Subgroups of individuals living with multiple sclerosis: Implications for intervention.
|Title||Subgroups of individuals living with multiple sclerosis: Implications for intervention.|
|Publication Type||Journal Article|
|Authors||Amtmann D, Johnson KL, Kuehn CM, Hinton K, Ehde DM, Kraft GH|
|Journal||International Journal of MS Care|
Three research questions were investigated: 1. Can reliable subgroups in a population of individuals with MS be identified? 2. Can membership in these groups be predicted by levels of disability? 3. Do characteristics of these subgroups suggest different interventions? MS symptoms vary by time and by individual. MS symptoms' variability, pattern and impact on functioning suggest different subgroups exist in the population. We used latent variable analysis to examine how disease history, symptoms, health care, health status, depression, coping, and use of immunomodulating therapies (IMT) clustered in a sample of 550 individuals with MS from Eastern Washington State. Variables in the model described physical, cognitive, and social aspects of functioning. The four-subgroup model had the best fit. Group 1 (n=159) had an average MS duration of 12 years, Group 2 (n=102) 14 years, and Group 3 (n=143) 20 years. The membership in the three groups could be predicted by the disease severity, e.g., the longer the duration, the higher the EDSS score, and the more symptoms subgroup members endorsed. All three groups endorsed good coping with MS, low levels of depression, and good perceived social support. Group 4 (n=138, duration = 10 years) did not follow this pattern, reporting the shortest MS duration, but the highest levels of pain, fatigue, heat sensitivity and depression. Their overall quality of life, coping with MS, and participation in important activities was also the poorest. The largest proportion of the individuals in this subgroup (62%) reported using IMT. In general, Group 4 seemed to be considerably more distressed than could be predicted by EDSS scores or duration. Preliminary findings suggest that early interventions should be aimed at reducing depression, anxiety, improving coping skills, and increasing social support. Many other complex research questions in MS could be addressed by using latent variable modeling.