Author Of 4 Presentations
P0448 - Comorbidities as predictors of all-cause emergency room usage in multiple sclerosis (ID 1345)
Abstract
Background
Certain comorbidities have been identified as being associated with hospitalization rates among persons with multiple sclerosis (MS); however, to date, there is limited information on their relationship with all-cause emergency room (ER) usage, which can be financially burdensome.
Objectives
1) To determine if the presence of comorbidities increases the odds of ER usage and 2) examine if certain groups of comorbidities are associated with utilization.
Methods
Data were extracted from the VA MS Center of Excellence Data Repository, which includes electronic health record-based information from US Veterans receiving services at any Veterans Affairs (VA) medical center. CPT codes were used to determine if Veterans had at least one ER visit during a 24-month time frame. Comorbidities were identified using ICD-9 codes present prior to 2013, and were grouped by ICD-9 category, with the exception of traumatic brain injuries (TBI), pain disorders, and sleep disorders, which were separate categories. Separate logistic regressions were conducted for the overall number of comorbidities and categorized comorbidities, controlling for age and gender.
Results
Nearly 32% (n = 1,191) had at least one ER visit, with those Veterans having an average of 6.67 ± 3.32 comorbidities. After controlling for age and gender, the number of comorbidities was a significant predictor of ER usage (odds ratio [OR]: 1.21). The odds of ER usage were higher among Veterans with co-occurring TBIs (OR: 1.62), pain (OR: 1.60), circulatory (OR: 1.50), nervous system and sense organ (OR: 1.48), digestive (OR: 1.46), neoplasms (OR: 1.42), respiratory (OR: 1.32), mental (OR: 1.32), and sleep disorders (OR: 1.20).
Conclusions
All-cause ER utilization is prevalent among Veterans with MS, with usage increasing in the presence of other chronic comorbidities. These findings underscore the need to view long-term MS care through the lens of chronic disease management and suggest that addressing comorbidities may be important to reduce all-cause emergency care, through such critical strategies as preventive and health promotion programs (e.g., physical activity for pain and circulatory disorders), self-management (e.g., patient activation and engagement in care), and increased coordination among healthcare providers of key disorders to optimize and reinforce good care.
P0795 - Cognitive and psychological predictors of self-management behaviors in persons with multiple sclerosis (ID 904)
Abstract
Background
Effectively managing all the symptoms associated with multiple sclerosis (MS) can be a challenge. One approach is self-management, which helps persons with chronic health conditions become more actively involved in their care. While there is evidence that self-management can be beneficial for persons with MS, little is known on the role that cognitive and psychological functioning play in self-management behaviors.
Objectives
To examine whether aspects of cognitive and psychological functioning are predictive of self-management behaviors, as measured by the MS Self-Management Scale-Revised (MSSM-R).
Methods
Participants (n = 111) were persons with MS who completed a brief neuropsychological battery, including demographics and measures of objective (performance-based) and subjective (self-reported) cognition, personality, emotional symptomatology, determinants of quality of life, and resiliency to MS-related challenges. Variables with a p-value of <.10 in the bivariate analyses were entered into logistic regressions, with the MSSM-R’s five subscales (Healthcare Provider Relationships and Communication, Treatment Adherence/Barriers, Social/Family Support, MS Knowledge and Information, and Health Maintenance Behavior) as individual outcomes.
Results
Self-reported cognition was a significant predictor in several models, with subjective prospective memory predicting Healthcare Provider Relationships and Communication (b = -.19) and Treatment Adherence/Barriers (b = -.41), attention predicting Social/Family Support (b = -.08), and planning/organization predicting Health Maintenance Behavior (b = -.28). Objective prospective memory, on the other hand, was a predictor of MS Knowledge and Information (b = .02). Certain personality traits emerged as predictors: high levels of conscientiousness were associated with Treatment Adherence/Barriers (b = 1.62), as were high levels of openness (b = 1.15) and agreeableness (b = 1.24) with MS Knowledge and Information. Components of resiliency and quality of life were also significant in certain models.
Conclusions
Cognitive functioning plays a significant role in self-reported self-management behaviors, with patients’ subjective report contributing more frequently in the models than their objective performance. Coupled with the involvement of certain personality traits and determinants of resiliency and quality of life in the models, these findings highlight the importance of cognitive and psychological functioning in persons with MS’ self-management abilities.
P1029 - Examining the relationship between the Multiple Sclerosis Resiliency Scale and the Five Factor Model of Personality (ID 905)
Abstract
Background
When faced with challenges related to their multiple sclerosis (MS), persons with MS can respond a number of ways. Being resilient or “bouncing back” is a common response. The association between trait resilience and the Five Factor Model of personality (neuroticism, extraversion, openness, agreeableness, and conscientiousness) has been examined with a number of resiliency measures, but not yet with the MS Resiliency Scale (MSRS), a measure designed to assess the psychological, physical, and social aspects pertaining to resilience to MS-related challenges.
Objectives
To examine the relationship between the MSRS and personality factors, as measured by the 60-item NEO Five Factor Inventory-3 (NEO-FFI-3).
