Assessing the Psychosocial Impact of Multiple Sclerosis: Learning from Research on Rheumatoid Arthritis

Abstract

Data concerning the functional and psychological status of a sample of 101 rheumatoid arthritis (RA) patients were compared with data on a similar sample of 102 multiple sclerosis (MS) patients. Because far more psychological research has been done regarding the personal and interpersonal factors that impact adaptation to RA, the current study was conducted to (1) underscore the similarities that exist between the two illnesses; (2) assess the usefulness in an MS sample of functional assessment measures commonly used with RA populations; and (3) identify the similarities and differences that exist between RA patients and MS patients with respect to functional status and psychological impact. It was determined that for these two samples the level of functional disability was similar but that there was greater psychological impact observed among the MS participants. Limitations to household activities most strongly predicted depression in the MS group, followed by limitations to social activity and more limited financial resources. Younger patients reported more anxiety. The relevance of these findings to related MS research is noted, as well as the utility of questionnaire research with this population.Multiple sclerosis (MS), an autoimmune disease of the central nervous system (CNS), is characterized by destruction of the myelin sheath that encases the axons of nerve cell and facilitates nerve transmission. The destruction of myelin occurs in a random manner throughout the brain and spinal cord, resulting in delayed or blocked transmission of nerve impulses (2). The onset of MS generally occurs between the ages of fifteen and fifty years, with an average age of onset of thirty. Approximately twice as many women as men are diagnosed with MS (2). MS is a difficult disease to diagnose due to its variable course, transient symptoms, and the lack of a specific diagnostic test (3). After the diagnosis has been made, the course of the illness is unpredictable. Most individuals have a relapsing-remitting course, which is typified by cycles of exacerbation and remission, although approximately 15% of the diagnosed population have a chronic-progressive course characterized by slow, steady deterioration of function throughout their lives. Among individuals with a relapsing-remitting course, a new exacerbation or outbreak of symptoms occurs on average once every six months to a year.Within four to twelve weeks of exacerbation, some or all of the new symptoms will remit (1).It is impossible to predict for any particular individual what course his or her MS will follow or what symptoms will be experienced. MS is characterized by a wide and varying range of symptoms, which impact physical, cognitive, and social functioning. Physical symptoms include visual impairment, speech difficulties, weakness, fatigue, loss of sensation, incoordination, and sexual dysfunction (3). The most frequently reported physical complaints are loss of the ability to walk and urinary dysfunction. While these physical symptoms alone may not be fatal, t...

Beyond unfavorable thinking: The Illness Cognition Questionnaire for chronic diseases.

“…Functional disability was assessed in both samples with a composite score on the Mobility and Self-Care scale of the Impact of Rheumatic Diseases on General Health and Lifestyle (IRGL; Evers, Taal, et al, 1998; Huiskes, Kraaimaat, & Bijlsma, 1990), a questionnaire derived from the Arthritis Impact Measurement Scales (AIMS), which was originally developed to assess various aspects of physical, psychological, and social health in arthritis patients. Previous research showed reliability and validity of the IRGL scales to be highly satisfactory in RA patients (Evers, Taal, et al, 1998; Huiskes et al, 1990), and the instrument from which it was derived, the AIMS, has also been shown to be reliable and valid for use in MS patients (Schiaffino, Shawaryn, & Blum, 1996; Schiaffino et al, 1998). Items of the IRGL scales are scored on a 4- or 5-point Likert scale.…”

The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis

“…The AIMS has shown to be reliable and valid for use in MS patients, while the reliability of the IRGL scales were highly satisfactory in rheumatoid arthritis patients. 22,23 Emotional instability Emotional instability was rated with the subscale Neuroticism of a Dutch version of the Eysenck Personality Questionnaire. 24,25 Neurological impairment The EDSS was rated by an experienced neurologist.…”

Examining the impact of illness representations on psychological adjustment to chronic illnesses.

“…Although there are many studies of psychological adjustment in RA, the few studies of this process in MS have borrowed constructs and measures from RA and adapted them for use in MS. For example, use of the Arthritis Impact Measurement Scale (AIMS; Meenan et al, 1984), a functional status measure developed for use with the broad range of rheumatological disorders, has revealed similar overall levels of functional disability for RA and MS. Moreover, the subscales of the AIMS captured expected differences between the two illnesses with respect to symptoms such as pain, which is more common in RA than in MS (Schiaffino, Shawaryn, & Blum, 1996). A measure developed to assess self-efficacy in arthritis samples was similarly adapted for use with an MS sample and demonstrated the same factor structure in both groups (Shnek, Foley, LaRocca, Smith, & Halper, 1995).…”