Department of Neurology and Psychiatry, Multiple Sclerosis Centre, S. Andrea Hospital, La Sapienza University Rome, Viale dell'Università 30, 00185, Rome, Italy.
J Neurol. 2012 Nov;259(11):2319-28. doi: 10.1007/s00415-012-6492-8. Epub 2012 Apr 18.
Enhancing quality of life (QoL) is an important objective of disease-modifying therapies in multiple sclerosis (MS). Strategies to substantiate the effect on QoL and depression have been suggested, including injection devices and nursing support. This study assesses QoL and depression in MS patients treated with interferon beta-1b (IFNB-1b) and evaluates the impact of different elements of a patient support programme and of coping strategies on QoL and depression. A prospective, observational, 2-year cohort study was conducted. MS patients were eligible if they had previously switched to IFNB-1b. Data were collected every 6 months. For the measurement of QoL the Functional Assessment of MS (FAMS) was used. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D); coping strategies were assessed using the 66-item version of Ways of Coping Questionnaire. A total of 1,077 patients were recruited into the study. Seven hundred (65 %) patients completed the study. Within the subgroup completing questionnaires on QoL (N = 472) and depression (N = 363), QoL increased (110.4 vs. 115.8, p < 0.001), and the proportion of depressed patients decreased from 53.7 to 43.3 % (p < 0.001). Modelling QoL and depressions, the use of the autoinjector Betaject(®) over time showed a positive association with QoL (p = 0.049). The support from a nurse was positively associated with lower depressive symptoms (p = 0.039). The coping strategies 'planful problem-solving' and 'positive reappraisal' were associated with higher QoL and lower depressive symptoms. Patients on IFNB-1b treatment who were included in the patient support programme and completed the study showed an improvement in QoL. Moreover, compared to baseline the proportion of depressive patients decreased. Coping strategies as well as supportive elements such as autoinjectors and nurses had a significant impact on QoL and depression. However, the study had the general limitations of a non-controlled design.
提高生活质量（QoL）是多发性硬化症（MS）中疾病修饰疗法的一个重要目标。已经提出了证实对 QoL 和抑郁影响的策略，包括注射装置和护理支持。本研究评估了接受干扰素β-1b（IFNB-1b）治疗的 MS 患者的 QoL 和抑郁，并评估了患者支持计划的不同元素以及应对策略对 QoL 和抑郁的影响。进行了一项前瞻性、观察性、2 年队列研究。如果患者之前已转为 IFNB-1b，则符合入组条件。数据每 6 个月收集一次。使用多发性硬化症功能评估量表（FAMS）测量 QoL。使用流行病学研究中心抑郁量表（CES-D）评估抑郁症状；使用 66 项应对方式问卷评估应对策略。共有 1077 名患者入组研究。700 名（65%）患者完成了研究。在完成 QoL 问卷的亚组（N=472）和抑郁问卷的亚组（N=363）中，QoL 增加（110.4 对 115.8，p<0.001），抑郁患者的比例从 53.7%降至 43.3%（p<0.001）。对 QoL 和抑郁进行建模，随着时间的推移使用自动注射器 Betaject（®）与 QoL 呈正相关（p=0.049）。接受护士支持与较低的抑郁症状呈正相关（p=0.039）。应对策略“有计划的解决问题”和“积极的重新评价”与更高的 QoL 和更低的抑郁症状相关。参加患者支持计划并完成研究的 IFNB-1b 治疗患者 QoL 得到改善。此外，与基线相比，抑郁患者的比例下降。应对策略以及自动注射器和护士等支持性元素对 QoL 和抑郁有显著影响。然而，该研究具有非对照设计的一般局限性。
