Subjective Well-Being, Positive Affect, Life Satisfaction, and Happiness With Multiple Sclerosis: A Scoping Review of the Literature.

PURPOSE: People with multiple sclerosis (MS) may face challenges maintaining their subjective well-being, life satisfaction, happiness, and positive emotions. This scoping review's purpose was to summarize studies on these positive psychological constructs among people with MS. METHODS: Observational and interventional studies that included measures of subjective well-being, life satisfaction, happiness, or positive affect were identified. Variables associated with these constructs were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS: The review included 22 observational and 10 interventional studies. Variables were categorized into each of the ICF domains. Cognitive behavior therapy was the most common intervention, with content and dosing varying widely. CLINICAL RELEVANCE: Subjective well-being, life satisfaction, happiness, and positive affect are crucial components of community and individual health. The findings of this scoping review highlight the complex interplay between function, personal factors, and environmental conditions in influencing positive psychological constructs. Given the limited evidence, rehabilitation nurses should leverage their skills in delivering holistic care and adopt data-driven approaches to integrate positive psychological strategies into care plans. CONCLUSION: Further research is needed to measure and compare interventions aimed at improving these constructs and to examine the influence of personal and environmental factors among diverse MS populations.

Correlates of stages of change for physical activity in adults with multiple sclerosis.

The Transtheoretical Model (TTM) is commonly used to understand physical activity (PA) behavior in the general population; however, few researchers have explored its relevance for persons with multiple sclerosis (MS). We examined the relative importance of health (symptoms and mobility impairments) and TTM constructs (behavioral and cognitive processes of change) in influencing stages of change placement for PA in a sample of 303 persons with MS using discriminant function analysis. The overall accuracy of predicting stages of change was 58.75%. Behavioral (r(2) = .35) and cognitive processes (r(2) = .17) accounted for the most variance, followed by mobility (r(2) = .11) and self-efficacy (r(2) = .05). Results provide support for evaluating whether TTM-based interventions can promote PA in adults with MS.

Comparing individualized rehabilitation to a group wellness intervention for persons with multiple sclerosis.

PURPOSE: Compare the efficacy of two interventions designed to promote health and physical activity (PA). DESIGN: This study was a randomized clinical trial using a time series design. Subjects were randomized into individualized physical rehabilitation (IPR) and group wellness intervention (GWI). Primary questionnaires were administered twice preintervention and twice postintervention. Physical fitness and PA frequency were assessed preintervention and postintervention. SETTING: Clinic based in a metropolitan area. SUBJECTS: Fifty volunteers with multiple sclerosis. INTERVENTIONS: IPR consisted of four physical therapy sessions plus three telephone calls. GWI consisted of seven educational sessions. MEASURES: Primary: SF-36 Health Survey, Modified Fatigue Impact Scale, Mental Health Inventory. Secondary: physical assessment, PA frequency. ANALYSIS: Stability of primary questionnaires between the two pretests was examined. Efficacy of interventions was evaluated by multivariate analysis of variance (MANOVA) and effect sizes. RESULTS: Primary measures were stable between pretests. MANOVA showed nonsignificant differences between interventions. Eight weeks postintervention, both groups had improved PA, fatigue, resting heart rate, and strength. Effect sizes suggested that IPR had a greater effect on preventing decline of physical health, whereas GWI had a greater effect on improving mental health. CONCLUSION: Preliminary evidence indicated that health and PA improved in both groups. Effect sizes suggested that participants benefited more physically from IPR and more mentally from GWI. Future research should determine whether combining therapeutic exercise with group education improves both mental and physical health.

Measuring participation as defined by the international classification of functioning, disability and health: an evaluation of existing measures.

OBJECTIVES: The content and theoretic underpinning of measures designed to assess participation, disability, and handicap vary widely, and few authors have attempted to compare the content of existing measures. The objectives of this study were to use the International Classification of Functioning, Disability and Health (ICF) taxonomy to (1) evaluate the participation content of measures and (2) identify the most comprehensive measures. DESIGN: We searched PubMed, Cumulated Index of Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify appropriate measures. Content analysis was conducted by classifying participation-related items of each measure into 1 or more of the 9 activities and participation chapters of the ICF taxonomy. SETTING: Not applicable. PARTICIPANTS: We evaluated 40 generic and condition-specific self-report measures that met study inclusion criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The most comprehensive measures were identified and coded by using second- and third-level ICF codes. RESULTS: Five measures containing participation items linked to all 9 chapters were the Community Living Skills Scale, the Assessment of Life Habits, Mayo-Portland Adaptability Inventory, the participation measure for postacute care, and the Psychosocial Adjustment to Illness Scale. The breadth and coverage of these 5 measures were compared. CONCLUSIONS: We identified 5 measures that had items that were linkable to all 9 chapters of activities and participation; however, these measures differed in specifics of coverage and the approach to assessing participation. These findings can be used by clinicians and researchers to select the most comprehensive participation outcome measure for their populations.

