Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study.

BACKGROUND: Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains. OBJECTIVE: This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS. METHODS: Participants-ambulatory adults with medically documented MS-are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames. RESULTS: The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026. CONCLUSIONS: Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS. TRIAL REGISTRATION: ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59876.

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.

Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the United States. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. Methods: This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 hours of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 hours will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient reported quality of life measures. Discussion: In-vitro and in-vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. Trial registration: ClinicalTrials.gov (NCT04217551, 2019-12-30).

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.

BACKGROUND: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. METHODS: This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures. DISCUSSION: In vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. TRIAL REGISTRATION: ClinicalTrials.gov NCT04217551. Registered on 30 December 2019.

Satisfaction with social roles and activities across mobility status among persons with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). SETTING: Community setting. METHODS: Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury - Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants' mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. RESULTS: A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). CONCLUSIONS: Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.

Nationwide Update on Prevalence of Falls, Injurious Falls, Concerns About Falling, and Fall Prevention in Persons With Multiple Sclerosis.

OBJECTIVE: The aim of the study is to estimate the current nationwide prevalence of falls, injurious falls, concerns about falling, and information on fall prevention among people with multiple sclerosis. DESIGN: This is a cross-sectional national web-based survey that included 965 adult people with multiple sclerosis. Participants self-reported falls and injurious falls experienced in the past 6 months. Participants also provided information on their concerns about falling and information on fall prevention received. RESULTS: A total of 56% reported falling in the past 6 months. The prevalence of falls at the population level ranges between 53% and 59%. Most falls occur inside of participants' homes (68%). About 30% of fallers reported an injurious fall. Most respondents, 87% expressed being concerned about falling and 68% reported they had cut down on activities due to their concerns about falling. Among participants who received information about falling (64%), only 9% received a formal fall prevention course. CONCLUSIONS: Despite advances in falls research over the last decades, falling continues to be a highly prevalent problem for people with multiple sclerosis. About one-third of those falls result in injuries. Concerns about falling among fallers and nonfallers affect the performance of daily activities and independence. Few people receive a formal falls prevention education or training.

Exploration of how valued living relates to resilience among people with spinal cord injury.

PURPOSE/OBJECTIVE: We lack critical information regarding promoting resilience in people with spinal cord injury (SCI). Living according to one's values may increase resilience. The aims of this study were to: (a) determine whether the degree to which individuals with SCI are living according to their values is associated with resilience; (b) identify values endorsed as most important; and (c) examine whether the importance of these values differs significantly by high vs. low resilience. RESEARCH DESIGN: Individuals with SCI (N = 202, Mage = 47.32) completed an online survey. Two linear regression analyses were performed to evaluate the extent to which domains of valued living (measured using the Valuing Questionnaire [VQ] and its subdomains, progress and obstruction, and the Valued Living Questionnaire [VLQ]) were associated with resilience. To explore whether resilience was associated with ratings of the perceived importance of specific types of values, we identified the top 10 most important values endorsed in the sample and performed independent sample t tests to analyze whether high (top quartile) versus low (bottom quartile) resilience groups differed on their importance ratings of specific types of values. RESULTS: Successful pursuit of values (VQ-progress) positively predicted resilience (B = 0.67, p < .001) while barriers in pursuit of values (VQ-obstruction) negatively predicted resilience (B = -0.16, p < .05). The VLQ score (living according to particular values) positively predicted resilience (B = 0.18, p < .001). Participants with high resilience levels rated the following values as significantly more important relative to those low in resilience: caring, respect, compassion, gratitude, responsibility, and contribution. CONCLUSIONS: Individuals with SCI who are able to pursue their values with intention had higher levels of resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Inaugural editorial: Rehabilitation Psychology.

