The Effect of Depression on Health-Related Quality of Life Is Mediated by Fatigue in Persons with Multiple Sclerosis

Exploring the relationship between disability status, depression, and quality of life in individuals with multiple sclerosis

INTRODUCTION

Depression and the presence of a disability emerge as noteworthy predictors of the quality of life (QoL) in patients with multiple sclerosis (MS). In this article, we explore the relationship between disability status, depression, and quality of life in individuals with multiple sclerosis.

METHODS

A total of 150 patients participated in this cross-sectional study. A Persian translation of the Multiple Sclerosis Quality of Life-54 questionnaire was utilized to assess their health-related quality of life (QoL), while the patients' disability levels were measured using the Expanded Disability Status Scale. Additionally, we assessed patients' depression levels using the 21-item BDI-II scale. The questionnaire data were analyzed using SPSS version 25.

RESULTS

A total of 150 MS patients participated in the study, with a mean age of 33.4 years (SD = 3.1). The majority were female (n = 71.2 %). The mean EDSS score was 3.7 (SD = 1.8). In the correlation analysis, we found that EDSS scores were not significantly correlated with mental QoL (r = -0.180, p = 0.109), but were significantly correlated with lower physical QoL (r = -0.393, p 0.001). Depression scores were significantly correlated with mental QoL (r = -0.776, P 0.001) and physical QoL (r = -0. 726, P 0.001). The results reveal that both EDSS and Beck scores significantly affect mental and physical health, explaining 62 % and 60 % of their variances, respectively.

CONCLUSION

Our findings indicate a significant relationship between physical quality of life and EDSS scores in MS patients. Higher EDSS scores consistently corresponded to more significant physical impact, as evidenced by higher impact ratings. Conversely, there was no clear association between EDSS scores and mental quality of life. Furthermore, increased depression levels were linked to reduced levels of both mental and physical well-being. These results emphasize the intricate interplay between the physical aspects of quality of life and their implications for the progression and severity of MS in patients.

The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

The cortical silent period (CSP), assessed with transcranial magnetic stimulation (TMS), provides insights into motor cortex excitability. Alterations in the CSP have been observed in multiple sclerosis (MS), although a comparison of the sometimes contradictory results is difficult due to methodological differences. The aim of this study is to provide a more profound neurophysiological understanding of fatigue's pathophysiology and its relationship to the CSP. Twenty-three patients with MS, along with a matched control group, underwent comprehensive CSP measurements at four intensities (125, 150, 175, and 200% resting motor threshold), while their fatigue levels were assessed using the Fatigue Scale for Motor and Cognitive Functions (FSMC) and its motor and cognitive subscore. MS patients exhibited a significantly increased CSP duration compared to controls (p = 0.02), but CSP duration was not associated with the total FSMC, or the motor or cognitive subscore. Our data suggest a systematic difference in MS patients compared to healthy controls in the CSP but no association with fatigue when measured with the FSMC. Based on these results, and considering the heterogeneous literature in the field, our study highlights the need for a more standardized approach to neurophysiological data collection and validation. This standardization is crucial for exploring the link between TMS and clinical impairments in diseases like MS.

Multiple sclerosis and quality of life: The role of cognitive impairment on quality of life in people with multiple sclerosis

BACKGROUND

Multiple Sclerosis (MS), a chronic disease of the central nervous system (CNS), affects functional ability and quality of life (QoL). Depression, fatigue, and disability status are among the many factors that have been shown to impact QoL in people with MS, but the extent to which MS-related cognitive impairment is related to QoL is understudied in the literature.

OBJECTIVE

The purpose of this study was to determine relevant predictors of QoL from a wide list of symptoms including physical disability, and a multi-dimensional computerized cognitive assessment battery (CAB), depression, fatigue, and demographic variables (including employment status). In addition, the unique predictive power of cognitive impairment on QoL was explored in relation to other common factors of disease impact.

METHODS

171 people with MS (PwMS) were evaluated with a computerized assessment battery (CAB), EDSS examination, and validated Patient Reported Outcome (PRO) measures (Multiple Sclerosis Impact Scale, MSIS-29; Beck Depression Inventory - Second Edition BDI-2; and the Modified Fatigue Impact Scale, MFIS).

RESULTS

171 PwMS were included [Age: 46.02 years ± 9.85, 124 (72.5%) female]. Depression and fatigue scores were highly correlated with MSIS-29. EDSS, unemployment, memory, executive functioning, and motor skills were moderately correlated with MSIS-29. Predictors of QoL were EDSS, depression, fatigue, executive functioning, and attention. Attention and executive functioning were predictive of QoL even after controlling for demographic variables, fatigue, depression, and physical disability status.

CONCLUSION

Findings indicate the need for comprehensive and quantified evaluation of all factors associated with disease burden, which will ultimately serve to improve the QoL in PwMS through more targeted and patient-centered care.

Impact of depression on the perception of fatigue and information processing speed in a cohort of multiple sclerosis patients

BACKGROUND

Information processing speed is commonly impaired in people with multiple sclerosis (PwMS). However, depression and fatigue can affect the cognitive profile of patients: fatigue has a negative impact from the disease's earliest stage and a reduced information processing speed is often associated with higher levels of depression. Therefore, the aim of this study was to investigate the correlations between information processing speed and physical fatigue in a cohort of Italian PwMS from a single center, considering the effect of depression.

