items yielded 165 theoretically linked pairs separately for women and men. Of these 330 possible pairs, 77 pairs (23%) had correlations ≥0.8, showing strong support for the link between performance tests and everyday function; 203 pairs provided moderate support (r≥0.5). Thirty-one pairs had a statistically significant interaction with gender with men having higher correlations than women (n=27/31).

CONCLUSION

The results support the ecological validity for physical performance tests, particularly balance tests and particularly for men. The observation that many indicators of everyday function derived from SROs were related to physical performance supports the routine use of SROs in clinical practice to guide therapy to meet the needs of clients with MS.

Selected health behaviors moderate the progression of functional limitations in persons with multiple sclerosis: Eleven years of annual follow-up

BACKGROUND

Multiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential.

OBJECTIVE

The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS.

METHODS

Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year.

RESULTS

After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11.

CONCLUSION

Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.