Locus of control and life's quality relationship in Multiple Sclerosis patients

Introduction: Life’s quality in Multiple Sclerosis may be influenced by any symptom arising from the central nervous system damage, but also by mood disorders¹־². We investigated the relationship between locus of control and life’s quality in Multiple Sclerosis patients. Materials and Methods: We enrolled 87 patients (66,7% women, 33.3% men; mean age 42.1) affected, according to the Mc Donald criteria, by relapsing–remitting multiple sclerosis. They were followed periodically at our Multiple Sclerosis Centre. The patients had a disability corresponding to a mean score of 1.9 on EDSS. As regards the medical treatment, 57.5% of them had been treated with interferon; the remaining 42.5% had been treated with monoclonal antibodies. We considered as exclusion criteria: co-morbidity with other neurological or psychiatric diseases and history of alcohol and drug abuse. Each participant submitted written informed consent. Life’s quality has been assessed using the SF-36 questionnaire, instead clinical disease progression was assessed using the EDSS; Locus of control has been used for psychological variable. The numerical data were expressed as mean and standard deviations; the categorical variables as number and percentage. The non parametric Spearman correlation test was applied in order to assess the existence of significant interdependence between EDSS and all variables related to individual profile (physical activity, etc) and to standardized profile (ISF and ISM). The same test was applied to assess the correlation between disease duration and above mentioned variables. Mann Whitney test was used to assess the existence of significant differences, for all examined variables, between patients undergoing first and second line 2 treatments. Statistical analyses were performed using SPSS 17.0 for Window package (P<0,05 two sided was considered to be statistically significant). Results: We found a significant positive correlation between years of disease and EDSS (p = 0.004), so the EDSS increases with the increasing of disease years. In addiction, there were no significant correlations between years of disease and the life’s quality perception. On the contrary, the EDSS was significantly correlated to all the life’s quality indexes (p <0.001), but it was not correlated to “mental health”. The perception of general health and and the physical state indicator decreased only with the increasing of the patient’s age (p = 0.007; p = 0.009). Comparing the different types of medical treatment, there were no significant differences, except for the parameter "emotional role limitation" (p = 0.019), which was significantly higher in the group of interferon treated patients (mean 63.3 ± 42.2) compared to monoclonal antibodies ones (mean 43.0 ± 39.1). Lastly, the locus of control analysis showed an an external locus prevalence both for patients attending the fisrt line (mean 22.8±8.9) and the second line (mean 21.1±8.8) treatment; on the contrary, an internal locus was present only in few patients attending the first line (mean 11.1±6.8) and the second line (mean 12.6±6.2) tretament. Discussion and conclusions: The results demonstrated that the patients with an external locus of control had lesser perception of physical pain (p = 0.0003), vitality (p = 0.019), social activity (p = 0.0022), physical condition indicator (p = 0.017) and disease status indicator (p = 0.019). On the other hand, internal locus decreased the “mental health” perception (p=0.006) and the disease status index (p = 0.018). The clinical relevance of the relationship between life’s quality and locus of control is very important because it may provide informations about the patients general health status and can also help physicians to choose the best treatment, mostly considering the significant role of the therapy adherence. • Benedict R.H., Zivadinov R., Carone D.A., Weinstock-Guttman B., Gaines J., Maggiore C. et al. (2005)Regional lobar atrophy predicts memory impairment in multiple sclerosis,AJNR Am J Neuroradiol 26:1824–1831 • Janardhan V., Bakshi R.(2002)Quality of life in patients with multiple sclerosis: the impact of fatigue • Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46:907–11. • Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000;343:938–52. • Olek MJ. Epidemiology, risk factors and clinical features of multiple sclerosis in adults. Available at:www.uptodate.com/contents/epidemiology-and-clinical-features-of-multiple-sclerosis-in-adults. Accessed October 31, 2011. Benedict R.H., Zivadinov R., Carone D.A., Weinstock-Guttman B., Gaines J., Maggiore C. et al. (2005)Regional lobar atrophy predicts memory impairment in multiple sclerosis,AJNR Am J Neuroradiol 26:1824–1831 Janardhan V., Bakshi R.(2002)Quality of life in patients with multiple sclerosis: the impact of fatigue