The meaning of health to persons aging with longstanding multiple sclerosis.

Understanding how persons aging with a chronic condition view their health is essential for planning and delivering person-centered care. The purpose of this study was to explore how persons aging with the chronic and disabling condition multiple sclerosis (MS) describe their health and how this has changed over time using data from Years 1 to 26 of an ongoing longitudinal survey study of health promotion and quality of life for persons with MS. The survey included measures of perceived meaning of health, self-rated health, health behaviors and quality of life outcomes. The sample included 168 persons with MS who returned the survey at Time 1 (1996) and again at Time 26 (2022). In 2022, participants had a mean age of 70.13 (SD = 8.19) and had been diagnosed with MS for an average of 34.47 years (SD = 6.27). Sixty percent of participants rated their overall health as good or excellent. Decreases in health self-ratings over time were not significant. Participants consistently agreed more strongly with items reflecting a wellness-oriented view of health than those reflecting a more clinical/biomedical model. At both time points, clinical definitions of health were negatively related and wellness definitions were positively related to reported frequency of health behaviors. Findings suggest that persons aging with the chronic condition of MS may be more responsive to health messages that emphasize function in daily living, carrying out normal responsibilities, and adjusting to changes in environment and demands. Patient or Public Contribution: Persons with MS provided study data, input on design, and construct measurement.

Development and Use of a Tech-Based Data Management System for a Cognitive Rehabilitation Randomized Controlled Trial for People With Type 2 Diabetes.

Successful technology-based interventions to improve patients' self-management are providing an incentive for researchers to develop and implement their own technology-based interventions. However, the literature lacks guidance on how to do this. In this article, we describe the electronic process with which we designed and implemented a technology-based data management system to implement a randomized controlled trial of a comprehensive cognitive rehabilitation intervention to improve cognitive function and diabetes self-management in people with type 2 diabetes. System development included feasibility assessment, interdisciplinary collaboration, design mapping, and use of institutionally and commercially available software. The resulting framework offers a template to support the development of technology-based interventions. Initial development may be time-consuming, but the benefits of the technology-based format surpass any drawbacks.

Longitudinal Effects of Sex, Aging, and Multiple Sclerosis Diagnosis on Function.

BACKGROUND: A gap in research about the trajectories of function among men and women aging with functional limitations because of multiple sclerosis (MS) hinders ability to plan for future needs. OBJECTIVES: Using a biopsychosocial model, we characterize how men and women with MS report changes over time in their function and test how person-level differences in age, diagnosis duration, and sex influence perceived function. METHODS: A longitudinal study with multiple waves of surveys was used to collect data on participant perceptions of function, as well as demographic and contextual variables. Self-reported functional limitation was measured over a decade. The study participants were community residing with physician-diagnosed MS. RESULTS: The people with MS had a diagnosis duration of about 13 years and were around 51 years of age, on average, at the start of the study. They were primarily women and non-Hispanic White. We analyzed the data using mixed-effects models. Subject-specific, functional limitation trajectories were described best with a quadratic growth model. Relative to men, women reported lower functional limitation and greater between-person variation and rates of acceleration in functional limitation scores. DISCUSSION: Results suggest function progressed through two pathways for over a decade, particularly closer to diagnoses. Variability in trajectories between individuals based on sex and years since diagnosis of disease indicates that men and women with MS may experience perceptions of their function with age differently. This has implications for clinician advice to men and women with MS.

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 effect 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 women, 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 limitation 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.

Moderator Effects in Intervention Studies.

