Chi Cho

Injurious Falls Among Middle Aged and Older Adults With Multiple Sclerosis

OBJECTIVE To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS). DESIGN Survey. SETTING United States. PARTICIPANTS Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never). RESULTS More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27-2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62). CONCLUSIONS Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.

Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45—90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45—90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating. Multiple Sclerosis 2007; 13: 1168—1175. http://msj.sagepub.com

Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis

Background: Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis (MS). Nevertheless, many people are unable to access these programs due to environmental barriers. Objectives: To test the efficacy and effectiveness of a group-based, teleconference-delivered fatigue management program for people with MS. Methods: A randomly allocated two-group time series design with a wait-list control group was used. In total 190 participants were allocated (94 intervention, 96 wait-list control). Primary outcomes (fatigue impact, fatigue severity, health-related quality of life (HRQOL)) were measured before, immediately after, at 6 weeks, 3 months, and 6 months post. Secondary outcome (self-efficacy) was measured at the same points. Effectiveness (intent-to-treat) and efficacy (per protocol) analyses were conducted. Results: The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity. Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact, fatigue severity, and 6 of 8 HRQOL dimensions. Changes were maintained for 6 months with small to moderate effect sizes. Conclusion: The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom.

A descriptive profile of caregivers of older adults with MS and the assistance they provide.

Purpose. To describe and compare spousal and non-spousal caregivers of older adults with multiple sclerosis (MS), the nature and extent of assistance they provide, and the challenges they experience in the course of their caregiving role. Methods. This cross-sectional descriptive study uses data from telephone interviews with 302 caregivers of older adults with MS. Descriptive statistics, Chi-square and Wilcoxon tests were used to generate and compare caregiver profiles. A proportional odds model examined factors associated the provision of greater extent of care. Results. Spousal and non-spousal caregivers differed in age, sex, location of residence, and employment status. The characteristics of the people with MS for whom they cared were very similar. Spousal caregivers assisted with more activities, although non-spousal caregivers provided equivalent caregiving time. Twenty percent of caregivers spent more than 3.5 h per day caregiving. Caregiving time was influenced by cognitive and ADL status of the person with MS, and the number of caregiving activities performed. Challenges reported by caregivers were similar. Conclusions. Both spousal and non-spousal caregivers of older adults with MS provide substantial assistance, and experience many challenges. Rehabilitation professionals need to be aware of the diversity of caregivers and the assistance they provide to facilitate appropriate support and resources.

Outcome Moderators of a Fatigue Management Program for People With Multiple Sclerosis

OBJECTIVE We determined whether age, gender, work status, or impairment moderated fatigue management program outcomes for people with multiple sclerosis (MS). METHOD We conducted a secondary analysis of longitudinal data from a randomized controlled trial using mixed-effects models (N = 181) and examined outcomes of fatigue impact, mental health, physical health, and self-efficacy. Measures were collected before and immediately after intervention and at 6 wk, 3 mo, and 6 mo postintervention. RESULTS Younger participants experienced greater reductions in fatigue impact and greater improvements in self-efficacy over time than did older participants, but we found no age differences in physical or mental health. Participants with less impairment experienced greater mental health gains and were more likely to retain these gains over time than were participants with greater impairment. Although women experienced greater fatigue impact benefits, men experienced greater mental health benefits. Work status did not moderate outcomes. CONCLUSION Fatigue management program outcomes for people with MS are moderated by age, gender, and impairment.

A Profile of Support Group Use and Need Among Middle-Aged and Older Adults with Multiple Sclerosis

This study compared middle-aged and older adults with multiple sclerosis (MS, N = 1,275) according to their use of support groups and identified factors associated with perceived need. Over 64.6% (n = 824) of participants had attended a MS support group meeting at least once. Individuals who had never attended a group were more likely to reside in urban or suburban communities, report lower symptom interference, and fewer activity limitations. Women, individuals without a helper, and people with greater symptom interference were more likely to perceive a need for a support group. Findings raise questions for professionals involved in developing and implementing multiple sclerosis support groups.

Correlates of stages of change for physical activity in adults with multiple sclerosis.

The Transtheoretical Model (TTM) is commonly used to understand physical activity (PA) behavior in the general population; however, few researchers have explored its relevance for persons with multiple sclerosis (MS). We examined the relative importance of health (symptoms and mobility impairments) and TTM constructs (behavioral and cognitive processes of change) in influencing stages of change placement for PA in a sample of 303 persons with MS using discriminant function analysis. The overall accuracy of predicting stages of change was 58.75%. Behavioral (r(2)  = .35) and cognitive processes (r(2)  = .17) accounted for the most variance, followed by mobility (r(2)  = .11) and self-efficacy (r(2)  = .05). Results provide support for evaluating whether TTM-based interventions can promote PA in adults with MS.

Impact of Comorbidity on Fatigue Management Intervention Outcomes Among People with Multiple Sclerosis: An Exploratory Investigation

This exploratory secondary analysis examined whether the presence of six chronic health conditions moderated the effectiveness of a teleconference-delivered fatigue self-management education program for people with multiple sclerosis (MS). The longitudinal data used were from a randomized controlled trial involving 181 community-dwelling adults with MS. The primary outcome was fatigue impact, as measured by the Fatigue Impact Scale (FIS). Mixed-effects analysis of variance (ANOVA) models were used to determine the best-fitting model. Just under 65% (n = 112) of participants had at least one comorbid condition. Only diabetes and arthritis moderated all three FIS subscales over time. People with diabetes were slower to show improvement after intervention than people without diabetes. People with arthritis made much more dramatic initial gains compared with people without arthritis but had difficulty maintaining those gains over time. The results point to the need for greater attention to the impact of comorbidities on rehabilitation interventions. These exploratory findings suggest that fatigue self-management education protocols may need to be customized to people who are trying to incorporate MS fatigue self-management behaviors while simultaneously managing diabetes or arthritis.

Use of Physical Therapy Services Among Middle-Aged and Older Adults With Multiple Sclerosis

Background There is limited understanding of the utilization of and perceived need for physical therapy services among middle-aged and older adults with multiple sclerosis (MS). The resulting knowledge gap compromises efforts for physical therapy service planning for this population. Objective The purpose of this study was to examine the use of and need for physical therapy services in a sample of adults with MS living in the Midwestern United States. Design This was a cross-sectional, descriptive study. Methods Data from telephone interviews with 1,065 people with MS, aged 45 to 90 years, were used for the study. A multinomial regression model was used to determine factors associated with use of physical therapy services (never, within the past year, more than a year ago). Logistic regression analysis examined factors associated with unmet needs for these services. Results Thirty-six percent of the sample reported never using physical therapy services, 33% reported using physical therapy services within the past year, and 31% reported using physical therapy services more than a year prior to the interview. Factors associated with recent use of physical therapy services included living in an urban or suburban community, deteriorating MS status, experiencing problems with spasticity (ie, hypertonicity), having difficulty moving inside the house, being hospitalized in the past 6 months, and seeing a family physician. These same factors were associated with unmet needs. Limitations Physical therapy service use was self-reported. Data were collected in 5 Midwestern states from people 45 years of age or older, which may limit generalizability. Conclusions Factors associated with use of and need for physical therapy services reflect issues of access (geographical, referrals), MS status, and mobility difficulties.

Correlates of nutritional behavior in individuals with multiple sclerosis

BACKGROUND Adults with multiple sclerosis (MS) have many health problems that can interfere with healthy nutritional behaviors. Self-management activities (e.g., strategies used to manage emotions and functional limitations) may help facilitate engagement in healthy nutritional behaviors. However, few studies have documented such relationships. OBJECTIVE Identify predictors of nutritional behaviors from among a set of variables (i.e., personal characteristics, health status indicators, and self-management activities) linked to the International Classification of Function. METHODS Data were obtained from an online survey of 292 individuals with MS. Significant bivariate correlates were entered into a logistic regression analysis using backward and forward selection methods to identify predictors of healthy nutritional behaviors (i.e., endorsing 4 out of 5 questions about frequently making good food choices, limiting fat intake, consuming 5 servings of fruits and vegetables, reading food labels, and eating regularly). RESULTS Sex, nutritional self-efficacy, optimism/pessimism, body mass index, physical activity, emotional self-management, and communication with physician were used in the logistic analysis. Nutritional self-efficacy (β = 0.69, p < 0.001) was the strongest predictor of nutritional behaviors, followed by physician communication (β = 0.08, p = 0.029) and physical activity (β = 0.01, p = 0.035). Neither impairments nor activity limitations were significantly associated with nutritional behaviors. CONCLUSIONS This study provides preliminary evidence that self-efficacy and self-management activities are correlates of nutritional behaviors in individuals with MS. Supporting the development of self-management skills and increasing self-efficacy might be methods for improving engagement in healthy nutritional behaviors among adults with MS.