Relationship between physical activity and coping with stress in people with multiple sclerosis: A moderated mediation model with self-efficacy and disability level as variables / Relación entre actividad física y afrontamiento del estrés en personas con esclerosis múltiple: un modelo de mediación moderada con autoeficacia y nivel de discapacidad como variables

Purpose: An increasing number of studies support the beneficial relationship between physical activity and stress coping in people with multiple sclerosis (MS). However, there has been limited understanding of the variables that may influence the nature of this relationship. Therefore, based on the social-cognitive framework and previous research, we aimed to examine the association between the habitual physical activity of people with MS and their coping effectiveness. Furthermore, we sought to determine the extent to which self-efficacy acts as a mediator in this relationship, considering the level of disability as a moderator variable. Methods: In this cross-sectional study, a total of 351 people with MS participated. The participants were asked to complete several assessment tools, including the Mini-COPE Inventory for Measurement—Coping with Stress, the Generalized Self-Efficacy Scale, and the Godin Leisure-Time Exercise Questionnaire. Additionally, a neurologist assessed the severity of the disease using the Expanded Disability Status Scale. Information on the demographic and clinical characteristics of the participants was collected via a self-report survey. Two moderated mediation analyses were conducted as part of the study. Results: The study findings indicated a positive correlation between engagement in physical activity and self-efficacy among participants with high and medium disability levels. This, in turn, demonstrated a positive association with effective stress-coping strategies and a negative association with ineffective coping methods. In particular, a significant relationship was observed between involvement in physical activity and self-efficacy in participants with high disability, while it was not statistically significant in participants with low disability.(AU)

Sense of happiness in Polish patients with multiple sclerosis.

INTRODUCTION: Happiness is crucial to patient well-being and their acceptance of their disease. The aim of this study was to assess the sense of happiness in persons with multiple sclerosis (PwMS), compare it to the level of happiness in patients with other neurological conditions, and determine which factors affect the sense of happiness in PwMS. MATERIAL AND METHODS: Five hundred and eighty-nine PwMS and 145 control subjects (post-stroke patients with chronic pain syndromes and neuropathies) were included in the study. Due to the differences between the groups in terms of demographic variables, an adjusted group of PwMS (n = 145) was selected from the entire group of PwMS. All patients were assessed using the Oxford Happiness Questionnaire (OHQ), the Satisfaction with Life Scale (SLS), and the Family APGAR Questionnaire. Based on regression analysis, the study examined which variables affected the level of happiness in the groups. RESULTS: Analysis of the OHQ scores showed that PwMS had a lower sense of happiness compared to the control group in the overall score [113.21 (25-42) vs. 119.88 (25-49), respectively; p = 0.031] and the subscales (OHQ subscale 1 - 54.52 vs. 57.84, respectively; p = 0.027; subscale 2 - 35.61 vs. 37.67; respectively; p = 0.044). Based on linear regression analysis, life satisfaction (ß = 0.40; p < 0.001), positive orientation (ß = 0.32; p < 0.001), and primary education (ß = 0.08; p = 0.009) were the most significant predictors of a higher level of happiness in PwMS. Similar results were found in the control group. CONCLUSIONS: The sense of happiness in PwMS was lower than in patients with other conditions. The most important factors influencing happiness included life satisfaction and positive orientation. Influencing these predictors should be the aim of psychological interventions, especially in patients with a reduced sense of happiness.

Symptoms of depression and anxiety among Ukrainian children displaced to Poland following the outbreak of the Russo-Ukrainian war: Associations with coping strategies and resilience.

This study sought to discern the association of resilience, coping, and contextual factors on depression and anxiety among Ukrainian children displaced to Poland following the Russo-Ukrainian war. A cross-sectional analysis was undertaken with 284 Ukrainian children, aged 11-15 years, relocated to Poland in 2022 due to the ongoing conflict. Participants were assessed using validated tools for anxiety, depression, resilience, and coping, alongside a study-specific questionnaire. Notable associations emerged between depression and variables including age (Mage = 12.04, 49% females), emotional coping, relational resilience, and significant loss, accounting for 39% of the variance (p < .001). Anxiety was intricately linked with heightened emotional coping and diminished problem-solving capabilities, accounting for notable variances (state: 32%, trait: 45%, p < .001). Resilience, particularly in relational contexts, and the experience of bereavement stood out as paramount determinants of mental health outcomes. Children's mental health in conflict zones is shaped by a convoluted interplay of individual and environmental factors. This study accentuates the pivotal role of relational resilience, bereavement, and coping mechanisms in modulating depression and anxiety amidst war-related adversities. It underscores the imperative for targeted interventions, fostering positive relationship frameworks, and enhancing adaptive coping mechanisms.