BACKGROUND: Although nursing intervention studies typically focus on testing hypothesized differences between intervention and control groups, moderator variables can reveal for whom or under what circumstances an intervention may be most effective. OBJECTIVES: The aim of the study was to explain and illustrate moderator effects using data from a nursing intervention study to improve cognitive abilities in those with a chronic health condition. METHODS: The sample consisted of 178 individuals with multiple sclerosis participating in an experimental study of a cognitive intervention. General linear models were used for analyses. Interaction terms were created to represent moderator effects on three outcomes: self-reported cognitive abilities, use of memory strategies, and verbal memory performance. RESULTS: The Charlson comorbidity index significantly moderated the intervention effect on self-perceived cognitive abilities. Years of education significantly moderated the intervention effect on use of memory strategies. Scores on a general self-efficacy measure significantly moderated the intervention effect on the Controlled Verbal Learning Test-Second Edition. DISCUSSION: These analyses highlight the key role that moderator effects can play in nursing research. Although random assignment to groups can control potentially biasing effects of extraneous differences among individuals in intervention and control groups, those very differences may suggest fruitful avenues for hypothesis generating research about what works best for whom in intervention studies.

Targeting cognitive function: Development of a cognitive training intervention for diabetes.

AIM: The aim of this project was to develop and demonstrate the feasibility of a comprehensive cognitive training intervention to build self-efficacy for implementation of cognitive strategies in people with diabetes. BACKGROUND: People with diabetes are at greater risk than the general population for developing cognitive dysfunction. Some attention has been paid to the effect of cognitive impairments on diabetes self-management, but even when cognitive problems have been identified, few interventions have been tailored for those with diabetes. METHODS: The intervention combines in-person classes and home-based online computer training. Development, in 2017, included (a) adaptation of prior established, tested interventions; (b) interviews with stakeholders; and (c) integration of course content. RESULTS: Information provided by the stakeholders was used to modify an existing intervention to meet the needs of people with diabetes so that feasibility testing could occur. Despite initial difficulty with recruitment, the intervention was found to be feasible, and nineteen participants found it to be acceptable. CONCLUSION: This comprehensive cognitive training intervention targeting type 2 diabetes and cognitive dysfunction demonstrates that existing interventions can be adapted for use with people with diabetes.

An initial investigation of the reliability and validity of the Compensatory Cognitive Strategies Scale.

Although many cognitive performance tests and self-reported cognitive concerns scales have been used to evaluate cognitive functioning, fewer measures assess the use of compensatory cognitive strategies for daily activities among those experiencing mild levels of cognitive impairment. The Compensatory Cognitive Strategies Scale was developed to measure frequency of self-reported cognitive strategies to decrease distractions, organise and sequence activities, and to utilise newly available computer aids to assist memory among those with multiple sclerosis (MS). Cronbach's alpha, a measure of internal consistency reliability, was .89 and .90 in two different samples. Concurrent validity was supported by the total score's moderate correlation with the MMQ-Strategy Scale (rs = .67) and by a statistically significant increase in total scores for those who had participated in an intervention designed to improve their cognitive abilities. Correlations were stronger with another strategy measure than with measures of other constructs such as health-promoting behaviours, thus supporting the scales convergent versus divergent validity. These initial findings suggest that the Compensatory Cognitive Strategies Scale may be useful to both researchers and clinicians working to build compensatory strategies for day-to-day functioning among those with mild cognitive impairment.

Predicting Health Promotion and Quality of Life With Symptom Clusters and Social Supports Among Older Adults With Multiple Sclerosis.

Symptoms common among individuals with multiple sclerosis (MS) may influence health promotion and quality of life, especially among older adults, who often experience multiple chronic conditions. To identify and examine symptom clusters' effect on health promotion and quality of life, data from 215 adults with MS older than 60 (average years with diagnosis = 29) were analyzed. Correlations among symptoms ranged from 0.33 to 0.81. Factor analysis identified two symptom clusters: (a) physical/psychological/cognitive symptoms and (b) pain symptoms. In multiple hierarchical regressions, controlling for demographics and functional limitations, physical/psychological/cognitive symptoms significantly improved prediction on Health-Promoting Lifestyle Profile II interpersonal relations, stress management, and total scores; pain symptoms predicted nutrition scores. Both symptom clusters predicted spiritual growth and quality of life. Social support was a significant predictor of all outcomes. Symptom clusters, along with social support, should be considered in care and interventions for older adults with MS. [Journal of Gerontological Nursing, 43(10), 27-36.].

The role of cognitive rehabilitation in people with type 2 diabetes: A study protocol for a randomized controlled trial.

Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).

A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis.

OBJECTIVE: To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention - Memory, Attention, and Problem Solving Skills for Persons with Multiple Sclerosis (MAPSS-MS) - for persons with multiple sclerosis on cognitive performance, memory strategy use, self-efficacy for control of symptoms and neuropsychological competence in activities of daily living (ADL). DESIGN: A randomized controlled single-blinded trial with treatment and wait list control groups. SETTING: Southwestern United States. SUBJECTS: Convenience sample of 61 persons (34 treatment, 27 wait list control) with multiple sclerosis (mean age 47.9 years, SD 8.8). INTERVENTION: The eight-week MAPSS-MS intervention program included two components: (a) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and (b) a computer-assisted cognitive rehabilitation program with home-based training. OUTCOME MEASURES: A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) and self-report instruments (use of memory strategies, self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL) were completed at baseline, two months (after classes), and at five months. RESULTS: Both groups improved significantly (P < 0.05) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL. There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies. CONCLUSIONS: The MAPSS-MS intervention was feasible and well-accepted by participants. Given the large relative increase in use of compensatory strategies by the intervention group, it holds promise for enhancing cognitive function in persons with multiple sclerosis.

A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome.

OBJECTIVE: To examine the effects of a wellness intervention, Lifestyle Counts, for women with fibromyalgia syndrome on the level of self-efficacy for health-promoting behaviours, health-promoting activity and perceived quality of life. DESIGN: A randomized controlled single-blinded trial with treatment and attention-control groups. SETTING: Community in the southwestern United States. SUBJECTS: Convenience sample of 187 women (98 treatment, 89 attention control) with fibromyalgia syndrome (mean age = 53.08 years, SD 9.86). INTERVENTION: The two-phase Lifestyle Counts intervention programme included lifestyle change classes for eight weeks, with goal-setting and telephone follow-up for three months. Participants in the attention-control group were offered an equivalent amount of contact in classes on general disease-related information and health education topics and unstructured follow-up phone calls. Participants were followed for a total of eight months after baseline. OUTCOME MEASURES: Self-report instruments measuring self-efficacy for health behaviours, health-promotion behaviours and health-related quality of life (SF-36 and the Fibromyalgia Impact Questionnaire) were completed at baseline, two months (after the classes), five months (after telephone follow-up) and at eight months. RESULTS: Both groups improved significantly (P<0.05) over time on the measures of self-efficacy, health behaviours, fibromyalgia impact and quality of life. There were significant group x time interactions for scores on the Health Promoting Lifestyle II subscales of physical activity and stress management. CONCLUSIONS: The Lifestyle Counts wellness intervention holds promise for improving health-promoting behaviours and quality of life of women with fibromyalgia syndrome.

A situation-specific theory of Midlife Women's Attitudes Toward Physical Activity (MAPA).

This paper presents a situation specific theory-the Midlife Women's Attitudes Toward Physical Activity (MAPA) theory-that explains how women's attitudes toward physical activity influence their participation in physical activity. Using the integrative approach of Im, the theory was developed based on the Attitude, Social Influence, and Self Efficacy Model; a review of the related literature; and a study of women's attitudes toward physical activity. As a situation-specific theory, the MAPA theory can be linked easily to nursing practice and research projects related to physical activity in midlife women, especially interventions aimed at increasing midlife women's participation in physical activity.

Psychological resilience and depressive symptoms in older adults diagnosed with post-polio syndrome.

Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post-polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self-efficacy, personal resources, interpersonal relationships, self-rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored > or = 10 on the Center for Epidemiologic Studies Short Depression Scale (CES-D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self-rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (beta = -.26). The implications for rehabilitation nurses in developing a patient-strengths perspective in the assessment and counseling of older adults with PPS are discussed.