Methods
Participants (n = 111) were persons with MS who completed a brief neuropsychological battery as part of a larger study examining self-management behaviors. Pearson’s correlation coefficients were used to examine the associations between the MSRS and the Five Factor Model. Receiver operating characteristic (ROC) analyses were run to determine how well the personality factors classified persons with high resilience on the MSRS (defined as ≥75th percentile).
Results
The MSRS total score has a large, negative association with neuroticism (r = -.61, p <.001), moderate, positive associations with conscientiousness (r = .44, p <.001) and extraversion (r = .43, p <.001), and a small, positive association with agreeableness (r = .27, p = .004). There was no significant relationship with openness (r = .02, p = .818). Neuroticism had good classification of high resilience (AUC = .84), with a T-score of 45 and below having 79% sensitivity and specificity. Extraversion and conscientiousness both had fair classification accuracy (AUC = .75) with their respective cut-off T-scores (≥57 and ≥53) having sensitivities of 62% and 69% and specificities of 85% and 72%.
Conclusions
Consistent with previous research, higher resilience to MS-related challenges was related to lower neuroticism, higher extraversion and conscientiousness, and to a lesser extent, agreeableness. These findings suggest that individuals who are more resilient experience fewer negative emotions and greater levels of self-control and social engagement, providing further insight into how persons with MS cope with MS-related challenges. Future interventions targeting resilience should consider building upon individual strengths (self-control, social engagement) while simultaneously reducing relative weaknesses (emotional dysregulation).
P1045 - Predicting fall risk in persons with Multiple Sclerosis utilizing the 12-Item Multiple Sclerosis Walking Scale (ID 262)
Abstract
Background
Evidence suggests that 50-80% of persons with Multiple Sclerosis (PwMS) have difficulty walking and impaired balance, with half of them falling at least once a year. Falls can lead to increased risk of injury and fear of falling, which may further impair a person’s function. Studies have previously shown that patient-reported outcomes (PRO’s) predict PwMS’ risk of falling but small sample sizes and variable cut-off scores have limited generalization of the findings.
Objectives
To determine the predictive value of a cut-off score for the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) to identify PwMS with greater fall risk.
Methods
A total of 135 PwMS were included as part of a preliminary analysis of an ongoing, larger cross-sectional study in which the MSWS-12 and frequency of falls (self-reported over past 6 months) were collected. PwMS were designed as “faller” if they had >1 fall in the past 6 months. Descriptive statistics were used to describe the clinical characteristics of the fallers (n=82) and non-fallers (n=53) (age, gender, disease duration, use of assistance, and Patient Determined Disease Steps; PDDS). Clinical characteristics and MSWS-12 scores of the faller and non-faller groups were compared. A Receiver Operating Characteristic (ROC) curve was used to estimate the classification accuracy of the MSWS-12. Optimal cut-off scores were calculated using the Youden index and sensitivity and specificity were calculated.
Results
There were no differences in age, gender, or disease duration between fallers and non-fallers. Fallers had higher median PDDS scores (3; 0-6 versus 1, 0-6; (p< 0.01)) and higher median MSWS-12 scores (67.5 versus 38.3; p<0.001) than non-fallers. Fallers were more dependent on assistive devices compared to non-fallers (p<0.01). The MSWS-12 cutoff score for fallers was ≥45.83 (Youden index: 0.46), with a sensitivity of 78.1%, specificity of 67.9% and a classification accuracy of 76.7% to detect fallers.
Conclusions
MSWS-12 was found to be predictive of fall risk in PwMS with a cut-off score much lower than previously reported. These findings indicate a lower threshold of the MSWS-12 score may help clinicians identify PwMS at greatest fall risk so that appropriate fall risk prevention interventions may be implemented.
Presenter Of 3 Presentations
P0448 - Comorbidities as predictors of all-cause emergency room usage in multiple sclerosis (ID 1345)
Abstract
Background
Certain comorbidities have been identified as being associated with hospitalization rates among persons with multiple sclerosis (MS); however, to date, there is limited information on their relationship with all-cause emergency room (ER) usage, which can be financially burdensome.
Objectives
1) To determine if the presence of comorbidities increases the odds of ER usage and 2) examine if certain groups of comorbidities are associated with utilization.
Methods
Data were extracted from the VA MS Center of Excellence Data Repository, which includes electronic health record-based information from US Veterans receiving services at any Veterans Affairs (VA) medical center. CPT codes were used to determine if Veterans had at least one ER visit during a 24-month time frame. Comorbidities were identified using ICD-9 codes present prior to 2013, and were grouped by ICD-9 category, with the exception of traumatic brain injuries (TBI), pain disorders, and sleep disorders, which were separate categories. Separate logistic regressions were conducted for the overall number of comorbidities and categorized comorbidities, controlling for age and gender.
Results
Nearly 32% (n = 1,191) had at least one ER visit, with those Veterans having an average of 6.67 ± 3.32 comorbidities. After controlling for age and gender, the number of comorbidities was a significant predictor of ER usage (odds ratio [OR]: 1.21). The odds of ER usage were higher among Veterans with co-occurring TBIs (OR: 1.62), pain (OR: 1.60), circulatory (OR: 1.50), nervous system and sense organ (OR: 1.48), digestive (OR: 1.46), neoplasms (OR: 1.42), respiratory (OR: 1.32), mental (OR: 1.32), and sleep disorders (OR: 1.20).