One World Project's Wheelchair Skills Training Camp in Morocco - effects of a community peer-based programme.

PURPOSE: The aim of this study was to assess wheelchair skills of persons with physical disabilities who attended the first Wheelchair Skills and Empowerment Camp in Morocco and their satisfaction with manual wheelchairs provided for the camp activities. MATERIALS AND METHODS: 19 persons (13 male and 6 female) with physical disabilities took part in the project. The average time since injury or illness was 24 years. To assess wheelchair skills/user satisfaction, the researchers used the Queensland Evaluation of Wheelchair Skills test and the Quebec User Evaluation of Satisfaction with assistive Technology. RESULTS: Study participants improved their overall wheelchair mobility skills (p = 0.002; d = 0.20), especially their ability to ascend and descend a ramp (p = 0.012; d = 0.67). The participants reported significantly greater satisfaction with the new provided wheelchairs in comparison to their own wheelchairs in regard to five satisfaction items; i.e., ease in adjusting (p = 0.011; d = 0.96), safety and security (p = 0.014; d = 0.97), durability (p = 0.037; d = 0.81), ease to use (p = 0.045; d = 0.87), and comfort (p = 0.006; d = 1.03). CONCLUSIONS: Findings of this study indicate that persons with physical disabilities in Morocco need structured training in wheelchair skills and better-quality wheelchairs. The study also confirmed that community peer-based programmes in low-resource countries can play a significant role in rehabilitation of persons with physical disabilities, even many years after their injury or illness.IMPLICATIONS FOR REHABILITATIONThe One World project educated local persons with disabilities and government officials about the need for buying appropriate wheelchairs and for providing them according to the World Health Organization guidelines.19 persons who use wheelchairs participated in 6-days of wheelchair skills training sessions, which were led by three peer mentors who use a wheelchair: two with spinal cord injury, and one with polio complications.The 19 participants, who had lived with their disabilities on average for 24 years, advanced their general wheelchair mobility skills, which was assessed through a practical test.The results confirmed that community peer-based programmes in low-resource countries are important for improving wheelchair skills not only when beginning rehabilitation but even after individuals live many years with a disability.

Religious meaning system and life satisfaction: the mediating role of meaning in life among Polish people with multiple sclerosis.

Introduction: The complexity of the associations between religiosity and indicators of well-being suggests the presence of a mediating mechanism. Previous studies indicate that religion may influence subjective well-being because it helps to find meaning and purpose. Therefore, the aim of our study was to examine the mediating role of the presence and search dimensions of meaning in life in the relationship between religious meaning system and life satisfaction in patients with multiple sclerosis (MS). Methods: This cross-sectional study included 600 MS patients recruited from Poland who completed the Satisfaction with Life Scale (SWLS), the Religious Meaning System Questionnaire (RMS) and the Meaning in Life Questionnaire (MLQ). Model 6 of Hayes PROCESS was used to test the hypotheses. Results: The results of our research indicate that there was a significant indirect effect of religious meaning system on life satisfaction through the presence of meaning in life. The specific indirect effect of religious meaning system on life satisfaction through searching for meaning in life was not significant. Discussion: The results of our study are relevant because they show that religion as a meaning system is positively related to the presence of meaning in life, which in turn positively predicts life satisfaction. This is particularly important in the case of incurable illness, where finding meaning in life is one of the natural stages of adaptation. By incorporating these findings into mental health practice, professionals can enhance the holistic well-being of people coping with MS and contribute to a more comprehensive and effective approach to mental health care.

The Clinical and Epidemiological Profile of Paediatric-Onset Multiple Sclerosis in Poland.