METHODS

Two hundred (W = 128; mean age = 39.83 years; SD = 11.86) PwMS, from the Bari University Hospital, underwent testing for processing speed (Symbol Digit Modalities Test [SDMT]), fatigue level (Fatigue Severity Scale [FSS]), and depression (Beck's Depression Inventory [BDI]).

RESULTS

Statistically significant correlations emerged between SDMT and FSS, SDMT and BDI, FSS and BDI. Mediation analyses revealed that while physical fatigue had no significant direct negative effect on information processing speed (z=-0.891; p > 0.05), depression predicted the relationship between fatigue and information processing speed (z=-2.181; p < 0.05).

CONCLUSION

Our findings showed that cognitive performance at SDMT was not affected by patients' perceived level of physical fatigue, but by depression. The presence of a high BDI score mediates the physical fatigue on cognitive performance impact.

A self-management intervention for people with multiple sclerosis: The development of a programme theory in the field of rehabilitation nursing

BACKGROUND

People with multiple sclerosis (PwMS) have recurrent stays in rehabilitation clinics because of progressive disease. Nurses are key players in supporting PwMS through self-management interventions. However, little is known about the effectiveness, or sustainability of nursing interventions. The aim of this study was to develop a nurse-led self-management intervention and its programme theory for PwMS in one Swiss rehabilitation clinic.

METHODS

On the basis of the Medical Research Council framework, we developed a theory-based programme for a nurse-led intervention. As key element of the intervention, we created a consulting guidance.

RESULTS

As part of the programme theory, we created a systematic plan (action model) to illustrate how contextual resources (e.g., skills of the MS nurse and responsibilities of the multidisciplinary team) need to be coordinated. The change model shows how changes in the intervention lead to the achievement of outcomes (e.g., increased self-efficacy). The consulting guidance was refined by PwMS and four Swiss MS experts.

CONCLUSIONS

An initial programme theory is a solid foundation for the next phases of the theory-based evaluations to refine the programme theory and sustainable implementation of the intervention.

The effects of Baduanjin and yoga exercise programs on physical and mental health in patients with Multiple Sclerosis: A randomized controlled trial

OBJECTIVE

To discuss whether Baduanjin and yoga exercise interventions improve motor function, posture control, and relieving fatigue and depression in MS patients. And to explore whether practicing Baduanjin benefits MS patients more than yoga.

DESIGN

A prospective, randomized, controlled, three-arm trial comparing BDJ (n = 30), yoga (n = 30) and control group (n = 20).

SETTING

Jiangsu Provincial Corps Hospital.

INTERVENTION

Eligible participants were randomized to a 24-week Baduanjin or yoga intervention, or a usual activity control group. Balance, posture control and trunk movement were measured with the Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS). Fatigue was measured using the Fatigue Severity Scale (FSS) and depressive symptoms via the Zung Self-Rating Depression Scale (SDS).

RESULTS

For BBS and TIS, there were significant changes pre- to post- exercise in two exercise groups (P < 0.05), with greater increases in the Baduanjin exercise group (BDJ group). For the FSS, there were significant changes pre- to post- exercise in both the BDJ (P = 0.0292) and yoga groups (P = 0.0150). For the SDS, the pre- and post-exercise difference of the BDJ group was larger than the yoga group (P < 0.0001). On the other hand, we could not find any changes of the BBS, TIS, FSS, and SDS scores in the control group (p > 0.05).

CONCLUSION

The results suggest that practicing Baduanjin was more effective than yoga and that it is suitable for the MS patients.

The mediating effect of sleep quality and fatigue between depression and renal function in nondialysis chronic kidney disease: a cross-sectional study

BACKGROUND

Depressive symptoms, fatigue, and poor sleep quality are associated with renal function deterioration in patients with nondialysis chronic kidney disease (CKD-ND). This study was designed to examine whether fatigue and sleep quality are mediators of the association between depression and renal function.

METHODS

This study adopted a cross-sectional study design. Patients with CKD-ND aged 20 years or older were recruited by purposive sampling at a medical center in Central Taiwan from December 2020 to July 2021. Data were collected using the Emotional and Social Support Scale, Fatigue Scale, Beck Depression Inventory-II (BDI-II), and Pittsburgh Sleep Quality Index. Medical records were reviewed to obtain the estimated glomerular filtration rate (eGFR) for the next month. The relationships among variables were analyzed using structural equation modeling to assess the goodness-of-fit of the model. Then, the bootstrapping method was used to analyze the mediated effect.

RESULTS

Two hundred forty-two participants (mean age 70.5 years and 53% males) were included in the analysis. About 39% of the participants met the criteria for depressive symptoms in BDI-II, and 91% reported having sleep disturbances. Participants' degree of fatigue was not high (20.4 ± 13.3). The average eGFR was 25.45 mL/min/1.73 m ² (± 13.36). The results showed that fatigue, sleep quality, and eGFR were significantly correlated with depression. The total effect size was - 0.8304 (95% confidence interval [CI], - 0.9602 to - 0.7006), and the indirect effect size was - 0.1738 (95% CI, - 0.2812 to - 0.0651), which was a statistically significant difference, indicating that the model has a mediating effect. According to mediation analysis, fatigue and sleep quality had a significant indirect effect on the relationship between depression and renal function (95% CI, - 0.0587 to - 0.0039).

CONCLUSIONS

The findings suggest that fatigue and poor sleep quality may mediate the association between depression and renal function.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.