For over 50 years, Rehabilitation Psychology has helped highlight important issues experienced by the disability community. We are extremely excited to continue that legacy in our role as the journal's first dual editors-in-chief, and we look forward to working with our associate editors, Kathleen Bogart and Daniel Klyce, our editorial fellows, and our large editorial board and ad hoc reviewer pool. In our tenure as the journal's editors, we will focus heavily on (a) providing exceptional service, (b) emphasizing diversity and disability identity, (c) broadening the scope of the field, (d) promoting high-quality research standards, and (e) looking ahead. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Widespread Pain With Nociplastic Features is an Independent Predictor of Low Physical Activity in People with Multiple Sclerosis.

Exploring the relationship between underlying pain mechanisms and physical activity could inform interventions to optimize physical activity in persons with multiple sclerosis (PwMS). This cross-sectional nationwide survey examined whether pain phenotype is a significant predictor of self-reported physical activity in PwMS. The study included 938 persons with a self-reported diagnosis of MS (93% reported neurologist-diagnosed MS) who completed surveys of demographic, clinical information, pain intensity, indicators of underlying pain mechanisms (Fibromyalgia Survey Criteria and painDETECT), and physical activity (Godin Leisure-Time Exercise Questionnaire). Responses were used to categorize pain phenotypes as widespread pain with nociplastic features (WPNF), neuropathic, nociceptive, or mixed (neuropathic/WPNF). Following current physical activity guidelines, self-reported physical activity was categorized as active or insufficiently active/sedentary. Applying multivariable logistic regression, participants with no chronic pain had 2.30 higher odds of being physically active when compared to participants with chronic mixed pain. Similarly, participants with neuropathic and nociceptive pain had, respectively, 1.90 and 1.66 higher odds of being physically active compared to individuals with mixed pain. Higher scores on the fibromyalgia survey criteria (operationalized in this study as an indicator of WPNF) were a significant independent predictor of insufficient physical activity (OR = .93, P < .01). Findings indicate that experience and phenotype of chronic pain, in particular WPNF, are associated with physical inactivity in PwMS. This suggests that assessing pain phenotype may be important to identify individuals at risk of inadequate physical activity and may guide the tailoring of behavioral therapeutic approaches to help PwMS achieve the recommended level of physical activity. PERSPECTIVE: This study examines the association between pain mechanism and physical activity in multiple sclerosis. These findings highlight the possibility that a basic screening for pain mechanism could offer clinically useful information without requiring extensive neurobiological phenotyping and may inform the development of behavioral interventions to enhance physical activity in multiple sclerosis.

Effects of a Resilience-Building Energy Management Program on Fatigue and Other Symptoms in Systemic Sclerosis: A Randomized Controlled Trial.

OBJECTIVE: Supported self-management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12-week resilience-building energy management program (called RENEW) for fatigue and other patient-reported outcomes. METHODS: Participants, who had physician-diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer-led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor-Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three-way interaction with group, time, and SSc duration was examined in each model. RESULTS: Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (ß = -4.7; 95% confidence interval -6.7 to -2.7; P < 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. CONCLUSION: An mHealth supported self-management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management.

Psychometric Properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Resilience Short Form in a Sample With Spinal Cord Injury.

