The role of psychological well-being in multiple sclerosis rehabilitation

BACKGROUND: In patients affected by multiple sclerosis (MS) the disabilities increase during the progression of the disease, with a negative impact on quality of life. Rehabilitation improves motor performances, but remains unclear the role of psychological variables on motor recovery. AIM: The aim of this study was to investigate the role of the psychological well-being during a rehabilitation care in MS patients with moderate to severe disability. DESIGN: Longitudinal study. SETTING: Outpatients in a Neurorehabilitation Unit of Pisa and Ferrara University Hospital. POPULATION: 93 subjects affected by MS with moderate to severe degree of impairment were recruited (43 male, 50 female; mean age 53±11.19 years). In relation to the Expanded Disability Status Scale (EDSS) score the sample was divided in two group: Group 1 with moderate impairment (EDSS 4-5.5) and Group 2 with severe impairment (EDSS 6-7). METHODS: Psychological and functional status was assessed before and after a motor rehabilitative treatment, appropriate to their clinical needs. Parameters collected were: Short Form 36, Patient Health Questionnaire, Fatigue Severity Scale, 6-minute walking test and 10-meter walking test. RESULTS: Mood disorders, low quality of life (QoL) and high perceived fatigue are characteristic symptoms in our sample. Results do not show a direct correlation with motor impairment. Mood improves in both groups, while walking endurance and speed ability recovers only in Group 1, on the contrary QoL improves only in Group 2. Regression analysis show that in Group 1 a better QoL predicts a higher motor recovery, whereas in Group 2 the improvement of walking endurance influences the subjective well-being at the discharge. CONCLUSIONS: Subjective well-being is related with the perception of the new condition of life. In less impaired patients psychological status can influence the liability toward rehabilitation treatment, while in more impaired patients motor recovery affect well-being. Therefore, the psychological counselling should be provided during the rehabilitation treatment in order to achieve a successful patients' care. CLINICAL REHABILITATION IMPACT: Our approach contributes to bring out the role of subjective factors on motor rehabilitation outcome and the functional recovery effect on the psychological well-being. The knowledge of subjective needs related to disability degree should be used to customize an appropriate care in MS patients.