Structural equation modeling of disability in women with fibromyalgia or multiple sclerosis.

Structural equation modeling (SEM), a popular statistical technique for analysis of multivariate data in the social sciences, is increasingly being used in the behavioral and clinical sciences. SEM is appropriate for posing complex models that evaluate the direct and indirect influence of several variables on one or more outcome variables. A biosocial model of disability, the Disablement Process Model, lends itself to evaluation by SEM. Using SEM, this study examined predictors of disability (Age, Education, Duration of Illness, and Economic Adequacy Functional Limitations, Depressive Symptoms, and Social Support) separately in women with multiple sclerosis (MS) and women with fibromyalgia syndrome (FMS) and compared the respective models across groups. Data were analyzed with Analysis of Moment Structures (Amos) 7.0. Problems identified in initial confirmatory model testing included collateral correlated errors, a negative error variance, and poor performance of the disability indicators. After specifying well-fitting confirmatory models for each group, a structural model for the larger FMS group was estimated. Model refinement resulted in the reversal of the path between Depressive Symptoms and Social Support. Further model revisions were based on comparative fit statistics and theoretical logic. The structural model developed from the FMS sample required minimal changes to fit the MS sample. The multisample model explained greater variance in disability in women with FMS than in women with MS. Social support and depressive symptoms mediated the effect of functional limitations on disability. Interventions that target modifiable characteristics, such as depression and social support, may improve outcomes such as disability.

Predictors of a health promoting lifestyle in women with fibromyalgia syndrome.

The purpose of this study was to describe the health practices of women with fibromyalgia syndrome (FMS) and the predictors of an overall health promoting lifestyle in these individuals. The predictors of a health promoting lifestyle examined in this study were barriers, social support, self-efficacy, demographic characteristics and illness factors. The sample consisted of 198 women who participated in a randomised clinical trial to test the effectiveness of a health promotion intervention for women with FMS. The women in this sample engaged most frequently in health practices in the domains of interpersonal relations and spiritual growth and least frequently in the domain of physical activity. Self-efficacy and social support were significant predictors of an overall health promoting lifestyle.

The effects of hormone therapy decision support for women with mobility impairments.

Deciding about hormone therapy (HT) use is particularly complex for women with mobility impairments. While HT controls menopausal symptoms, the potential increased risk of blood clots resulting from physical inactivity can contraindicate HT use. These women, therefore, may benefit from interventions to help them tailor standard information about HT. We randomly assigned women to receive either a tailored decision support intervention or standard menopausal information. Both groups (n = 176) significantly decreased their decisional conflict and uncertainty and increased knowledge after receiving the treatment materials. We interpret the findings in the context of limited medical information about HT for women with disabilities.

A Nurse-Led Cognitive Training Intervention for Individuals With Type 2 Diabetes.

Diabetes increases the risk for cognitive impairment and doubles the rate of cognitive decline after diagnosis. In turn, cognitive dysfunction makes diabetes self-management more difficult. Nurses who help manage these conditions are focused on identifying patients at risk for complications, promoting symptom management, and preventing further decline. The purpose of the current study was to develop and pilot test a nurse-led comprehensive cognitive training intervention for individuals with type 2 diabetes mellitus (T2DM), the Memory Attention and Problem Solving Skills in Persons With Diabetes Mellitus (MAPSS-DM). The 8-week intervention combined in-person classes and online computer training. Development included: (a) adaptation of established, tested interventions; (b) interviews with stakeholders; (c) integration of course content; and (d) pilot testing of the intervention in a one-group, pre-/posttest design (N = 19). Postintervention scores improved in all areas; improvements were statistically significant for diet adherence (t[18] = -2.41, p < 0.005), memory ability (t[18] = 5.54, p < 0.01), and executive function (t[18] = 3.11, p < 0.01). Fifty-eight percent of participants stated the intervention helped their diabetes self-management, and 74% indicated they wanted to continue using cognitive strategies learned in the intervention. Results from this study showed the MAPSS-DM to be a promising cognitive training intervention for individuals with T2DM. TARGETS: Individuals with T2DM. INTERVENTION DESCRIPTION: In-person classes and online computer training of a cognitive training intervention. MECHANISMS OF ACTION: Participants who completed the intervention would show improved cognitive function, which would result in improved self-management adherence followed by better glycemic control. OUTCOMES: Improved diabetes self-management and sustained use of learned cognitive strategies. [Res Gerontol Nurs. 2019; 12(4):203-212.].