OBJECTIVE: To explore the psychometric properties (eg, data distribution characteristics, convergent or discriminant validity, internal consistency reliability) of the Spinal Cord Injury-Quality of Life measurement system (SCI-QOL) Resilience 8-item short form (SF) in comparison to the criterion standard resilience measure, Connor Davidson Resilience Scale (CD-RISC) in a sample of individuals with spinal cord injury (SCI). DESIGN: Descriptive statistics were calculated to examine variable data distribution characteristics. Correlation analyses were conducted for convergent and discriminant validity. Reliability statistics were calculated for resilience and other validity measures. SETTING: General community. PARTICIPANTS: Individuals with SCI (N=202; 51.5% male, 48% female). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System measures (depression, anxiety, ability to participate in social roles and activities, pain intensity, fatigue, sleep disturbance), SCI-QOL short forms (SF) (resilience, positive affect and well-being, mobility), CD-RISC, National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function - perceived stress (NIH Toolbox-perceived stress), and the Satisfaction with Life Scale were administered. RESULTS: The mean and SD for the SCI-QOL Resilience SF (mean=48.60; SD=8.20) approximated the normative mean (mean=50, SD=10). The SCI-QOL Resilience SF scores were essentially normally distributed though somewhat kurtotic, with skew=-0.17 and excess kurtosis=1.4; internal consistency reliability was good (Cronbach's alpha=0.89). Convergent validity was supported by significant moderate correlations in expected directions between the SCI-QOL Resilience SF and measures of CD-RISC resilience, depressive symptoms, anxiety, social participation, positive affect and well-being, stress, and satisfaction with life. Discriminant validity was supported by small non-significant correlations between the SCI-QOL Resilience SF and age, sex, injury level, time since injury, pain intensity, mobility, sleep disturbance, and fatigue. CONCLUSION: The SCI-QOL Resilience SF demonstrated good convergent and discriminant validity. Our study showed that the SCI-QOL Resilience SF is a psychometrically valid tool that can reliably estimate levels of resilience in the SCI population.

Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study.

OBJECTIVE: To provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. DESIGN: Nationwide cross-sectional web-based survey. SETTING: Community setting. PARTICIPANTS: Adult PwMS (n=965). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed self-report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. RESULTS: The most common self-reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities-related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P<.01) and higher pain interference (OR=1.02, P<.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.78 - 3.95, all P<.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 - 10.26, all P<.05) was significantly associated with higher odds of sustaining an injurious fall. CONCLUSIONS: Findings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activities-related factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.

Episodes of Atrial Fibrillation and Symptoms: A Temporal Analysis.

Background: Data on the relationship between symptoms and atrial fibrillation (AF) episodes are limited. Objective: The objective of this study was to determine the strength of temporal association between AF episodes and symptoms. Methods: This cross-sectional ambulatory assessment study was performed in a tertiary care center between June 2018 and December 2021. Patients with paroxysmal AF (1 episode of AF, burden not exceeding 95%) who used a mobile application and continuous wearable electrocardiogram monitor for 21 days were enrolled. The primary outcome was worse symptoms (symptoms above the mean score) over the study period. The association between worse symptoms and the presence of AF was evaluated for different time epochs. Multilevel mixed-effects models were used to quantify associations after accounting for confounders. Results: Worse symptoms were more likely to be associated with the presence of AF episodes 15 minutes prior to the reporting of palpitations (OR, 2.8 [95% CI, 1.6-5.0]; P < .001), shortness of breath (OR, 2.2 [95% CI, 1.3-3.7]; P = .003), dizziness/lightheadedness (OR, 2.0 [95% CI, 1.0-3.7]; P = .04), and fatigue (OR, 1.7 [95% CI, 1.0-2.9]; P = .03). The correlation between the severity of symptoms and AF lessened as the time interval from AF events to symptoms increased. Conclusion: There is a significant relationship between onset of AF episodes and reporting of symptoms. This association diminishes over time and varies across different symptoms. If confirmed in larger studies, these findings may inform AF interventions that target symptoms just in time prior to a clinical visit.

Predictors of performance and perceived fatigability in people with multiple sclerosis.

