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Mediating Role of Resilience on Quality of Life in Individuals With Multiple Sclerosis: A Structural Equation Modeling Approach

Published:March 10, 2020DOI:https://doi.org/10.1016/j.apmr.2020.02.010

      Abstract

      Objective

      To examine the relationship between disease-related risk factors, protective factors, coping, and resilience on quality of life in adults with multiple sclerosis (MS).

      Design

      Quantitative descriptive research employing structural equation modeling.

      Setting

      Online survey fielded to community members associated with the Greater New England Chapter of the National Multiple Sclerosis Society.

      Participants

      Convenience sample of 271 individuals with MS.

      Intervention

      Not applicable.

      Main Outcome Measures

      The Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale was the primary outcome. Other measures entered into the model included the Brief Resilience Scale (BRS) and the Coping Orientation to Problems Experienced (COPE) scale modeled as 2 latent variables: emotion-based coping and problem-based coping. Disability level, fatigue, walking impairment, fear of falling, falls, and pain were modeled as a latent variable for risk factors while physical activity, self-efficacy, social support, optimism, and health locus of control were modeled as a latent variable of protective factors.

      Results

      BRS had a total effect of –0.44 on LMSQoL, significant at P<.001. Protective factors also directly and significantly increased QoL (total effect size –0.46; P<.001). Emotion-based coping and problem-based coping had insignificant effects on QoL. Risk factors had a complex influence on QoL, mediated by resilience, protective factors, emotion-based coping, and problem-based coping. Risk factors had total effect size of 0.32 on quality of life (significant at P<.001). Whereas higher risk factors decreased QoL, both directly and indirectly, resilience increased the likelihood of higher QoL with a slightly higher effect size. The model fit the data reasonably well and explained 96.7% of the variance in QoL in people with MS.

      Conclusions

      The model suggests that developing interventions that increase protective factors and broaden and build resilience may contribute to improved quality of life in individuals with MS.

      Keywords

      List of abbreviations:

      BRS (Brief Resilience Scale), COPE (Coping Orientation to Problems Experienced), LMSQoL (Leeds Multiple Sclerosis Quality of Life), MHLC-C (Multidimensional Health Locus of Control–Form C), MS (multiple sclerosis), QoL (quality of life)
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