Background. Paediatric-onset MS (POMS) has a unique clinical profile compared to the more prevalent adult-onset MS. For this study, we aimed to determine the demographic and clinical characteristics of POMS in Poland as well as addressing some of its epidemiological aspects. Methods. A retrospective study was conducted based on the Polish Multiple Sclerosis Registry, considering a population of children and adolescents with MS (age ≤ 18 years). Data were collected by all 13 centres across Poland specializing in diagnosing and treating POMS. The actual course of the disease and its clinical properties were compared between child (≤12 years) and juvenile (>12 years) patients. MS onset and its prevalence were assessed at the end of 2019, stratified by age range. Results. A total of 329 paediatric or juvenile patients (228 girls, 101 boys) with a clinically definite diagnosis of MS, in conformity with the 2017 McDonald Criteria, were enrolled. For 71 children (21.6%), the first symptoms appeared before the age of 12. The female: male ratio increased with age, amounting to 1:1 in the ≤12 years group and to 2.9:1 in the >12 years group. In most cases, the disease had multi-symptomatic onset (31.3%), and its course was mostly of a relapsing−remitting character (95.7%). The initial Expanded Disability Status Score for both groups was 1.63 ± 1.1, whereas the annual relapse rate was 0.84 during the first 2 years. The time between the onset of symptoms and diagnosis was longer in the younger patients (8.2 ± 4.2 vs. 4.6 ± 3.6 months; p < 0.005). On 31 December 2019, the age-adjusted prevalence standardized to the European standard population was 5.19/100,000 (95% CI, 4.64−5.78). Significantly higher prevalence was noted in the 13−18 years group (7.12; 95% CI, 6.64−7.86) than in the 9−12 years group (3.41; 95% CI, 2.98−3.86) and the <9 years group (0.56; 95% CI, 0.46−0.64; p < 0.001). Conclusion. POMS commencing at the age of ≤12 years is rare, differing significantly from the juvenile-onset and adult MS in terms of clinical characteristics, course, and incidence, as stratified by gender.

Neurological consequences of COVID-19.

In December 2019, cases of pneumonia caused by infection with the previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to coronavirus disease 2019 (COVID-19), were identified. Typical manifestations of COVID-19 are fever, cough, fatigue and dyspnoea. Initially, it was thought that the mechanism of action of SARS-CoV-2 was only associated with respiratory tract invasion, but it was later revealed that the infection might involve many other organs and systems, including the central and peripheral nervous systems. Neurological complications associated with SARS-CoV-2 infection include encephalopathy, encephalitis, meningitis, acute disseminated encephalomyelitis (ADEM), ischaemic and haemorrhagic stroke and cerebral venous sinus thrombosis. In cases of peripheral nervous system involvement, smell and taste disorders, myopathy or the signs and symptoms of Guillain‒Barré syndrome are observed. The most common early neurological complications, particularly during the first year of the epidemic, were anosmia and taste disorders, which, according to some studies, occurred in over 80 percent of patients with COVID-19. The proportion of patients with serious neurological manifestations was small compared to the global number of patients, but the numbers of SARS-CoV-2 infections and critical patients increased substantially. The experience from 2 years of the pandemic has shown that approximately 13% of infected patients suffer from severe neurological complications. The relationship between SARS-CoV-2 and the nervous system is not only a cause of neurological complications in previously healthy individuals but also directly and indirectly affects the courses of many nervous system diseases.

The Big Five Personality Traits and Positive Orientation in Polish Adults with Multiple Sclerosis: The Role of Meaning in Life.

Scientific achievements concerning the direct relation between personality traits and positive orientation among patients with multiple sclerosis do not explain the role of potential mediators. In fact, some researchers argue that the traits-positivity association is much more complex than it seems to be. For this reason, we made an attempt to analyze the indirect relationship between the above-mentioned variables, including meaning in life as a mediator. In total, 618 patients with MS took part in the study. The NEO Five-Factor Inventory, the Positive Orientation Scale, and the Meaning in Life Questionnaire were used. The results showed that positive orientation/the presence of meaning/searching for meaning correlated positively with extraversion, openness to experience, agreeableness, and conscientiousness, and were negatively associated with neuroticism. Moreover, meaning in life in both its dimensions acted as a mediator in 9 of 10 models. It can be assumed that a propensity to establish interpersonal relationships (extraversion), use active imagination (openness), inspire confidence among others (agreeableness), and take responsibility (conscientiousness) can have an impact on someone's positive attitude toward oneself and the surrounding world (positive orientation) when people have meaning in life and when they are seeking it.

