Spain L A, Tubridy N, Kilpatrick T J, Adams S J, Holmes A C N
Department of Neurology, Royal Melbourne Hospital, Parkville, Vic., Australia.
Acta Neurol Scand. 2007 Nov;116(5):293-9. doi: 10.1111/j.1600-0404.2007.00895.x. Epub 2007 Sep 11.
AIMS - A number of physical and psychological factors have been shown to affect health-related quality of life (HRQoL) in patients with multiple sclerosis (MS). Among these, the role of illness perceptions has not been established as an independent factor. This study, the first of its kind in an Australian population, aimed to use a large sample to determine the relative importance of individual factors to each domain of HRQoL, in particular the role of illness perception. MATERIALS AND METHODS - 580 patients with confirmed MS were assessed cross sectionally in a designated research clinic to determine the relative impact of physical factors (illness severity, duration, age, fatigue and pain) and psychological factors (mood, cognition and illness representations) on each domain of the SF-36. RESULTS - Categorical regression analysis showed that a combination of physical and psychological factors predicted 38-71% of variance in HRQoL. Illness perception was shown to have an independent effect on HRQoL in MS. The Extended Disability Status Scale was a significant determinant in all domains except for mental health. Depression was less prevalent than anxiety, but had a greater effect on function. CONCLUSION - Illness perception is an independent factor contributing to HRQoL in people with MS. Individual domains of HRQoL are associated with different patterns of physical and psychological factors. In the domains of role and social function, activities most highly valued by patients with MS, depression, anxiety, fatigue and illness perceptions are key determinants, all of which have the potential to be improved through specific interventions.
目的——多项生理和心理因素已被证明会影响多发性硬化症（MS）患者的健康相关生活质量（HRQoL）。其中，疾病认知的作用尚未被确立为一个独立因素。本研究是澳大利亚人群中的首例此类研究，旨在使用大样本确定各个因素对HRQoL各领域的相对重要性，尤其是疾病认知的作用。材料与方法——在指定的研究诊所对580例确诊为MS的患者进行横断面评估，以确定生理因素（疾病严重程度、病程、年龄、疲劳和疼痛）和心理因素（情绪、认知和疾病表征）对SF-36各领域的相对影响。结果——分类回归分析表明，生理和心理因素的组合可预测HRQoL中38%-71%的方差。疾病认知对MS患者的HRQoL具有独立影响。扩展残疾状态量表是除心理健康外所有领域的重要决定因素。抑郁症的患病率低于焦虑症，但对功能的影响更大。结论——疾病认知是影响MS患者HRQoL的一个独立因素。HRQoL的各个领域与不同模式的生理和心理因素相关。在角色和社会功能领域，这是MS患者最看重的活动，抑郁症、焦虑症、疲劳和疾病认知是关键决定因素，所有这些都有可能通过特定干预得到改善。
