Autonomy and Participation in Exercise in Persons with Multiple Sclerosis
Deconditioning of patients with multiple sclerosis (MS) has been shown before. Attitudes toward exercise are important in predicting change in behavior. Subjects were patients who sought treatment for MS; who consented to participate in a prospective study of exercise attitudes and behaviors. This abstract presents the initial results of the cohort at time of entry into the study.
Objectives: prospective cohort study designed to assess relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed.
Patients from an academic MS center completed two physical measures: grip strength dynamometry and the 2 minute walk test (2MWT). They also completed the Guys Neurological Disability Scale (GNDS), the Impact on Participation and Autonomy Questionnaire (IPA) and the Multidimensional Outcome Expectations for Exercise Scale (MOEES) previously validated in the ambulatory MS population. A medical history relevant to MS was elicited, and in the second part of the study, the subjects completed an exercise diary for 2 weeks. Data were analyzed using IBM SPSS v. 21. Std. deviations and confidence intervals reported.
46 subjects (35 female) were recruited and enrolled. Mean GNDS score was 10.7 (7.1) for males and 12.1(9.4) for females, which were not significantly different. Bivariate correlation analyses showed significant relationship between GNDS and 2MWT (r = -0.425, p <.003); GNDS and presence of pain or spasticity (r = 0.452, p < .002; r = 0.541, p < .001).
The IPA subscales showed significant correlations with average daily pain rating: Autonomy Indoors (AI Scale) r = 0.450; Family Role Scale (FR) r = 0.463 and Autonomy Outdoors (AO Scale) r = 0.453, all with p values less than .01. Social Role (SR) scale and pain rating showed r = 0.365, p = .013.
The MOEES scale data evaluated by principal components analysis showed excellent agreement with published 3-subscale factor model. The Self-Evaluative (SELF) subscale showed significant correlation with average daily pain rating (Kendall’s tau-b, 0.247, p = .036; Somer’s d = 0.247, p = .012).
Grip dynamometry was left hand: 30.9 kg (11.1) and R hand: 32.1 kg (12.1). Regression model showed R hand grip was predicted by MOEES Self-Evaluative, Fatigue and gender, R = 0.731, adjusted R² = 0.463 (F = 7.46, p < .001).
GNDS correlates well with walking distance, and presence of pain or spasticity. Early analysis shows interesting relationships between MS patients’ perceived autonomy and daily pain score. MOEES questionnaire 3 subscales appear valid, and Self-Evaluative scale correlates with pain score as well as physical measure (grip). Of interest, the use of assistive devices did not correlate with other measures. The second half of our study will evaluate the subjects' pain diaries over time, and determine any predictors of exercise quantity and frequency.