The influence of resources on perceived functional limitations among women with multiple sclerosis.

Abstract: The purpose of this longitudinal investigation was to identify the effects of external resources (i.e., education, marriage, employment, social support, economic status) on the trajectory of perceived functional limitation among women with multiple sclerosis (MS). We hypothesized that these resources would have a long-term influence upon MS-related functional limitation. As part of a longitudinal study of health promotion and quality of life among persons with MS, we tested hypothesized relationships using data obtained at five time points, using repeated-measures MANOVA. We found that functional limitation scores increased over time &r all participants. In general, women who were unemployed as a result of MS consistently had higher functional limitation scores, and employed women consistently had lower functional limitation scores. Women with lower social support scores consistently perceived greater functional limitation than those with higher social support scores. Women with lower perceived-economic-adequacy scores consistently had higher functional limitation scores than women with higher perceived-economic-adequacy scores. Nurses and other healthcare professionals are in an optimum position to observe and assess the resources of women with MS. They can use presence, listening, and observational skills to identify verbal and nonverbal cues of resource depletion. In addition, they can act as advocates for women with MS and speak out on policy issues and legislation at the local and national levels. Healthcare professionals can thus influence the presence of resources for those who are particularly vulnerable to resource loss, so they can participate successfully in work, recreational, and home environments.

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Multiple sclerosis (MS), a progressive disease of the central nervous system, is one of the most disabling conditions to affect young adults (Boyden, 2000; Paty & Ebers, 1998). Its course is highly variable. Often it begins with a relapsing-remitting pattern of episodic exacerbations, then develops into the secondary, progressive form (Paty & Ebers, 1998; Wallin, Page, & Kurtzke, 2000). Characterized by periods of deterioration and remission, MS often leads to a general deterioration of health (Lublin & Reingold, 1996). The etiology and a cure have not yet been established, and there are no preventive measures (Antonak & Livneh, 1995).

One of the risk factors for developing MS is female gender (Vollmer, Hadjimichael, Preiningerova, Ni, & Buenconsejo, 2002). Of the 350,000 persons affected by MS in the United States, 75% are women (Shabas & Weinreb, 2000). Women experience greater difficulty than men in coping with MS and its related problems (Steck, Amsler, Kappos, & Burgin, 2001). Impairments associated with MS can result in loss or abnormality of mental, physiological, or biochemical/traction (Brandt & Pope, 1997; Wendell, 2001). The symptoms associated with impairment include weakness, sensory dysfunction, fatigue, bladder or bowel disturbances, imbalance, visual loss, and cognitive decline (Ford, Gerry, Johnson, & Tennant, 2001; McCabe & McKern, 2002).

Traditional biomedical management of MS focuses on treating the underlying disease process and managing the secondary symptoms. It includes pharmacologic interventions designed to prevent or slow the illness (Stuifbergen & Becker, 2001). Clinicians and researchers are interested in understanding the disease and developing and implementing interventions that can provide relief from symptoms and maximize the health of women living with MS (Stuifbergen & Roberts, 1997).

Coping with the stress of chronic or disabling conditions requires people to spend their personal, social, and material resources to preserve their lives in the midst of evolving and multiple threats (McDonough, Badley, & Tennant, 1995). Women with MS, like women with other chronic conditions, face multiple, pervasive, longstanding, and unpredictable stressors as a result of living with their functional limitations (Brooks & Matson, 1982; Florian & Dangoor, 1994). For individuals living with a chronic illness, stress may be compounded when their physical, economic, and social resources are threatened or lost (Hobfoll, 2001).

Ensel and Lin (1991) suggest that coping is enhanced by the presence of resources. The conservation of resources theory, discussed more fully below, suggests that the presence of resources can influence the degree of functional limitation that accompanies daily living with MS. To help women living with MS plan and care for their health, it is important to identify their most important resources. This study sought to identify the relationship of several external resources to MS-related functional limitation and examine how these external resources (i.e., education, marriage, employment, social support, economic status) were associated with the trajectory of increasing functional limitation across a 5-year period.