Adaptive Tasks in Multiple Sclerosis: Development of an Instrument to Identify the Focus of Patients' Coping Efforts

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

BACKGROUND

While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake.

OBJECTIVES

To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing.

PATIENTS AND METHODS

This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role's responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making.

CONCLUSION

Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients' daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Beyond Disease: Happiness, Goals, and Meanings among Persons with Multiple Sclerosis and Their Caregivers

The experience of persons with multiple sclerosis (MS) and their caregivers is usually investigated in terms of emotional distress and health-related quality of life, while well-being indicators remain largely underexplored. In addition, findings are often interpreted from the clinical perspective, neglecting socio-cultural aspects that may crucially contribute to individuals' functioning. At the methodological level, most studies rely on scaled instruments, not allowing participants to freely express their needs and resources. Based on the bio-psycho-social perspective endorsed by the International Classification of Functioning, well-being indicators were investigated among 62 persons with MS (PwMS), their 62 caregivers and two control groups, matched by age and gender. Participants completed the Positive Affect Negative Affect Schedule (PANAS), the Satisfaction with Life Scale (SWLS), and the Eudaimonic and Hedonic Happiness Investigation instrument (EHHI). EHHI provides information on participants' happiness, goals and meanings through scaled and open-ended questions, contextualized within major life domains. No relevant differences emerged among PwMS and caregivers, compared with the respective control groups, as concerns life domains associated with happiness, goals and meaning. Participants across groups prominently mentioned family, highlighting its intrinsic value and its relevance as a sharing context; health did not represent a major theme for PwMS; community, society and religion/spirituality issues were substantially neglected by all participants. PwMS and caregivers reported lower levels of positive affect than their control groups, while no substantial differences emerged for negative affect, happiness and meaningfulness levels in life and across most domains. Results suggest that the experience of MS is associated with well-being in relevant life domains, such as family and close relationships. Although PwMS and caregivers identified a lower number of goals and meaning-related opportunities compared to control groups, they showed a positive adjustment to disease through the development of personal and family resources. These assets are often undervalued by health professionals and social institutions, while they could be fruitfully exploited through the active involvement of PwMS and their families as expert and exemplary informants in initiatives aimed at promoting the well-being of individuals and communities

Development and validation of the coping with multiple sclerosis questionnaire

BACKGROUND

Development of a self-report measure of coping with multiple sclerosis is required based on cultural factors, which can advance our understanding of the level of coping for care planning and improvement of coping and quality of life. The current study aimed to develop and validate the scale of coping with Multiple Sclerosis.

METHODS

This methodological study was conducted in three phases. In the first phase, the concept of coping with MS was defined by the hybrid model. In the second phase, the item pool was generated from findings of the first phase. In the third phase, psychometric properties of the scale were evaluated including face, content and construct validity as well as reliability.

RESULTS

192 items in primary item pool were finally reduced to 35 items after evaluating the validity (face, content and construct validity) and reliability. Factor analyses revealed five factors: self-efficacy, self-regulation, accepting the current situation, treatment seeking and adherence to it, and emotional balance. Internal consistency and stability of the developed questionnaire confirmed with 0.93 and 0.96 respectively that indicated excellent reliability.

CONCLUSION

The 35-item developed questionnaire is valid and reliable for assessment of levels of coping in Iranian people with MS.

A multicenter, prospective, quasi-experimental evaluation study of a patient education program to foster multiple sclerosis self-management competencies

OBJECTIVE

To determine the impact of the self-management training program "S.MS" for new multiple sclerosis (MS) patients.

METHOD

Multicenter, prospective, quasi-experimental study with 31 MS patients in the intervention group (training program) and 33 participants in the control group (CG) (brochures). Data were collected before, after and 6 months after the interventions. Analysis of change was done by ANCOVA with repeated measurements.

RESULTS

At baseline, participants in CG were younger at the time of diagnosis, suffered more frequently from relapsing-remitting MS and took more MS-medication on a permanent basis. The intervention had a stable significant effect on each dimension of self-management ability, on total self-management ability (ES=0.194, p<0.001), on anxiety (ES=0.193, p=0.001), and on disease-specific quality of life (ES=0.120, p=0.007). Regarding depression, a significant interaction effect of time and intervention could be observed (ES=0.106, p=0.011). No effect was found on disease-specific knowledge. High participant acceptance was reported.

CONCLUSION

"S.MS" participation was associated with a significant and sustained improvement of self-management abilities, anxiety and disease-specific quality of life in a quasi-experimental study design. Using RCT or CRT-designs would be desirable to further improve the evidence of treatment effectiveness.