Pediatric-onset multiple sclerosis in Poland: A registry-based retrospective cohort study.

BACKGROUND: Epidemiologic data on pediatric-onset multiple sclerosis (POMS) in Central and Eastern Europe are limited. The aim of this study was to determine the incidence, prevalence and the clinical features of POMS in Poland. METHODS: Registry-based retrospective study was conducted among Polish children population (age ≤ 18 years), between 1 January 2010 and 31 December 2019. A total of 329 pediatric or juvenile patients fulfilled the International Pediatric MS Study Group (IPMSSG) criteria for MS, reported to the Polish Multiple Sclerosis Registry, were considered for estimation of age- and sex-specific prevalence (per 100,000 persons), and incidence rates (per 100,000 person-years). The demographic data, clinical presentation and treatment strategies also were investigated. RESULTS: On December 31, 2019 in the database were collected data of 329 patients up to 18 years with POMS diagnosis (101 boys and 228 girls; mean age 15.3 ± 3.8 years). The age-adjusted prevalence standardized to the European Standard Population was 5.19/100,000 (95% confidence interval (CI), 4.64-5.78). A significantly higher prevalence was recorded in girls (7.41; 95% CI, 6.48-8.44) than in boys (3.08; 95% CI, 2.50-3.74; P<0.001). The mean annual standardized incidence in Poland between 2015 - 2019 was 0.77 (95%CI, 0.45-1.02) per 100,000 person-years. The highest overall standardized incidence 1.06 (95%CI, 0.82-1.34) was noted in 2018. Most of patients (95.7%) had relapsing-remitting disease with polysymptomatic onset in one-thirds of the cases, and 82.3% were treated with disease-modifying drugs. Family history of MS was reported in 26 cases (7.9%). CONCLUSION: In this first report of registry-based study from Poland an increasing prevalence and incidence of POMS was found during the last years. This temporal trend corroborate the findings of studies conducted elsewhere.

Mental Health Status of People with Multiple Sclerosis during the COVID-19 Pandemic.

OBJECTIVE: This study assesses and compares the mental health status of people with multiple sclerosis (PwMS) in Poland during the second wave of the Coronavirus Disease 2019 (COVID-19) pandemic (November 2020) to a similar group whose mental health status was examined in November 2017. It also analyzed the psychological resources such as self-efficacy and health locus of control (HLC) and their relationship to mental health in both groups. METHODS: Cross-sectional study included two groups of PwMS with 113 respondents each. The respondents completed the General Health Questionnaire-12 and questionnaires for assessing self-efficacy and HLC. The clinical and demographic data of participants were also collected. RESULTS: No differences in mental health status were observed between the studied groups. A hierarchical regression model of the group studied in 2020 revealed that general self-efficacy (ß = -0.21, p = 0.032), HLC-internal (ß = -0.21, p = 0.035), and education (ß = -0.18, p = 0.048) explained 18% of the variance in the mental health of PwMS, whereas according to the model of the group assessed in 2017 self-efficacy (ß = -0.31, p < 0.001), HLC-chance (ß = 0.45, p < 0.001), and HLC-internal (ß = -0.37, p < 0.001) explained 48% of the variance. CONCLUSIONS: Study results suggest that the pandemic and the related lockdown had no effect on the mental health status of PwMS. At the same time, it was noted that well known determinants of mental health such as self-efficacy and HLC seemed to retain their prominent role for mental functioning in the pandemic.

Psychometric properties of the Polish version of the Multiple Sclerosis Self-Management Scale - Revised.