Conclusions
All-cause ER utilization is prevalent among Veterans with MS, with usage increasing in the presence of other chronic comorbidities. These findings underscore the need to view long-term MS care through the lens of chronic disease management and suggest that addressing comorbidities may be important to reduce all-cause emergency care, through such critical strategies as preventive and health promotion programs (e.g., physical activity for pain and circulatory disorders), self-management (e.g., patient activation and engagement in care), and increased coordination among healthcare providers of key disorders to optimize and reinforce good care.
P0795 - Cognitive and psychological predictors of self-management behaviors in persons with multiple sclerosis (ID 904)
Abstract
Background
Effectively managing all the symptoms associated with multiple sclerosis (MS) can be a challenge. One approach is self-management, which helps persons with chronic health conditions become more actively involved in their care. While there is evidence that self-management can be beneficial for persons with MS, little is known on the role that cognitive and psychological functioning play in self-management behaviors.
Objectives
To examine whether aspects of cognitive and psychological functioning are predictive of self-management behaviors, as measured by the MS Self-Management Scale-Revised (MSSM-R).
Methods
Participants (n = 111) were persons with MS who completed a brief neuropsychological battery, including demographics and measures of objective (performance-based) and subjective (self-reported) cognition, personality, emotional symptomatology, determinants of quality of life, and resiliency to MS-related challenges. Variables with a p-value of <.10 in the bivariate analyses were entered into logistic regressions, with the MSSM-R’s five subscales (Healthcare Provider Relationships and Communication, Treatment Adherence/Barriers, Social/Family Support, MS Knowledge and Information, and Health Maintenance Behavior) as individual outcomes.
Results
Self-reported cognition was a significant predictor in several models, with subjective prospective memory predicting Healthcare Provider Relationships and Communication (b = -.19) and Treatment Adherence/Barriers (b = -.41), attention predicting Social/Family Support (b = -.08), and planning/organization predicting Health Maintenance Behavior (b = -.28). Objective prospective memory, on the other hand, was a predictor of MS Knowledge and Information (b = .02). Certain personality traits emerged as predictors: high levels of conscientiousness were associated with Treatment Adherence/Barriers (b = 1.62), as were high levels of openness (b = 1.15) and agreeableness (b = 1.24) with MS Knowledge and Information. Components of resiliency and quality of life were also significant in certain models.
Conclusions
Cognitive functioning plays a significant role in self-reported self-management behaviors, with patients’ subjective report contributing more frequently in the models than their objective performance. Coupled with the involvement of certain personality traits and determinants of resiliency and quality of life in the models, these findings highlight the importance of cognitive and psychological functioning in persons with MS’ self-management abilities.
P1029 - Examining the relationship between the Multiple Sclerosis Resiliency Scale and the Five Factor Model of Personality (ID 905)
Abstract
Background
When faced with challenges related to their multiple sclerosis (MS), persons with MS can respond a number of ways. Being resilient or “bouncing back” is a common response. The association between trait resilience and the Five Factor Model of personality (neuroticism, extraversion, openness, agreeableness, and conscientiousness) has been examined with a number of resiliency measures, but not yet with the MS Resiliency Scale (MSRS), a measure designed to assess the psychological, physical, and social aspects pertaining to resilience to MS-related challenges.
Objectives
To examine the relationship between the MSRS and personality factors, as measured by the 60-item NEO Five Factor Inventory-3 (NEO-FFI-3).
Methods
Participants (n = 111) were persons with MS who completed a brief neuropsychological battery as part of a larger study examining self-management behaviors. Pearson’s correlation coefficients were used to examine the associations between the MSRS and the Five Factor Model. Receiver operating characteristic (ROC) analyses were run to determine how well the personality factors classified persons with high resilience on the MSRS (defined as ≥75th percentile).
Results
The MSRS total score has a large, negative association with neuroticism (r = -.61, p <.001), moderate, positive associations with conscientiousness (r = .44, p <.001) and extraversion (r = .43, p <.001), and a small, positive association with agreeableness (r = .27, p = .004). There was no significant relationship with openness (r = .02, p = .818). Neuroticism had good classification of high resilience (AUC = .84), with a T-score of 45 and below having 79% sensitivity and specificity. Extraversion and conscientiousness both had fair classification accuracy (AUC = .75) with their respective cut-off T-scores (≥57 and ≥53) having sensitivities of 62% and 69% and specificities of 85% and 72%.
Conclusions
Consistent with previous research, higher resilience to MS-related challenges was related to lower neuroticism, higher extraversion and conscientiousness, and to a lesser extent, agreeableness. These findings suggest that individuals who are more resilient experience fewer negative emotions and greater levels of self-control and social engagement, providing further insight into how persons with MS cope with MS-related challenges. Future interventions targeting resilience should consider building upon individual strengths (self-control, social engagement) while simultaneously reducing relative weaknesses (emotional dysregulation).