Stuifbergen Alexa K, Blozis Shelley, Becker Heather, Harrison Tracie, Kullberg Vicki
School of Nursing, The University of Texas at Austin, USA.
The University of California, Davis, USA.
Disabil Health J. 2016 Jul;9(3):472-8. doi: 10.1016/j.dhjo.2016.01.006. Epub 2016 Jan 28.
Multiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential.
The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS.
Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year.
After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11.
Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.
多发性硬化症（MS）是一种通常在青壮年时期被诊断出的慢性神经疾病，会出现各种各样的症状、损伤和功能限制。鉴于这种疾病的慢性、不可预测性和长期性，保持功能至关重要。
本研究的目的是通过对一组多发性硬化症患者进行为期11年的纵向随访，确定可能影响功能限制轨迹的心理社会和行为因素。
参与者（N = 606）在11年中每年完成健康行为、相关构念和功能限制的测量。使用随机效应回归分析功能限制的纵向测量，该分析允许研究一项测量轨迹中的个体差异。使用最佳拟合二次增长模型，我们测试了营养、人际关系、运动、压力管理、健康责任、精神成长、自我健康评分和障碍在个体内部和个体之间的效应，并控制年龄、诊断后年份和退出年份，对第11年的功能限制的影响。
在调整协变量后，运动和自我健康评分的较高平均得分与第11年较低的功能限制水平相关。压力管理、健康责任和障碍的较高平均得分与第11年较高的功能限制水平相关。较高的运动平均得分和较低的健康责任平均得分与第11年功能限制进展较慢的速率相关。
研究结果表明，多发性硬化症中功能限制的高度可变轨迹可能通过健康行为策略得到延长和塑造。