BACKGROUND AND OBJECTIVE: Fatigability is a distinct construct from fatigue that has been reported to contribute to activity limitations in people with multiple sclerosis (PwMS). Identifying predictors of performance and perceived fatigability may guide the development of interventions to mitigate fatigability. This study investigated predictors of performance and perceived fatigability among PwMS. METHODS: PwMS (N = 51) completed self-report measures of demographics, clinical history, symptoms severity (Modified Fatigue Impact Scale), and functioning (PROMIS Physical Function and PROMIS Cognitive Function Abilities). Performance fatigability measures included Ambulatory Fatigue Index (AFI), Deceleration Index (DI), and Distance Walking Index (DWI). Perceived fatigability measures included Pittsburgh Fatigability Scale (PFS), Perceived Physical Exertion, and Perceived Fatigue Intensity. Performance and perceived fatigability measures were calculated based on the Timed 25-Foot Walk Test and the 6-Minute Walk Test. RESULTS: Multivariable linear regression analyses indicated that PROMIS Cognitive Function was a significant independent predictor of performance fatigability measured with AFI (ß = -0.515, p = 0.007), DI (ß = -0.511, p = 0.008), and DWI (ß = -0.516, p = 0.007). Regarding perceived fatigability, PROMIS Pain Intensity predicted Perceived Fatigue Intensity (ß = 0.325, p = 0.035). PROMIS Physical Function predicted PFS Mental fatigability (ß = -0.503, p < 0.001). PROMIS Physical Function (ß = -0.619, p < 0.001) and Cognitive Function (ß = -0.249, p = 0.037) predicted PFS Physical fatigability. CONCLUSIONS: Preliminary findings suggest that self-reported functioning levels, including physical and perceived cognitive function, are potential predictors of performance and perceived fatigability in MS. Notably, perceived fatigue impact showed no association with performance or perceived fatigability. Future studies are warranted to confirm and extend our findings.

Self-reported fatigue impact is associated with frequency of falls and injurious falls in people with multiple sclerosis.

BACKGROUND: Fatigue is the most common symptom associated with multiple sclerosis (MS). Fatigue as a risk factor for injurious falls and frequency of falls is understudied. Falling recurrently is associated with injurious falls which may lead to reduced functional independence and poor quality of life of people with MS. Identifying contributors of recurrent falls and injurious falls is clinically useful to develop effective interventions. OBJECTIVE: To investigate the associations between fatigue impact and frequency of falls and injurious falls in people with MS. METHODS: Fifty-one participants completed the Modified Fatigue Impact Scale (MFIS) and a survey of number of falls and injurious falls during the past year. Logistic regression analyses were conducted to investigate whether scores on the MFIS (Total, Physical, Cognitive, and Psychosocial) predicted odds of being a recurrent faller (> 2 falls) or infrequent faller (1- 2 falls) versus a non-faller, and odds of experiencing an injurious fall (yes/no). The analyses were adjusted for demographic and clinical characteristics and common symptoms of MS (depression, cognition, pain, and sleep disturbance). RESULTS: Higher MFIS Total score was associated with higher odds of infrequent falls (OR = 1.07, 95% CI, 1.00 - 1.15, p = 0.05) and recurrent falls (OR = 1.10, 95% CI, 1.00 - 1.20, p = 0.04) relative to not falling in the past year. Higher scores on the MFIS Physical subscale were significantly associated with high odds of infrequent falls (OR = 1.15, 95% CI, 1.02 - 1.30, p = 0.03) and recurrent falls (OR = 1.19, 95% CI, 1.02 - 1.39, p = 0.03). MFIS Psychosocial subscale was significantly associated with higher odds of infrequent falls (OR = 2.01, 95% CI, 1.14 - 3.53, p = 0.02). MFIS Total and MFIS Cognitive subscale were significantly associated with higher odds of injurious falls (OR = 1.11, 95% CI, 1.00 - 1.23, p = 0.04) and (OR = 1.28, 95% CI, 1.02 - 1.60, p = 0.04), respectively. CONCLUSION: The findings indicated self-reported fatigue impact and its specific domains were associated with an increased risk of falling and injurious falls. Further studies using prospective falls assessment and longitudinal evaluation of fatigue are warranted to extend our findings.

Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia.

OBJECTIVE: Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms). DESIGN: Micro-longitudinal design. SETTING/SUBJECTS: Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia. METHODS: Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days. RESULTS: Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue. CONCLUSION: Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.

Sleep-disordered breathing and neurocognitive function in multiple sclerosis: Differential associations across cognitive domains.

