Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont.
Community Development and Applied Economics, University of Vermont, Burlington, Vermont.
Arch Phys Med Rehabil. 2020 Jul;101(7):1152-1161. doi: 10.1016/j.apmr.2020.02.010. Epub 2020 Mar 10.
To examine the relationship between disease-related risk factors, protective factors, coping, and resilience on quality of life in adults with multiple sclerosis (MS).
Quantitative descriptive research employing structural equation modeling.
Online survey fielded to community members associated with the Greater New England Chapter of the National Multiple Sclerosis Society.
Convenience sample of 271 individuals with MS.
Not applicable.
The Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale was the primary outcome. Other measures entered into the model included the Brief Resilience Scale (BRS) and the Coping Orientation to Problems Experienced (COPE) scale modeled as 2 latent variables: emotion-based coping and problem-based coping. Disability level, fatigue, walking impairment, fear of falling, falls, and pain were modeled as a latent variable for risk factors while physical activity, self-efficacy, social support, optimism, and health locus of control were modeled as a latent variable of protective factors.
BRS had a total effect of -0.44 on LMSQoL, significant at P<.001. Protective factors also directly and significantly increased QoL (total effect size -0.46; P<.001). Emotion-based coping and problem-based coping had insignificant effects on QoL. Risk factors had a complex influence on QoL, mediated by resilience, protective factors, emotion-based coping, and problem-based coping. Risk factors had total effect size of 0.32 on quality of life (significant at P<.001). Whereas higher risk factors decreased QoL, both directly and indirectly, resilience increased the likelihood of higher QoL with a slightly higher effect size. The model fit the data reasonably well and explained 96.7% of the variance in QoL in people with MS.
The model suggests that developing interventions that increase protective factors and broaden and build resilience may contribute to improved quality of life in individuals with MS.
探讨多发性硬化症（MS）患者的疾病相关风险因素、保护因素、应对方式和适应能力与生活质量之间的关系。
采用结构方程模型的定量描述性研究。
全国多发性硬化症协会大新英格兰分会的社区成员在线调查。
271 名多发性硬化症患者的便利样本。
不适用。
主要结局指标为利兹多发性硬化症生活质量量表（LMSQoL）。进入模型的其他测量指标包括简要适应量表（BRS）和应对体验量表（COPE），这两个量表被建模为 2 个潜在变量：基于情绪的应对和基于问题的应对。残疾程度、疲劳、步行障碍、跌倒恐惧、跌倒和疼痛被建模为风险因素的潜在变量，而身体活动、自我效能、社会支持、乐观和健康归因控制被建模为保护因素的潜在变量。
BRS 对 LMSQoL 的总效应为-0.44，具有统计学意义（P<.001）。保护因素也直接且显著地提高了生活质量（总效应大小为-0.46；P<.001）。基于情绪的应对和基于问题的应对对生活质量没有显著影响。风险因素对生活质量的影响较为复杂，通过适应能力、保护因素、基于情绪的应对和基于问题的应对进行间接影响。风险因素对生活质量的总效应大小为 0.32（有统计学意义，P<.001）。较高的风险因素直接和间接降低了生活质量，而适应能力则增加了生活质量较高的可能性，其影响效应稍高。该模型对数据的拟合情况较好，解释了多发性硬化症患者生活质量 96.7%的方差。
该模型表明，开发增加保护因素和拓宽并增强适应能力的干预措施可能有助于提高多发性硬化症患者的生活质量。