PURPOSE: The main aim of this study was to analyse the psychometric properties of the Polish version of the Multiple Sclerosis Self-Management-Revised Scale. METHODS: A total of 663 patients with multiple sclerosis were included in this study. The Polish version of the Multiple Sclerosis Self-Management-Revised Scale, The General Self-Efficacy Scale, Multiple Sclerosis Impact Scale-29, and Expanded Disability Status Scale were used. Cronbach's alpha and McDonald's omega coefficients were calculated to assess the Polish version of the scale's reliability. The reliability of the scale's test items was assessed using an information function with the multidimensional graded response model. Confirmatory factor and principal component analyses were conducted. RESULTS: Cronbach's α and McDonald's ω were obtained (α = 0.896, ω = 0.909). Correlations between the scores of the Polish version of the Multiple Sclerosis Self-Management-Revised Scale and the General Self-Efficacy Scale (r = 0.34; p < 0.001) and the neurological assessment of patients by a physician (r = -0.23; p < 0.001) were significant. The original factor structure of the scale was not confirmed (Chi2(242) = 1480; p < .001; CFI = 0.829; TLI = .805; RMSEA = 0.088, 90% CI = [0.084-0.092]; SRMR = 0.079). CONCLUSIONS: Using only the total score of the Multiple Sclerosis Self-Management-Revised Scale is recommended for Polish patients. The scale's factor structure requires further study.Implications for rehabilitationThe Polish version of the Multiple Sclerosis Self-Management-Revised Scale was reliable and valid when used in adult multiple sclerosis patients.At present, we recommend using only the total score of the Multiple Sclerosis Self-Management-Revised Scale. Further research is needed to distinguish the detailed subscales of the Polish version of the tool.The Polish version of the Multiple Sclerosis Self-Management-Revised Scale can be used in clinical practice and for research purposes to assess the general level of self-management in Polish-speaking multiple sclerosis patients in Poland.

Coping profiles in multiple sclerosis: Comparison of personal resources.

BACKGROUND: Identifying the profiles of multiple sclerosis (MS) patients who employ similar patterns of coping may improve the understanding of how coping is associated with psychological adjustment. The purpose of this study was to identify the groups of MS patients using different coping strategies and compare the levels of psychological resources across the groups. METHODS: In this cross-sectional study 382 patients with MS completed a battery of self-report measures that assessed their use of different coping strategies, optimism, self-efficacy, health locus of control (HLC), and perception of disease. The groups with different coping profiles were selected by performing a cluster analysis. RESULTS: Five different coping profiles were highlighted and were defined as follows: "Emotional," "Temperate," "Active," "Passive," and "Problem copers." Significant differences were detected between the groups in the levels of optimism, self-efficacy, HLC, and perception of disease. CONCLUSION: Patients with MS use a varied repertoire of coping strategies, which allowed distinguishing coping profiles. Groups representing particular profiles differ in terms of psychological resources. This study contributed to increasing the interest in investigating coping profiles. Identifying subgroups of individuals based on their coping profiles and recognizing the differences is important for providing psychological support.

The perceived impact of multiple sclerosis and self-management: The mediating role of coping strategies.

Low level of self-management in people with multiple sclerosis (MS) is considered to be a predominant factor that leads to poor rehabilitation efficacy. Studies focusing on the relationship between self-management and psychological variables that can be modified could contribute to expanding the knowledge needed to propose interventional programs aiming at patient activation. This study aimed to analyze whether coping strategies play a mediating role in the association between the perceived impact of MS and level of self-management in people with MS. The cross-sectional study included 382 people with MS. The participants completed the Multiple Sclerosis Self-Management Scale-Revised, Multiple Sclerosis Impact Scale-29, and Coping Inventory for Stressful Situations. The study hypothesis was evaluated using mediation analysis. The STROBE checklist specifically prepared for cross-sectional research was applied in this study for reporting. Results indicate that the emotion- and problem-focused strategies of coping can be treated as mediating the association between the MS impact and level of self-management in people with MS. A negative relationship was found between the perceived MS impact and problem-oriented coping, while a positive relationship was found between problem-oriented coping and self-management. Furthermore, a positive relationship was found between the MS impact and emotion-oriented coping, while a negative relationship was found between emotion-oriented coping and self-management. The indirect role of avoidance-oriented coping was not significant. Our study confirms the role played by coping strategies in individuals' self-management. In MS, self-management determined by perceived MS impact can be controlled by decreasing emotional-coping while increasing problem-coping strategies. Our study imparts new knowledge regarding the potential interventions for improving the level of self-management in people with MS. It indicates that recognition of individuals' illness perceptions as well as maladaptive coping strategies can help health professionals identify those who might be having lower level of self-management.