BACKGROUND: Sleep disorders are common in people with multiple sclerosis (PwMS) and could contribute to cognitive dysfunction. However, effects of pathological sleep on cognitive domains are insufficiently characterized. OBJECTIVE: To evaluate associations between cognitive performance and polysomnographic (PSG)-based sleep disturbances in PwMS. METHODS: PwMS with known/suspected untreated obstructive sleep apnea (OSA, N = 131) underwent PSG and cognitive tests: Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), California Verbal Learning Test-II (CVLT-II), Brief Visuospatial Memory Test-Revised (BVMT-R Total and Delayed), Judgment of Line Orientation (JLO), Controlled Oral Word Association Test (COWAT), Trail Making Test, Go/No-Go, and Nine-Hole Peg Test (NHPT). RESULTS: Apnea severity measures were associated with worse processing speed, attention, and working memory (SDMT); immediate and delayed visual memory (BVMT-R Total and Delayed); attention, psychomotor speed, and cognitive flexibility (Trails); and manual dexterity and visuomotor coordination (NHPT) (ps ⩽ 0.011). Sleep macrostructure measures showed stronger associations with verbal memory and response inhibition (CVLT-II Total Recognition Discriminability Index), and immediate visual memory (BVMT-R Total) (ps ⩽ 0.011). CONCLUSIONS: Pathological sleep, including hypoxia, sleep fragmentation, and disturbances in sleep/wake states, are differentially associated with worse cognitive performance in PwMS. These findings could inform future personalized approaches to cognitive impairment in PwMS with sleep disorders. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02544373 (https://clinicaltrials.gov/ct2/show/NCT02544373).

Emotional Dynamics in Fibromyalgia: Pain, Fatigue, and Stress Moderate Momentary Associations Between Positive and Negative Emotions.

Affective disruptions, particularly deficits in positive affect, are characteristic of fibromyalgia (FM). The Dynamic Model of Affect provides some explanations of affective disruptions in FM, suggesting that the inverse association between positive and negative emotions is stronger when individuals with FM are under greater stress than usual. However, our understanding of the types of stressors and negative emotions that contribute to these affective dynamics is limited. Using ecological momentary assessment (EMA) methods, 50 adults who met the FM survey diagnostic criteria rated their momentary pain, stress, fatigue, negative emotions (depression, anger, and anxiety), and positive emotions 5X/day for eight days using a smartphone application. Results of multilevel modeling indicate that, consistent with the Dynamic Model of Affect, there was a stronger inverse association between positive emotion and negative emotions during times of greater pain, stress, and fatigue. Importantly, this pattern was specific to depression and anger, and was not present for anxiety. These findings suggest that fluctuations in fatigue and stress may be just as important or more important than fluctuations in pain when understanding the emotional dynamics in FM. In addition, having a more nuanced understanding of the role that different negative emotions play may be similarly important to understanding emotional dynamics in FM. PERSPECTIVE: This article presents new findings on the emotional dynamics in FM during times of increased pain, fatigue, and stress. Findings highlight the need for clinicians to conduct a comprehensive evaluation of fatigue, stress, and anger in addition to more routinely assessed depression and pain when working with individuals with FM.

Self-efficacy trajectories of individuals newly diagnosed with multiple sclerosis.

PURPOSE/OBJECTIVE: The first year following a new multiple sclerosis (MS) diagnosis may be a critical time for individuals as they learn to manage their disease. Effective self-management of MS likely requires healthy self-efficacy levels, yet little is known about self-efficacy in the postdiagnosis period. This study aims to improve our understanding of self-efficacy in individuals newly diagnosed with MS by examining self-efficacy trajectories and identifying patient characteristics associated with trajectories in the first postdiagnosis year. RESEARCH METHOD/DESIGN: Newly diagnosed adults with MS/clinically isolated syndrome (CIS) (N = 230) completed a battery of questionnaires, including the University of Washington Self-Efficacy Scale, at 1, 2, 3, 6, 9, and 12 months, postdiagnosis. Sankey diagrams characterized self-efficacy trajectories and a multiple regression model tested patient characteristics as predictors of self-efficacy change scores. RESULTS: Mean self-efficacy T-scores ranged from 50.79 to 52.04 (SD = 9.40 and 10.12, respectively) across the postdiagnosis year. MS diagnosis (vs. CIS), higher disability levels, and higher MS symptom severity were associated with lower self-efficacy levels at baseline. Baseline symptom severity predicted change in self-efficacy levels from baseline to month 12 (B = -0.05, p = .030). CONCLUSIONS/IMPLICATIONS: Self-efficacy remains relatively stable in the first year following a MS diagnosis, though high symptom severity is associated with decreased self-efficacy at 12-months postdiagnosis. Clinical characteristics (e.g., MS diagnosis, disability level) also appear to play a role in setting the course of self-efficacy in this postdiagnosis year. Timely interventions that enhance self-efficacy and/or improve certain clinical characteristics may promote healthy self-management of MS that carries forward in disease course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feasibility, reliability, and validity of ambulatory cognitive tests in fibromyalgia and matched controls.

OBJECTIVE: This observational study examined the feasibility, reliability, and validity of repeated ambulatory cognitive tests in fibromyalgia (FM). METHOD: Adults with FM (n = 50) and matched controls (n = 50) completed lab-based neuropsychological tests (NIH Toolbox) followed by eight days of smartphone-based ambulatory testing of processing speed (symbol search) and working memory (dot memory) five times daily. Feasibility was assessed based on response rates. Reliability was evaluated using overall average between-person reliabilities for the full assessment period and by determining the number of assessment days necessary to attain reliabilities of >.80 and >.90. To assess convergent validity, correlations were calculated between ambulatory test scores and NIH Toolbox scores. Test performance was contrasted between the FM and non-FM groups to examine known-groups validity. RESULTS: Average rates of response to the ambulatory cognitive tests were 89.5% in FM and 90.0% in non-FM. Overall average between-person reliabilities were ≥.96. In FM, between-person reliability exceeded .90 after two days for symbol search and three days for dot memory. Symbol search scores correlated with NIH Toolbox processing speed scores in both groups, though there were no significant group differences in symbol search performance. Dot memory scores correlated with NIH Toolbox working memory scores in both groups. FM participants exhibited worse dot memory performance than did non-FM participants. CONCLUSIONS: Repeated ambulatory tests of processing speed and working memory demonstrate feasibility and reliability in FM, though evidence for construct validity is mixed. The findings demonstrate promise for future research and clinical applications of this approach to assessing cognition in FM.

An Interventional Response Phenotyping Study in Chronic Low Back Pain: Protocol for a Mechanistic Randomized Controlled Trial.

Evidence-based treatments for chronic low back pain (cLBP) typically work well in only a fraction of patients, and at present there is little guidance regarding what treatment should be used in which patients. Our central hypothesis is that an interventional response phenotyping study can identify individuals with different underlying mechanisms for their pain who thus respond differentially to evidence-based treatments for cLBP. Thus, we will conduct a randomized controlled Sequential, Multiple Assessment, Randomized Trial (SMART) design study in cLBP with the following three aims. Aim 1: Perform an interventional response phenotyping study in a cohort of cLBP patients (n = 400), who will receive a sequence of interventions known to be effective in cLBP. For 4 weeks, all cLBP participants will receive a web-based pain self-management program as part of a run-in period, then individuals who report no or minimal improvement will be randomized to: a) mindfulness-based stress reduction, b) physical therapy and exercise, c) acupressure self-management, and d) duloxetine. After 8 weeks, individuals who remain symptomatic will be re-randomized to a different treatment for an additional 8 weeks. Using those data, we will identify the subsets of participants that respond to each treatment. In Aim 2, we will show that currently available, clinically derived measures, can predict differential responsiveness to the treatments. In Aim 3, a subset of participants will receive deeper phenotyping (n = 160), to identify new experimental measures that predict differential responsiveness to the treatments, as well as to infer mechanisms of action. Deep phenotyping will include functional neuroimaging, quantitative sensory testing, measures of inflammation, and measures of autonomic tone.