Rasch validation of the falls prevention strategies survey.

UNLABELLED: Finlayson ML, Peterson EW, Fujimoto KA, Plow MA. Rasch validation of the Falls Prevention Strategies Survey. OBJECTIVE: To validate the Falls Prevention Strategies Survey. DESIGN: Cross-sectional descriptive survey design. With the use of Rasch analysis, the following aspects of the Falls Prevention Strategies Survey were evaluated: rating scale structure, item quality, participant fit and participant ability, invariance structure, and the potential to change in response to intervention. SETTING: Community-based, national sample. PARTICIPANTS: Adult registrants of the North America Research Committee on Multiple Sclerosis volunteer patient registry (N=457). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Falls Prevention Strategies Survey is a self-report instrument addressing protective behaviors related to fall risk among adults with multiple sclerosis (MS) (eg, monitoring MS symptoms, wearing proper footwear, modifying activities). Response options reflect the frequency with which the respondent engages in the behavior (ie, never, sometimes, regularly). RESULTS: Analysis indicated that the rating scale structure (ie, response options) was valid. Of the original 19 items, 8 of them misfit and needed to be dropped to obtain a valid instrument under the Rasch model. With the final 11 items, the instrument was able to distinguish participants of different ability levels across a range of 11.58 logits. Invariance structure analysis demonstrated that the instrument functioned equally for men and women, for mobility device users and nonusers, and for participants with diagnosed MS for less than or greater than 10 years. Findings indicated that approximately 50% of respondents would have room to improve on their Falls Prevention Strategies Survey scores over time. CONCLUSIONS: Rasch analysis supports the use of the Falls Prevention Strategies Survey to examine the frequency of engaging in protective behaviors related to fall risk among adults with MS. The instrument shows potential to track outcomes of behaviorally oriented fall reduction interventions in this population.

Exploring physical activity behaviour of persons with multiple sclerosis: a qualitative pilot study.

PURPOSE: Identify facilitators and barriers to physical activity (PA), and explore the utility of Social Cognitive Theory (SCT) and Transactional Model of Stress and Coping (TMSC) in understanding PA behaviour among persons with multiple sclerosis (MS). METHODS: Thirteen participants from a clinical trial were interviewed and classified as physically active, sometimes active or inactive based on the Health-Promoting Lifestyle Profile-II. Interviews were analysed using analytical induction, which consisted of coding data into pre-established categories and then exploring similarities and differences between groups. Pre-established coding categories were constructs from SCT (i.e. environment, expectations, self-efficacy and self-regulation) and TMSC (i.e. stress appraisal and coping style). RESULTS: Inactive and active participants differed in their self-regulation skills, self-efficacy and coping styles. Common barriers to PA included symptoms and the physical and social environment. Facilitators of PA included strong self-regulation skills, confidence to overcome symptoms to engage in PA (i.e. barrier self-efficacy) and positive coping styles. CONCLUSION: Results from this pilot study suggest that PA interventions will need to implement multiple strategies that target self-efficacy, social environment and coping styles. We found SCT and TMSC useful in understanding PA behaviour among persons with MS; however, a limitation to these theories is that they are not explicit in the relationship between health and cognitions. Future research will need to explore how to incorporate models of health and function into existing behaviour change theories.

Multiple sclerosis: impact of physical activity on psychosocial constructs.

OBJECTIVES: To determine the impact of physical activity (PA) interventions and experience with PA on psychosocial constructs. METHODS: PA, self-efficacy, self-identity, social support, and expected PA frequency were measured pre and post intervention in 39 persons with multiple sclerosis. RESULTS: The MANOVA analysis indicated that self-efficacy and expectation decreased, whereas self-identity and PA improved (P<0.05). Regressions analyses indicated pretest self-identity (beta(2)=0.44) and social support (beta(2)=0.34) were associated with PA. Posttest self-efficacy (beta(2)=0.38) and social support (beta(2)=0.31) were associated with PA (P<0.05). CONCLUSIONS: The interventions and experience with PA caused changes in psychosocial constructs, which subsequently affected the correlation of these constructs with PA.

A Qualitative Study of Multiple Health Behaviors in Adults with Multiple Sclerosis.

