Health Promotion and Quality of Life in Chronic Illness

描述（由申请人提供）：在过去的十年中，大量的研究工作在定义MS的病理变化，使用MRI技术评估疾病进展以及开发疾病修饰药物方面取得了重大进展（Joy & Johnston, 2001）。然而，随着时间的推移，我们对多发性硬化症的自然史知之甚少，对于他们疾病的可能结果或他们的个人行为可能影响疾病相关限制和残疾的方式，我们只能提供很少的指导。当前研究（2R01NRO3195 06-10）的研究结果表明，ms相关的功能限制和生活质量结果（感知生活质量、抑郁、继发性疾病）随时间（7年）的变化轨迹缓慢但显著，并且朝着反映限制和继发性疾病增加的方向发展。目前的研究结果支持健康促进行为能够调节疾病相关限制对社区ms患者感知生活质量的影响的假设。这种竞争延续的主要目的是确定可能影响功能限制轨迹的社会心理和行为因素。通过对现有样本（N=565）的持续纵向随访，研究MS患者的残疾和生活质量。在10多年的早期工作中发展、完善和验证的慢性疾病健康促进和生活质量的解释模型（R29NR03195和2R01NR03195）将与著名的失能过程模型（Verbrugge & Jette, 1994）相结合，以更好地了解影响MS相关功能限制和残疾轨迹的因素，以及这些变量随后如何与生活质量的变化相关。我们还将探讨随着年龄的增长（平均年龄54岁），随着时间的推移，对衰老和伴随衰老的共病状况的认知如何影响功能限制和残疾的进展。我们将改进当前研究中使用的方法，纳入基于性能的功能限制测量，以更全面地了解MS限制随时间变化的临床表现。纵向数据将分析与层次线性模型（HIM）和结构方程建模技术。

DESCRIPTION (provided by applicant): During the last decade substantial research efforts have resulted in significant progress in defining the pathologic changes of MS, using MRI techniques to evaluate disease progress, and developing disease modifying medications (Joy & Johnston, 2001). However, we still know very little about the natural history of MS over time and can offer persons with MS little guidance about the likely outcome of their disease or ways that their individual behaviors might influence the trajectory of disease-related limitations and disability. Findings from the current study (2R01NRO3195 06-10) indicate that the trajectory of change over time (7 years) in MS-related functional limitations and quality of life outcomes (perceived quality of life, depression, secondary conditions) is slow but significant and in a direction reflecting increased limitations and secondary conditions. Findings from the current study support the hypothesis that health promoting behaviors are able to mediate the effects of illness related limitations on perceived quality of life in community residing persons with MS. The primary purpose of this competing continuation is to identify psychosocial and behavioral factors that may influence the trajectory of functional limitations, disability and quality of life in persons with MS through continuing longitudinal follow-up of the existing sample (N=565). The explanatory model of health promotion and quality of life in chronic illness that was developed, refined and validated over 10 years of earlier work (R29NR03195 and 2R01NR03195) will be integrated with the well known disablement process model (Verbrugge & Jette, 1994) to obtain a better understanding of factors affecting the trajectory of MS related functional limitations and disability and how these variables are subsequently related to changes in quality of life. We will also explore how perceptions of aging and co-morbid conditions commonly experienced with aging may influence the progression of functional limitations and disability over time as this sample (average age 54) ages with a chronic disabling condition. We will enhance the methods used in our current study by incorporating performance-based measures of functional limitation to obtain a more complete understanding of varying clinical expressions of MS limitations over time. Longitudinal data will be analyzed with hierarchical linear models (HIM) and structural equation modeling techniques.