PRACTICE IMPLICATIONS

This study provides substantial evidence that "S.MS" fosters patients' self-management ability.

Stress-stimulated volitional coping competencies and depression in multiple sclerosis

OBJECTIVE

The present study examined the relationship between volitional modes of coping (self-regulation, volitional inhibition, and self-control) and depression in individuals with multiple sclerosis.

METHODS

A cross-sectional study of 121 participants aged 22-60 years with clinically defined MS who were consecutively admitted to a neurological rehabilitation center during a 23-month period. Correlation analyses and hierarchical regressions were conducted to evaluate the predictive value of volitional competencies (Volitional Components Questionnaire, short form, VCQ-S) on depression (Centre for Epidemiologic Studies Depression Scale, CES-D), while controlling for demographic (age, gender, and education) and certain clinical variables (Expanded Disability Status Scale, EDSS; disease duration; and Modified Fatigue Impact Scale, MFIS).

RESULTS

Hierarchical regression analyses of depression revealed a model in which 68% of the variance in the CES-D was explained by daily stress situations (VCQ-S), self-regulation (VCQ-S), fatigue (MFIS), and education. However, when the analysis included only participants who had scored above the cut-off of the CES-D (n=42), the VCQ-S factor volitional inhibition seemed to play a more relevant part in depression. In particular, the VCQ-S scales stimulation of self-access, stimulation of volitional inhibition, self-motivation, and emotional perseverance/state orientation after failure appear to be valuable predictors on CES-D.

CONCLUSIONS

The results suggest that personality-accentuated volitional coping competencies elicited by daily stressful situations could be a relevant factor for depressive mood states in individuals with MS. However, to clarify the exact relationships of this rather circular framework, longitudinal study designs with objective measurements and a stronger focus on MS-specific stressors are needed.

Coping with neuroimmunological diseases

Although there is little doubt about a considerable need for psychosocial support in patients with severe neuroimmunological diseases, the theoretical elaboration of stressful illness consequences as well as the development of standardised intervention programs are still in their beginnings. In the present paper, models of coping with chronic illness are characterised as a suitable framework. After a short overview of psychological dimensions of physical illness, concepts from the coping literature that seem to meet these demands are briefly introduced. Furthermore, recent results of coping research especially in multiple sclerosis (MS) are outlined in an overview which also includes findings from evaluation studies. Moreover, aims and techniques, which constitute necessary elements of coping skills training for patients with neuroimmunological disease, are described. Questions of suitability of coping interventions for subgroups of patients with multiple sclerosis are finally discussed.

Development, content, and process evaluation of a short self-management intervention in patients with chronic diseases requiring self-care behaviours

Many patients with asthma, diabetes, and heart failure do not succeed in integrating the required self-management behaviours into their lives, and fail to attain optimal disease control. The purpose of this study was to describe the development of a theory-driven intervention to enhance self-management that would be appreciated and accepted by participants and providers. Based on self-regulation theory and proactive coping, the program emphasised goal-setting and the planning of behaviour. In five 2h group sessions, participants first decided upon their own goal and behaviours they wanted to change. Next, they wrote an action-plan to implement these behavioural intentions. Behavioural rehearsal and self-monitoring took place between the sessions. Participants and nurse providers evaluated the intervention positively. Evaluations were unrelated to patients' health at baseline, or to feelings of self-efficacy regarding self-management. But patients of older age, lower education, or no current employment responded best to the intervention.

Fatigue in multiple sclerosis: reciprocal relationships with physical disabilities and depression

OBJECTIVE

To explore relations of fatigue, physical disabilities, and depression in patients with multiple sclerosis (MS) cross-sectionally and over time.

METHODS

Ninety-eight MS patients were interviewed twice at an interval of a year. Relationships of physical and mental fatigue, and reduced activity and motivation with depression and physical disabilities were established cross-sectionally by regression analyses and longitudinally by structural equation modelling.

RESULTS

Cross-sectionally, physical fatigue was related with physical disabilities, and mental fatigue was associated with depression. Prospectively, physical fatigue was a predictor of the physical disabilities of a year later. The reverse relationship of physical disabilities predicting the physical fatigue of one year later was, however, not significant, while depression predicted this physical fatigue and reduced activity of a year later. Depression did not predict the later mental fatigue nor was depression predicted by preceding fatigue experiences.

CONCLUSIONS

Fatigue in MS should be studied over time as relationships of fatigue with physical and mental health change during the course of a year. Moreover, differentiating in fatigue experiences sheds light on the relationship of fatigue with physical and mental health.