Background: Evidence regarding inflammatory pathways, elevated cardiovascular risk, and negative effects of secondary conditions on disability progression provide a strong rationale for promoting multiple health behaviors in adults with multiple sclerosis (MS). However, many unanswered questions remain about the best ways to design multiple behavior change interventions for adults with MS. We sought to identify facilitators and barriers to engaging in multiple health behaviors (physical activity, nutrition, and sleep) and to gain further insights into how to develop multiple health behavior change interventions based on preferences of adults with MS. Methods: Focus groups and one-on-one interviews were conducted with 17 participants with MS. Results: Five qualitative themes were identified as either facilitating or hindering engagement in multiple health behaviors: 1) roles, priorities, and preferences; 2) sense of duty; 3) the fatigue and mobility problem; 4) taking control; and 5) resiliency. Participants identified advantages and disadvantages of delivery formats (eg, face-to-face group vs. telephone), frequency of contacts, and intervention strategies based on their individual circumstances and obligations. Participants felt that discussing the benefits of engaging in multiple health behaviors, developing action plans, accommodating preferences, and addressing health problems would be helpful strategies to include in a multiple behavior change intervention. Conclusions: These findings indicate that there may be common facilitators and barriers that can be targeted to promote multiple behavior changes. Future research should explore the best ways to tailor multiple behavior change interventions to preferences, symptoms, psychological traits, and social cognitions.

Correlates of the timed 25 foot walk in a multiple sclerosis outpatient rehabilitation clinic.

The Timed 25 Foot Walk (T25FW), a test of maximum walking speed on a short distance, is commonly used to monitor ambulation status and to assess treatment outcomes in multiple sclerosis (MS). The main aim of this study was to determine how walking speed on the T25FW correlates with other clinician-reported and patient-reported measures in an outpatient MS rehabilitation clinic. We analyzed cross-sectional data systematically collected during a physiatry evaluation for the management of spasticity and walking limitations. In addition to demographic variables and the Expanded Disability Status Scale (EDSS), measures of body functions [lower extremity manual muscle testing (LE MMT), lower extremity Modified Ashworth Scale, Fatigue Severity Scale, leg pain], and measures of activity and quality of life (reported frequency of falls, Incapacity Status Scale, Rivermead Mobility Index, EQ5D health questionnaire, and Patient Health Questionnaire-9 items) were administered. A multivariate regression analysis was carried out. 199 patients were included in the analysis [age 49.41 (9.89) years, disease duration 15.40 (10.22) years, EDSS score 5.6 (1.2), and T25FW speed 70.93 (44.13) cm/s]. Both EDSS and LE MMT were correlated significantly with T25FW speed (R=0.692, P<0.001). After adjusting for EDSS and LE MMT, lower T25FW speed was associated with higher Incapacity Status Scale scores (R=0.316, P<0.001), lower Rivermead Mobility Index scores (R=0.540, P<0.001), and higher frequency of falls. EQ5D and Patient Health Questionnaire-9 items were not significantly associated with T25FW speed. Our findings support the clinical relevance of the T25FW in the rehabilitation of patients with MS.

Correlates of participation in meaningful activities among people with multiple sclerosis.

OBJECTIVE: To explore the associations between impairments, self-management self-efficacy, self-management behaviors, and environmental factors and their role in predicting participation in meaningful activities among people with multiple sclerosis. DESIGN: Online cross-sectional survey. SUBJECTS/PATIENTS: Randomly selected individuals (n = 335) from a large multiple sclerosis patient registry. METHODS: Participation in activities that are meaningful to the individual was measured with Community Participation Indicators (CPI), the dependent variable. Independent variables included symptom severity, activities of daily living limitations, cognitive problems, stages of change for physical activity, nutritional behaviors, self-efficacy, and environmental barriers. A backwards selection regression analysis was used to compare the relative contributions of independent variables in predicting the CPI. A path analysis was conducted to explore the associations between independent variables and their direct and indirect effects on the CPI. RESULTS: The final regression model included self-management self-efficacy (ß = 0.12), environmental barriers (ß = -0.16), cognitive problems (ß = -0.22), and stages of change for physical activity (ß = 0.12). Path analysis indicated that impairments and environmental barriers might negatively influence self-management self-efficacy. Self-management self-efficacy might have indirect effects on the CPI via engagement in self-management behaviors. CONCLUSION: Future research should explore whether interventions that promote self-management self-efficacy can facilitate participation in meaningful activities.

A scoping review of self-management interventions for adults with multiple sclerosis.

The purpose of this scoping review is to identify self-management tasks and skills that are being taught in existing interventions for persons with multiple sclerosis and to describe intervention strategies used to facilitate the learning of self-management tasks and skills. Multiple strategies were used to search for studies published or in press between 1980 and 2008 that evaluated self-management interventions. The main exclusion criteria were case studies, inadequate description of the intervention, and traditional clinical patient education interventions. Two independent coders categorized the interventions by using Lorig and Holman's self-management framework and Abraham and Michie's taxonomy of behavior change techniques. Twenty-seven interventions were identified from 34 articles. Common intervention topics included fatigue management (n = 12), coping, depression, and stress management (n = 10), and medication management (n = 6). Also, no 2 interventions used the same delivery format to implement the same combination of intervention strategies. Furthermore, markedly different intervention strategies were used to improve the same outcomes. These results highlight a need to systematically test intervention strategies one at a time, or in a clear specified combination, as well as compare existing interventions to determine which are most effective in supporting persons with multiple sclerosis to learn and incorporate self-management tasks and skills.