Kessler Foundation, East Hanover, NJ, USA; Rutgers, The State University of New Jersey, New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, USA.
Disabil Health J. 2018 Oct;11(4):555-561. doi: 10.1016/j.dhjo.2018.05.003. Epub 2018 May 31.
Reductions in quality of life (QOL) exist among individuals with multiple sclerosis (MS).
The present investigation aimed to adopt a biopsychosocial model in examining QOL in the early stages of MS.
Individuals with MS (34 with average to low QOL and 35 with high QOL) were compared on measures of disease symptoms, psychological functioning, personality, self-efficacy, locus of control (LOC), social support, and coping to determine the most salient predictors of QOL.
Individuals were matched on disease course and duration. Individuals with lower QOL reported more fatigue, sleep problems, pain, depression, and anxiety (d = 0.83-1.49, p's < 0.001). They also reported lower levels of self-efficacy, LOC, and social support (d = 0.75-1.50 p's < 0.01). They indicated higher levels of neuroticism (d = 1.31, p < .001) and lower levels of extraversion (d = 1.21, p < .001) and reported greater levels of disengagement as a means of coping (d = 0.75, p = .002). Those with high QOL endorsed more use of adaptive coping (d = 0.52 - 0.86, p's < 0.05). When taken together, LOC and anxiety were the most significant predictors, accounting for 40% of the variance.
Even early on in the illness, there exists differing levels of QOL. Identifying the psychological and social variables as well as the disease related factors is important, and in this case, may make a much greater contribution. Efforts to assure routine assessment and effective intervention aimed at these factors are warranted, particularly as an early intervention to assure maintenance/improvement in QOL among individuals with MS.
多发性硬化症（MS）患者的生活质量（QOL）下降。
本研究旨在采用生物心理社会模式来考察 MS 早期的 QOL。
将 34 名 QOL 处于中低水平的 MS 患者和 35 名 QOL 处于高水平的 MS 患者进行对比，对比项目包括疾病症状、心理功能、人格、自我效能、心理控制源（LOC）、社会支持和应对方式，以确定 QOL 的最显著预测因素。
患者的疾病进程和持续时间相匹配。低 QOL 组患者报告了更多的疲劳、睡眠问题、疼痛、抑郁和焦虑（d 值为 0.83-1.49，p 值均<0.001）。他们的自我效能感、LOC 和社会支持水平也较低（d 值为 0.75-1.50，p 值均<0.01）。他们的神经质水平较高（d 值为 1.31，p 值<0.001），外向性水平较低（d 值为 1.21，p 值<0.001），采用逃避的应对方式较多（d 值为 0.75，p 值=0.002）。高 QOL 组患者更多地采用适应性应对方式（d 值为 0.52-0.86，p 值均<0.05）。综合来看，LOC 和焦虑是最重要的预测因素，占方差的 40%。
即使在疾病早期，也存在不同水平的 QOL。识别心理和社会变量以及与疾病相关的因素很重要，在这种情况下，它们可能会做出更大的贡献。有必要努力确保对这些因素进行常规评估和有效干预，特别是作为一种早期干预措施，以确保 MS 患者的 QOL 保持/改善。