The influence of positive experiences on depression and quality of life in persons with multiple sclerosis.

PURPOSE: This correlational study determined the extent to which positive, rather than negative, experiences influence depressive symptoms and quality of life in persons with multiple sclerosis (MS). METHOD: Data collected during the 7th year of an ongoing longitudinal study of quality of life in community-dwelling persons with MS were used for this analysis. FINDINGS: Higher number of positive experiences was associated with fewer depressive symptoms, less functional limitations, and better quality of life. Using hierarchical multiple regression, age, education, functional limitations, and positive experiences accounted for 21.7% of the variance in depressive symptoms, and functional limitations, positive experiences, and depressive symptoms explained 58% of the variance in quality of life. CONCLUSIONS: Higher number of positive experiences predicted lower levels of depressive symptoms, even while taking disease-related functional limitations into account. Incorporating positive experiences into daily life may improve quality of life, even when battling depression and substantial limitations in functioning.

Participant Perspectives of Cognitive Rehabilitation for Type 2 Diabetes: Expectations and Impact.

PURPOSE: To describe the experiences of people with type 2 diabetes who have completed a comprehensive cognitive rehabilitation intervention. METHOD: Nineteen participants with type 2 diabetes enrolled in an 8-week intervention consisting of 4 educational classes to learn strategies to improve cognitive function and an online training program at home to practice cognitively stimulating activities. Two focus groups were conducted as part of a study designed to assess the feasibility of the comprehensive cognitive rehabilitation intervention. RESULTS: Three main themes were identified in the qualitative data: (1) expectations of cognitive change; (2) use of cognitive strategies; and (3) effect on diabetes self-management. Participants shared valuable insight into how their experiences with the intervention changed and how they viewed diabetes. CONCLUSIONS: While the participants did not initially tie their cognitive complaints to diabetes, they were able to show how and why they might use cognitive strategies to improve diabetes self-management activities. By adapting those strategies for diabetes, quality of life can improve as well as potentially glycemic control.

Computer-assisted cognitive rehabilitation in persons with multiple sclerosis: Results of a multi-site randomized controlled trial with six month follow-up.

BACKGROUND: The effects of multiple sclerosis (MS) on cognition have gained increasing recognition as one of the major disabling symptoms of the disease. Despite the prevalence of these symptoms and their impact on quality of life, limited attention has been given to strategies that might help manage the cognitive changes commonly experienced by persons with MS. OBJECTIVE: The primary purpose of this study was to determine the effectiveness of a novel computer-assisted cognitive rehabilitation intervention MAPSS-MS (Memory, Attention, Problem Solving Skills in MS) in a multi-site trial with persons with MS. METHODS: Persons with MS (N = 183) with cognitive concerns were randomly assigned to either the 8-week MAPSS-MS intervention or usual care plus freely available computer games. Participants completed self-report and performance measures of cognitive functioning, compensatory strategies and depression at baseline, immediately after the MAPSS-MS intervention, and three and six months post-intervention. Changes in study outcomes were analyzed using intention to treat methodology, ANOVA with repeated measures, and ANCOVA. RESULTS: Both groups improved significantly on all outcome measures. The intervention group outperformed the comparison group on all measures, and there were statistically significant differences on selected measures. CONCLUSION: Findings suggest that MAPSS-MS is a feasible intervention that could be broadly implemented in community settings. It has been shown to be modestly successful in improving cognitive functioning.