Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis

Structural relations of illness perception, fatigue, locus of control, self-efficacy, and coping strategies in patients with multiple sclerosis: a cross-sectional study

BACKGROUND

Patients with multiple sclerosis (MS) experience extensive problems due to fatigue and illness perception. Reducing these problems may improve these patients' quality of life (QoL). Accordingly, the current study is aimed at investigating the mediating role of self-efficacy, locus of control, coping strategy, and outcome expectancy in the relationship between illness perception and fatigue severity in patients with MS.

METHODS

In a cross-sectional analytical study, data of 172 MS patients were collected by self-report questionnaires including illness perception questionnaires (IPQ-R), Multiple Sclerosis Self-Efficacy (MSSES) scale, health locus of control (MHLC), coping strategies in MS(CMSS), outcome expectancy, level of physical activity (IPAQ-SF), patient activation measure (PAM-13) and fatigue severity scale (FSS). The data were analyzed using linear and multiple regression analysis in SPSS software version 24 (SPSS Inc., Chicago, IL, USA).

RESULTS

The final model explained 62% of the fatigue variance. Illness perception both directly and indirectly (through self-efficacy, physical activity level, internal health locus of control, patient activation, and negative coping strategies) could predict the participants' fatigue severity. Among the mediating variables, internal health locus of control, self-efficacy, and negative coping strategies had the greatest impact, respectively. moreover, outcome expectancy variable did not a mediating role in the aforementioned relationship.

CONCLUSIONS

To enhance the well-being of MS patients and to improve the efficiency of treating MS related fatigue, a comprehensive treatment protocol is needed, encompassing psychological factors affecting fatigue severity.

Predictors of fatigue self-management behaviors in adults with multiple sclerosis

BACKGROUND

Fatigue is one of the most common and disabling symptoms in people with multiple sclerosis (MS). Fatigue self-management behaviors may be effective in reducing the impact of fatigue in people with MS. However, few studies have examined the factors that influence engagement in fatigue self-management behaviors.

OBJECTIVE

Identify factors that directly and indirectly influence fatigue self-management behaviors.

METHODS

Participants with MS (n = 300) completed online questionnaires at baseline and 6-weeks. Using the Self- and Family Management Framework, we examined the influence of health status, resources and environment, healthcare utilization, and self-management processes on fatigue self-management behaviors at 6-weeks. Multiple regression and path analyses were conducted.

RESULTS

The final regression model variables accounted for 41.58% of the variance in fatigue self-management behavior, which included outcome expectation (β= 0.287), disability (β= 0.265), environmental barriers (β= 0.188), self-efficacy (β= 0.153), symptom severity (β= 0.113), living in a rural community (β= -0.108), and living alone (β= 0.103). Path analysis indicated that outcome expectations may mediate the relationship between disability levels and fatigue self-management behavior.

CONCLUSIONS

Health status (i.e., disability and symptom severity), environmental factors (e.g., living situation), and self-management processes (i.e., self-efficacy and outcome expectations) may play an important role in influencing engagement in fatigue self-management behaviors.

Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis

OBJECTIVE

To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS).

DATA SOURCES

PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020.

STUDY SELECTION

The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria.

DATA EXTRACTION

Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs.

DATA SYNTHESIS

Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49.

CONCLUSIONS

This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.