How do pain, fatigue, depressive, and cognitive symptoms relate to well-being and social and physical functioning in the daily lives of individuals with multiple sclerosis?

Publication date: Available online 18 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Anna L. Kratz, Tiffany J. Braley, Emily Foxen-Craft, Eric Scott, John Murphy, Susan L. Murphy
ObjectiveTo examine the relative association between daily change in pain, fatigue, depressed mood, and cognitive function, and four outcomes (positive affect and well-being, ability to participate in social roles and activities, upper extremity (UE) functioning, and lower extremity (LE) functioning).DesignRepeated-measures observational study including a baseline lab visit, followed by seven days of home monitoring that included ecological momentary assessment (EMA) of symptoms (pain, fatigue, depressed mood, and cognitive function) and end-of-day diary surveys of outcomes of interest. Multilevel mixed models were used to test study hypotheses.SettingGeneral community.ParticipantsAmbulatory adults (n=102) with MS recruited through [masked] and the surrounding community.InterventionsNot applicable.Main Outcome Measure(s)Customized short-forms of the Neuro-QOL Positive Affect and Well-Being, Upper Extremity Functioning, and Lower Extremity Functioning item banks and the PROMIS Ability to Participate in Social Roles and Activity item banks, adapted for daily use and administered as end-of-day diaries.ResultsAbove and beyond the effects of demographic and clinical covariates, daily pain was associated with three of the four outcomes; days of higher pain were related to lower same-day social participation (B=-1.00, p=0.002), UE functioning (B=-1.04, p=0.01), and LE functioning (B=-0.71, p=0.04). Daily fatigue and depressed mood were independently related to daily positive affect and well-being; days of worse fatigue (B=-0.54, p=0.006) and depressed mood (B=-1.17, p<0.0001) were related to lower same-day well-being.ConclusionsResults demonstrate the role of fluctuations in symptoms in daily functioning and quality of life of individuals with MS. Daily increases in pain intensity are related to social and physical functioning, whereas increases in fatigue and depressed mood is related to daily lower levels of well-being. Findings implicate a person-centered approach to monitoring and treating symptoms.



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