Department of Neurology, Clinics of Valens, Rehabilitation Centre Valens, Taminaplatz 1, 7317 Valens, Switzerland; Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Otto-Hahn-Straße 3, 44227 Dortmund, Germany.
Mult Scler Relat Disord. 2024 Oct;90:105826. doi: 10.1016/j.msard.2024.105826. Epub 2024 Aug 17.
Symptomatic treatment in people with multiple sclerosis (pwMS) requires multidisciplinary rehabilitation to alleviate disease progression and increasing health-related quality of life (HRQoL). However, the participant- and disease-specific factors that predict sustained improvement in HRQoL in pwMS undergoing inpatient rehabilitation remain unclear. Identifying these factors can help individually tailor inpatient rehabilitation programmes. Therefore, the aim of this study was to identify factors of pwMS at clinic entry for a three-week multidisciplinary inpatient rehabilitation that predict the change in physical and mental HRQoL over six months.
This is a secondary data analysis of a randomized controlled trial (NCT04356248) conducted at the Valens Rehabilitation Centre, Switzerland. HRQoL was assessed with the Medical Outcome Study 36-item Short Form Health Survey (SF-36) at clinic entry (T; baseline) and six months after (T; six-month follow-up). Data for 99 pwMS (mean age in years: 49.60 ± 10.17 SD, mean Expanded Disability Status Scale (EDSS) score: 4.62 ± 1.33 SD, 68.7 % female) were analysed using multiple linear regression. Outcome variables were six-month change in SF-36 Physical (ΔPCS) and Mental Component Scale (ΔMCS) scores. Predictor variables included baseline scores of PCS or MCS, fatigue, anxiety, depressive mood, cardiorespiratory fitness (V̇O), self-efficacy, smoking status, education level, age, EDSS, sex, time since diagnosis and MS phenotype.
The regression model with ΔPCS as outcome variable explained 18.6 % of the variance of the ΔPCS score (p = .003). Lower PCS score (p < .001) and lower depressive mood (p = .032) at baseline predicted higher ΔPCS score. The regression model with ΔMCS as outcome variable explained 26.8 % of the variance of the ΔMCS score (p < .001). Lower MCS score (p < .001) and longer time since diagnosis (p = .048) at baseline predicted higher ΔMCS score.
PwMS with lower physical HRQoL and better mood at clinic entry improved most in physical HRQoL over six months. PwMS with lower mental HRQoL and longer time since diagnosis at clinic entry improved most in mental HRQoL over six months. The results of this study contribute to the development of individualized rehabilitation programmes with the aim of maintaining and/or improving HRQoL of pwMS beyond the inpatient rehabilitation stay.
多发性硬化症（pwMS）患者的对症治疗需要多学科康复，以减轻疾病进展和提高健康相关生活质量（HRQoL）。然而，在接受住院康复治疗的 pwMS 中，哪些患者能够持续改善 HRQoL，目前尚不清楚与患者和疾病相关的预测因素。确定这些因素可以帮助针对个体量身定制住院康复计划。因此，本研究的目的是确定 pwMS 在进入为期 3 周的多学科住院康复治疗时的预测因素，以预测其在 6 个月内身体和心理健康 HRQoL 的变化。
这是在瑞士瓦伦斯康复中心进行的一项随机对照试验（NCT04356248）的二次数据分析。使用医疗结局研究 36 项简短健康调查（SF-36）在诊所就诊时（T；基线）和 6 个月后（T；6 个月随访）评估 HRQoL。对 99 名 pwMS（平均年龄为 49.60 ± 10.17 岁，平均扩展残疾状态量表（EDSS）评分为 4.62 ± 1.33 分，68.7%为女性）的数据进行了多线性回归分析。使用多个线性回归分析因变量为 SF-36 身体（ΔPCS）和心理成分量表（ΔMCS）评分的 6 个月变化。预测变量包括基线 PCS 或 MCS 评分、疲劳、焦虑、抑郁情绪、心肺功能（V̇O）、自我效能、吸烟状况、教育水平、年龄、EDSS、性别、诊断后时间和 MS 表型。
以 ΔPCS 为因变量的回归模型解释了 ΔPCS 评分变异的 18.6%（p =.003）。基线时较低的 PCS 评分（p <.001）和较低的抑郁情绪（p =.032）预测了较高的 ΔPCS 评分。以 ΔMCS 为因变量的回归模型解释了 ΔMCS 评分变异的 26.8%（p <.001）。基线时较低的 MCS 评分（p <.001）和较长的诊断后时间（p =.048）预测了较高的 ΔMCS 评分。
在进入诊所时具有较低身体 HRQoL 和较好情绪的 pwMS 在 6 个月内身体 HRQoL 改善最多。在进入诊所时具有较低心理 HRQoL 和较长诊断后时间的 pwMS 在 6 个月内心理 HRQoL 改善最多。本研究的结果有助于制定个性化康复计划，以维持和/或提高 pwMS 的 HRQoL，使其超出住院康复治疗期。
