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Polick CS, Darwish H, de Olivera LP, Watson A, Vissoci JRN, Calhoun PS, Ploutz-Snyder R, Connell CM, Braley TJ, Stoddard SA. Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.06.24302405. [PMID: 38370736 PMCID: PMC10871453 DOI: 10.1101/2024.02.06.24302405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Intro Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45). Conclusions This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
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Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- VA Healthcare System, Durham, NC, USA
| | - Hala Darwish
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Ali Watson
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Patrick S Calhoun
- VA Healthcare System, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | | | | | - Tiffany J Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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Söylemez B, Çetİşlİ-Korkmaz N, Tekİn S, Bİr LS, Şenol H. The effect of balance, walking capacity, and fear of falling on the level of community integration in individuals with Multiple Sclerosis: A cross-sectional study. Physiother Theory Pract 2023:1-7. [PMID: 37377114 DOI: 10.1080/09593985.2023.2229903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Social participation levels of individuals with Multiple Sclerosis (iwMS) are lower than those of healthy individuals. OBJECTIVE This study aimed to evaluate to which extent the walking capacity, balance, and fear of falling (FoF) affect the community integration levels of iwMS. METHODS Thirty-nine iwMS were evaluated for their participation levels [The Community Integration Questionnaire (CIQ)], walking capacity [The Six-Minute Walk Test (6MWT)], balance [Kinesthetic Ability Trainer (SportKAT®)], and FoF [The Modified Falls Efficacy Scale (MFES)]. Correlation and regression analyses were performed to detect the effects of SportKAT®, 6MWT, and MFES on CIQ. RESULTS CIQ scores were significantly correlated with 6MWT (p = .043) and MFES (p = .005) scores, while CIQ was not related with static (for two feet test p = .356, for right single-leg stance test p = .412, for left single-leg stance test p = .730) and dynamic balance (for clockwise test p = .097, for counterclockwise test p = .540) measured with the SportKAT®. It was found that CIQ could be predicted by 6MWT and MFES at the level of 16% and 25%, respectively. CONCLUSION FoF and walking capacity are associated with community integration in iwMS. Therefore, physiotherapy and rehabilitation programs of iwMS should be combined with treatment goals to increase community integration, balance, and gait and decrease the disability and FoF from an early stage. Comprehensive studies examining other factors that may impact participation in iwMS with different levels of disability are needed.
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Affiliation(s)
- Betul Söylemez
- Department of Medical Services and Techniques, Burdur Vocational School of Health Services, Burdur Mehmet Akif Ersoy University, Burdur, Türkİye
| | - Nilüfer Çetİşlİ-Korkmaz
- Department of Neurological Rehabilitation, Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Türkİye
| | - Selma Tekİn
- Department of Neurology, Faculty of Medicine, Pamukkale University, Denizli, Türkİye
| | - Levent Sinan Bİr
- Department of Neurology, Faculty of Medicine, Pamukkale University, Denizli, Türkİye
| | - Hande Şenol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Türkİye
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Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data. Mult Scler Relat Disord 2022; 66:104019. [PMID: 35839614 DOI: 10.1016/j.msard.2022.104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients. OBJECTIVES This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data. METHODS Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression. RESULTS According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively. CONCLUSIONS MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.
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Assessment of economic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data. Mult Scler Relat Disord 2022; 65:103971. [DOI: 10.1016/j.msard.2022.103971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]
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Berardi A, Conte A, Cimmino L, Cimmino C, Baione V, Crisafulli SG, Tofani M, Tartaglia M, Fabbrini G, Galeoto G. Evaluation of the Psychometric Properties of the Health Assessment Questionnaire (HAQ) in a Population of Individuals With Multiple Sclerosis. Front Neurol 2022; 13:847786. [PMID: 35418933 PMCID: PMC8995553 DOI: 10.3389/fneur.2022.847786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The Health Assessment Questionnaire (HAQ) has been translated into many languages and it has been classified as the predictor of disability and medical costs, however, the psychometric properties of the HAQ have never been studied in a population with neurological disease. The purpose of this study was the evaluation of the psychometric properties of HAQ in a population of individuals with multiple sclerosis (MS). Materials and Methods This cross-sectional study was conducted with patients diagnosed with MS. The evaluation tools administered were the 36-item short form health survey (SF-36) to evaluate the health state of the patients and HAQ and to evaluate the limitations of the activities of daily living (ADL). Results A total of 34 patients were included in this study. Cronbach's alpha assessed the internal consistency of the HAQ, and it is equal to 0.94. The study revealed some significant correlations between the dimensions of the SF-36 and the sub-categories of the HAQ using Pearson's Correlation Coefficient. Significant correlations emerged between the demographic and clinical characteristics of patients and the subcategories of HAQ. Discussion The HAQ is a valid and reliable tool to assess the limitations of the activities of daily living, and it could provide for the healthcare and rehabilitation sector with an additional evaluation tool.
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Affiliation(s)
- Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
| | | | | | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marco Tofani
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
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