Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

Self-efficacy and self-esteem as predictors of participation in spinal cord injury--an ICF-based study

STUDY DESIGN: A multi-centre cross-sectional study. OBJECTIVE: To examine the relationship of self-efficacy and self-esteem with participation of persons with spinal cord injury (SCI) from a comprehensive bio-psycho-social perspective, based on the conceptual framework of the International Classification of Functioning, Disability and Health (ICF). SETTING: Community-dwelling participants, <5 years post discharge, recruited through three SCI rehabilitation centers in Switzerland. METHODS: Data were collected by means of standardized self-report questionnaires sent to the eligible participants by postal mail. The questionnaires covered the different components of the ICF's bio-psycho-social model, namely health conditions, body functions, participation, environmental and personal factors. Bivariate correlations and multivariate linear regression analyses with participation as the dependent variable have been conducted. RESULTS: In all, 102 persons with SCI answered the survey, response rate 25.9%. Self-esteem (r=0.61) and self-efficacy (r=0.54) correlated highly with participation and were the strongest correlates of participation. They were stronger correlates of participation than symptoms of anxiety, depressive symptoms, pain, health conditions, social support, coping styles or sense of coherence. Participation seemed to be independent of gender, age, level or completeness of injury. Self-efficacy and self-esteem explained together with time since discharge and years of education 48% of the variance in participation adjusting for health condition, depressive symptoms, pain interference and social support. CONCLUSION: Considering self-efficacy and self-esteem within the comprehensive framework of the ICF can contribute to a better understanding of functioning, disability and health in SCI, which in turn may facilitate the development of interventions to support the persons' adjustment and reintegration

What is setting the stage for abdominal obesity reduction? A comparison between personality and health-related social cognitions

The present longitudinal study examines whether changes in abdominal obesity are best predicted by relatively stable and broad personality traits (dispositional optimism and pessimism), by modifiable and domain-specific social cognitions (health-related self-efficacy), or a combination of these. Altogether 385 participants (74% women; 50-65 years) attended the GOAL Implementation Trial, a lifestyle counseling intervention to improve diet and physical activity. Measurements were conducted prior to the intervention (T1), and 3 months (T2) and 12 months (T3) after T1. Three different models of the potential interplay between dispositional optimism and pessimism and health-related self-efficacy were tested. The analyses showed that the change in health-related self-efficacy during the intervention (T1-T2) was negatively related with waist circumference change between T1 and T3, indicating that increases in self-efficacy during the intervention resulted in reduction in waist circumference over 12 months. However, optimism and pessimism were unrelated to waist circumference change either directly or indirectly through changes in self-efficacy. Weight loss interventions enhancing participants positive health-related expectancies such as self-efficacy are likely to be effective even when participants dispositional expectancies are pessimistic