Symptoms that predict participation in people with multiple sclerosis.

TitleSymptoms that predict participation in people with multiple sclerosis.
Publication TypeJournal Article
AuthorsCook KF, Bamer AM, Molton IR, Borson S, Yorkston KM, Heinemann A, Jensen MP
JournalInternational Journal of MS Care
Management of activities of daily living in MS, Quality of Life in MS

Background: People with multiple sclerosis (MS) often experience an array of symptoms, the accumulation of which can greatly affect participation in valued activities. Objectives: This study identified symptoms that predict community participation in a sample of 1271 individuals with MS. Methods: Participants completed a 15-item participation scale and rated severity of heat sensitivity, numbness, bowel or bladder problems, imbalance, problems thinking, sexual dysfunction, slurred speech, spasticity, swallowing problems, tremor, vision loss, arm weakness, leg weakness, fatigue, and pain. The sample was partitioned randomly into a training set (n = 847) used for model building and a validation set (n = 424) for cross-validation. A multiple regression model was fit that included 15 symptom severity scores as predictors of participation (adjusted R2 = 0.39). Using backward selection, nonsignificant (a > .05) predictor variables were deleted one at a time until only significant predictors remained. Results: The resulting model had an adjusted R2 of 0.37 and included problems thinking, spasticity, vision loss, weakness in the legs, and fatigue. In this regression model, the strongest predictors were weakness in the legs (P < .001; standardized ßcoefficient = -0.29) and fatigue (P < .001; standardized ßcoefficient = -0.26). When this model was applied in the validation set, vision loss did not add significantly to variance accounted for by the other four predictors. An adjusted R2 of 0.34 was obtained, suggesting that the model is robust and likely to generalize to other samples. Conclusions: Because causal conclusions cannot be made from correlational data, research is needed to test whether interventions for the symptoms identified (eg, stimulants to decrease fatigue, exercise programs to increase strength) improve participation. In the meantime, when a goal of treatment is maximizing patient participation in valued activities, clinicians might consider targeting reduction in MS-related symptoms, particularly reducing leg weakness and fatigue.

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