Personality of patients with multiple sclerosis and the use of hippotherapy.

BACKGROUND: Hippotherapy is an acknowledged form of rehabilitation for multiple sclerosis (MS) in Poland, but is still rarely used. The aim of the study was to assess the differences in the intensity of the personality traits of patients with MS who use and who do not use hippotherapy. METHODS: The examination covered 92 patients with MS, aged 15-81 years old (85.9% women), average age 41.78 (± 15.02) years old, both using hippotherapy and not using this method of rehabilitation. The NEO-FFI Personality Inventory has been used for the study of personality traits. Socio-demographic and clinical data, as well as information regarding the use of hippotherapy, has been collected with the assistance of a self-designed survey. RESULTS: For all of the patients, the trait expressed with the greatest intensity was conscientiousness (31 ± 7.51), and the least-expressed trait was neuroticism (24±10.42). 46% of the patients used hippotherapy and, compared to the non-users, they had a significantly greater level of agreeableness (34 v. 29, P<.001) and conscientiousness (33 v. 29, P=.009). Hippotherapy was most often used by the elderly patients (age average 49 ± 13.7, years old), while the average age of the non-users was 36 ± 13.6, years old (P<.001). Gender, education, place of residence, and economic status did not affect the choice of hippotherapy as a rehabilitation method. CONCLUSIONS: The patients who use hippotherapy had a significantly higher level of agreeableness, conscientiousness, and openness to experience. The most important trait influencing the decision to try hippotherapy was agreeableness.

The Effects of Nordic Walking With Poles With an Integrated Resistance Shock Absorber on Cognitive Abilities and Cardiopulmonary Efficiency in Postmenopausal Women.

Late adulthood is associated with atrophy of brain areas, which contribute to cognitive deterioration and increase the risk of depression. On the other hand, aerobic exercise can improve learning and memory function, ameliorate mood, and prevent neurodegenerative changes. This study demonstrates the effect of Nordic walking (NW) and NW with poles with an integrated resistance shock absorber (NW with RSA) on aerobic capacity and body composition in postmenopausal women. It also measures the brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) serum levels and determines correlations with cognitive functions and depression symptoms. These relationships with the use of NW with RSA as a new form of exercise have not been described thus far. In this study, 31 women (NW - 16, NW with RSA - 15) participated in eight weeks of training. The findings showed that only NW with RSA training caused a significant decrease in body mass and body mass index (p < 0.05). There were no significant changes in GDNF levels between groups studied. Regarding BDNF, a significant decrease (p < 0.05) in the NW group and an increase (not statistically significant) in the NW with RSA group was found. A comparative analysis of cognitive and depression outcomes and changes in BDNF and GDNF concentration showed no significant differences in the efficacy of either form of training. Training loads resulted in a significant increase in VO2max in both the NW (p < 0.01) and NW with RSA (p < 0.05) groups. This indicates an improvement in cardiopulmonary efficiency of the examined women.

Relationship between Pre-Competition Mental State and Sport Result of Disabled Boccia Athletes.

The relationship between sport result and pre-competition mental state of 109 boccia athletes was analyzed. Mental state was described by: athletic identity, self-esteem, self-efficacy for sports, hope for success, fear of failure, anxiety, and expectancy of success. Correlation analyses were made for all four boccia classes (BC1, BC2, BC3, and BC4) and revealed that only athletic identity was associated with sport result in class BC4. Four hierarchical multiple regression models (for BC1, BC2, BC3, and BC4 boccia classes) were created, with sport result as the dependent variable. Only the BC4 model was significant and included athletic identity, anxiety, self-efficacy for sports, and expectancy of success, which explained 49% of variance in sport result. BC4 class results indicate that psychological variables have a potential impact on sport performance in boccia, and the type and level of disability should be taken into account.

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.

Health-related quality of life in multiple sclerosis: Links to acceptance, coping strategies and disease severity.

