Article

OBJECTIVE: To describe the daily variability and patterns of pain, fatigue,
depressed mood, and cognitive function in persons with multiple sclerosis (MS).
DESIGN: Repeated-measures observational study of 7 consecutive days of home
monitoring, including ecological momentary assessment (EMA) of symptoms.
Multilevel mixed models were used to analyze data.
SETTING: General community.
PARTICIPANTS: Ambulatory adults (N=107) with MS recruited through the University
of Michigan and surrounding community. INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURE: EMA measures of pain, fatigue, depressed mood, and cognitive
function rated on a 0 to 10 scale, collected 5 times a day for 7 days. RESULTS:
Cognitive function and depressed mood exhibited more stable within-person
patterns than pain and fatigue, which varied considerably within person. All
symptoms increased in intensity across the day (all P<.02), with fatigue showing
the most substantial increase. Notably, this diurnal increase varied by sex and
age; women showed a continuous increase from wake to bedtime, whereas fatigue
plateaued after 7 pm for men (wake-bed B=1.04, P=.004). For the oldest subgroup,
diurnal increases were concentrated to the middle of the day compared with
younger subgroups, which showed an earlier onset of fatigue increase and
sustained increases until bed time (wake-3 pm B=.04, P=.01; wake-7 pm B=.03,
P=.02). Diurnal patterns of cognitive function varied by education; those with
advanced college degrees showed a more stable pattern across the day, with
significant differences compared with those with bachelor-level degrees in the
evening (wake-7 pm B=-.47, P=.02; wake-bed B=-.45, P=.04). CONCLUSIONS: Findings
suggest that chronic symptoms in MS are not static, even over a short time frame;
rather, symptoms-fatigue and pain in particular-vary dynamically across and
within days. Incorporation of EMA methods should be considered in the assessment
of these chronic MS symptoms to enhance assessment and treatment strategies.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS