Author Of 6 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).
P1089 - Depressive Symptoms and Suicidal Ideation in Progressive Multiple Sclerosis Compared to Relapsing-Remitting Multiple Sclerosis (ID 1492)
Abstract
Background
Depression is one of the most common and impactful symptoms experienced by people with multiple sclerosis (MS). Most participants in prior studies of depression in MS had relapsing-remitting MS (RRMS), the most common MS subtype. Consequently, little is known about whether persons with progressive forms of MS have unique rehabilitation needs, such as higher risk for depression or suicidal ideation (SI), compared to persons with RRMS.
Objectives
To (1) describe depressive symptom severity and SI in persons with progressive MS; (2) compare depressive symptom severity and SI in persons with progressive MS and persons with RRMS; and (3) identify common and unique risk factors for greater depressive symptom severity and SI risk in persons with progressive MS compared to individuals with RRMS.
Methods
Adults with MS (N = 573) completed an observational survey study on quality of life in people with physical disabilities, including but not limited to MS. The dependent variables were depression symptoms and any SI as measured by the Patient Health Questionnaire-9. Comparisons between groups used t-test and chi-square analyses, and risk factors were tested by examining the interaction of MS subtype (progressive MS and RRMS) and each risk factor in multiple regression models with bootstrapping. Risk factors for greater depression severity and SI risk included age, race, gender, education level, marital status, employment status, household income, age at MS diagnosis, disease duration, disability level, problems with speech and/or swallowing, and current smoking status.
Results
Persons with progressive MS did not differ from persons with RRMS in levels of depressive symptoms or SI. Both groups reported mild depression symptoms and approximately 10% endorsed SI. Common risk factors for greater depressive symptom severity were younger age, greater disability, greater speech and swallowing problems, and lower household income (p’s<.05). Common risk factors for SI were shorter disease duration, greater disability, and greater speech and swallowing problems (p’s<.05). For persons with progressive MS, shorter disease duration and being non-White were associated with greater depressive symptom severity, and being employed was associated with SI risk (p’s<.05).
Conclusions
In this sample, there were no group differences between persons with progressive MS and persons with RRMS in depressive symptom severity and SI, though shorter disease duration, identifying as a racial minority, and being employed were unique risk factors for depression outcomes in persons with progressive MS. Consistent with current treatment guidelines for MS care, these findings underscore the importance of screening for and treating depressive disorders in all persons with MS, with particular attention to the factors that place some individuals with progressive MS at greater risk for both depression and SI, whether common or unique to their course.
P1090 - Differences in correlates of fatigue between relapsing and progressive forms of multiple sclerosis (ID 1564)
Abstract
Background
Fatigue is one of the most prevalent and impactful symptoms for people with multiple sclerosis (MS). MS fatigue can have detrimental effects on activities of daily living, employment, and quality of life. An inadequate number of studies have explored the extent to which fatigue and fatigue-related outcomes differ by MS disease course.
Objectives
To compare fatigue severity and fatigue interference, as well as identify common and unique demographic and clinical risk factors for fatigue severity and fatigue interference in persons with progressive MS compared to individuals with RRMS.
Methods
Participants were 573 community dwelling individuals with MS. The main outcome measures were fatigue severity and fatigue interference. T-test and chi-square analyses were used to compare group differences and multiple regression analyses were used to examine the extent to which the association of risk factors with fatigue severity and interference are moderated by MS subtype.
Results
There were no group differences between persons with progressive MS and RRMS in average fatigue severity or fatigue interference. Results also revealed there were no common risk factors between persons with progressive MS and RRMS. Longer MS disease duration was associated with lower average fatigue severity [b = -0.082, t(529) = -3.637, p < .001] for persons with progressive MS compared to persons with RRMS [b = -0.025, t(529) = -1.900, p = .058]. Having a college degree or higher was associated with higher fatigue interference in persons with progressive MS [b = 2.90, t(520) =2.28, p = .023] compared to persons with RRMS [b =-0.17, t(520) = -0.22, p = .825].
Conclusions
Contrary to previous research, in this sample, there were no group differences between persons with progressive MS and RRMS in average fatigue severity or fatigue interference. Given the similarity between fatigue and its correlates for both progressive and relapsing forms of MS, future research should consider if the interventions that work for fatigue management in people with relapsing forms of MS work similarly for people with progressive forms of MS.
P1103 - Moderators of improvements in fatigue impact following a self-management intervention in multiple sclerosis (ID 835)
Abstract
Background
Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). A recent randomized controlled trial (RCT) showed a self-management program for fatigue and a general MS education program that controlled for time and attention had equivalent effects on reducing fatigue impact in adults with MS.
Objectives
Examine moderators of treatment-related improvements in fatigue impact following self-management and education interventions in adults with MS.
Methods
Secondary analysis of a recent RCT (N=218) using multilevel modeling to assess moderators of treatment improvements in fatigue impact through six-month follow-up. Hypothesized moderators included age, gender, cohabitation with or without a spouse/partner, MS subtype (relapsing-remitting MS or progressive MS) as well as baseline depression symptoms, sleep disturbance, and self-efficacy.
Results
Living with or without a spouse/partner moderated intervention effects on fatigue impact through the six-month follow-up (b = -0.23, t(588) = 2.09, p = .04; controlling for MS subtype and income). The findings suggested that, in the fatigue self-management group, participants living with a spouse/partner showed greater improvement in fatigue impact (within group Cohen’s d = 0.55) compared to participants who did not live with a spouse/partner (d = 0.14). However, in the general MS education group, improvements in fatigue impact were similar between participants living with a spouse/partner (d = 0.23) and those who did not live with a spouse/partner (d = 0.50). Age, gender, MS subtype and baseline depression symptoms, sleep disturbance, and self-efficacy did not moderate treatment effects on fatigue impact.
Conclusions
Although the findings are exploratory, this study emphasizes that the presence of a close relationship may facilitate benefit from self-management interventions for MS-related fatigue. Future research should investigate how to promote engaging supportive others in self-management interventions for MS-related fatigue.