BACKGROUND: People with multiple sclerosis (MS) report lower health-related quality of life (HRQoL). Improvements in quality of life can be made by identifying the factors that contribute to HRQoL in MS, which are both person specific and disease related. OBJECTIVE: The primary objective of this study was to examine the mutual roles of acceptance, coping, and MS severity on HRQoL. MATERIALS AND METHODS: This study included 382 patients with MS who completed the 29-item Multiple Sclerosis Impact Scale, Coping Inventory for Stressful Situations, and Acceptance of Illness Scale. A standardized questionnaire was used to collect patient clinical and demographics data. General MS severity was determined using the Expanded Disability Status Scale. RESULTS: Six variables, acceptance of illness (ß = -0.24, p < 0.001), emotional coping strategy (ß = 0.40, p < 0.001), avoidance coping strategy (ß = -0.19, p < 0.001), illness duration (ß = -0.18, p < 0.001), age at the time of the study (ß = 0.14, p = 0.009) and problem coping strategy (ß = -0.09, p = 0.05), were found to be the significant correlates of HRQoL in MS. The model that included these variables explained 36% of variance in self-management in MS. CONCLUSION: Psychological variables are more salient correlates of HRQoL in MS than the objective clinical variables, such as the severity or type of MS. Specifically, this study showed that MS patients who accept their illness and use more problem-solving and avoidance coping strategies and less emotional coping strategies assess their HRQoL highly.

Perception of Multiple Sclerosis Impact and Treatment Efficacy Beliefs: Mediating Effect of Patient's Illness and Self-Appraisals.

CONTEXT: Patients with multiple sclerosis (MS) experience many negative, seriously aggravating disease symptoms, and hence, research studies are utmost required to improve their coping with symptoms. Our research is an attempt to show ways to increase participation of patients with MS in the treatment and treatment planning process, as well as in managing the symptoms of the disease. OBJECTIVES: To examine the relationship between perception of MS impact and treatment efficacy beliefs in patients with MS and the extent to which self and illness appraisals can be regarded as mediator variables in this relationship. METHODS: The cross-sectional study included 278 MS patients who completed the Treatment Beliefs Scale, Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and Brief Illness Perception Questionnaire. Demographic and clinical characteristics of the participants were collected with a self-report survey. RESULTS: Illness perception and general self-efficacy mediated the relationship between perception of MS impact and treatment efficacy beliefs under the control of age and time from diagnosis. The standardized indirect effects for illness perception and general self-efficacy were -0.131 95% CI [-0.2029, -0.0739] and -0.086 95% CI [-0.1663, -0.0165], respectively. CONCLUSION: Our results indicate that worse perception of physical condition in patients with MS is associated with more negative treatment efficacy beliefs, and that this association is mediated by self-efficacy and illness perception. To inhibit the increase of negative treatment efficacy beliefs, health care specialists can work on improving self-efficacy and illness appraisals.

Health locus of control and mental health in patients with multiple sclerosis: Mediating effect of coping strategies.

In patients with multiple sclerosis (MS), mental health is significantly affected and conditioned by many factors, including psychological ones. This study team aimed to determine whether different coping strategies mediate the relationship between health locus of control (HLC) and mental health in MS patients. In this cross-sectional study, a total of 382 patients with MS were included. The patients completed General Health Questionnaire-12, Coping Inventory for Stressful Situations, and Multidimensional Health Locus of Control Scale. The demographic and clinical characteristics of the patients were collected using a self-report survey and neurological assessment. A mediation analysis was used to test the study hypothesis. Problem-oriented coping was found to be a significant mediator in the relationship between internal HLC and mental health (indirect effect: -0.129 [95% confidence interval [CI]: -0.193, -0.079]; standardized indirect effect: -0.113 [95% CI: -0.165, -0.070]). Emotion-focused coping was found to be a significant mediator in the relationship between power of others HLC and mental health (indirect effect: 0.114 [95% CI: 0.058, 0.178]; standardized indirect effect: 0.125 [95% CI: 0.062, 0.195]). Emotion-focused coping was also found to be a significant mediator in the relationship between chance HLC and mental health (indirect effect: 0.215 [95% CI: 0.154, 0.281]; standardized indirect effect: 0.209 [95% CI: 0.149, 0.272]). Patients with internal HLC were found to have positive mental health due to their problem-focused coping strategies, while patients with external HLC had worse mental health as they used more emotion-focused strategies. Hence, problem-focused and emotion-focused coping strategies can be considered mediators of the relationship between HLC and mental health in patients with MS.