Functional and self-care capacity of people with multiple sclerosis

Oliveira-Kumakura, Ana Railka de Souza; Bezutti, Larissa Maria; Silva, Juliany Lino Gomes; Gasparino, Renata Cristina

doi:10.1590/1518-8345.3068.3183

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.3068.3183 copy

Functional and self-care capacity of people with multiple sclerosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

describe the self-care and functionality levels of patients with multiple sclerosis and determine whether sociodemographic, clinical and functional variables interfere with self-care and/or functionality.

Method:

correlational, cross-sectional study with a quantitative approach performed with individuals in outpatient follow-up. We collected sociodemographic and clinical data and applied the Appraisal of Self-care Agency Scale, the Barthel index, the Lawtton and Brody Scale, and the instrument to investigate the performance in Advanced Activities of Daily Living. We performed descriptive and inferential analysis.

Results:

most patients were classified as “having self-care” (82.14%); with moderate dependence (51.19%) for the basic activities of daily living, partial dependence for the instrumental activities of daily living (55.95%), and more active for the advanced activities of daily living (85.71%). Patients with longer disease duration had a higher number of disabilities and, in those with better socioeconomic and educational profile, the functionality was better.

Conclusion:

disease duration was strongly correlated with a higher number of disabilities and better socioeconomic and educational profiles showed to be protective factors for functionality. Care planning should consider the needs observed by the multidisciplinary team, stimulating the development of self-care, functionality and sociability.

Descriptors:
Activities of Daily Living; SelfCare; Multiple Sclerosis; Human Activities; Chronic Disease; Nursing

Variables	n (%)	Mean (SD)^* * SD = Standard Deviation;	Median	Variation
Appraisal of Self-care Agency (ASA-R)^† † ASA-R = Appraisal of Self-care Agency Scale - Revised;		53,8 (3,9)	53,5	45,0 - 65,0
Having capacity for self-care	69 (82,1)
Developing capacity self-care	15 (17,9)
Classification for BI^‡ ‡ BI = Barthel index;		84,0 (18,9)	87,5	5,0 - 100,0
Independent	28 (33,3)
Slight dependence	8 (9,5)
Moderate dependence	43 (51,2)
Severe dependence	3 (3,6)
Total dependence	2 (2,4)
Classification for LBS^§ § LBS = Lawton and Brody Scale;		18,4 (3,6)	20,0	8,0 - 21,0
Independent	37 (44,0)
Partial dependence	47 (55,9)
Classification for AADL^\|\| \|\| Advanced Activities of Daily Living		6,6 (2,9)	6,5	1,0 - 12,0
More active	72 (85,7)
Less active	12 (14,3)

Variables	ASA-R^* * ASA-R = Appraisal of Self-care Agency Scale - Revised;	BI^† † BI = Barthel index;	LBS^‡ ‡ LBS = Lawton and Brody Scale;	AADL^§ § AADL = Advanced Activities of Daily Living;
Age
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,0787	-0,4937	-0,3929	-0,4054
p-value^¶ ¶ p-value = level of significance;	0,4770	<0,0001	0,0002	0,0001
N	84	84	84	84
Income
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,1738	0,0489	0,2226	0,2371
p-value^¶ ¶ p-value = level of significance;	0,1208	0,6646	0,0458	0,0331
N	81	81	81	81
Diagnosis time
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,0724	-0,3282	-0,2037	-0,2609
p-value^¶ ¶ p-value = level of significance;	0,5127	0,0023	0,0631	0,0165
N	84	84	84	84
Symptoms onset time
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,1210	-0,4794	-0,2631	-0,1879
p-value^¶ ¶ p-value = level of significance;	0,2729	<0,0001	0,0156	0,0869
N	84	84	84	84
Outpatient follow-up time
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,0238	-0,3692	-0,2066	-0,1583
p-value^¶ ¶ p-value = level of significance;	0,8319	0,0006	0,0626	0,1554
n	82	82	82	82
EDSS^ EDSS = Kurtzke Expanded Disability Status Scale score
ρ^\|\| \|\| ρ = Spearman Correlation Coefficient;	-0,0388	-0,7832	-0,5728	-0,5166
p-value^¶ ¶ p-value = level of significance;	0,7262	<0,0001	<0,0001	<0,0001
n	84	84	84	84

Variables		n	Mean (SD^* * SD = Standard Deviation; )	Median	Variation	p-value^† † p-value = level of significance;
	BI ^‡ ‡ BI = Barthel Index;
Age	Independent/Slight	36	33,2 (9,8)	31,0	18,0 - 61,0	< 0,001
	Moderate/Severe/Total	48	45,5 (10,2)	46,5	26,0 - 66,0
Diagnosis	Independent/Slight	36	6,7 (5,5)	5,0	0,0 - 20,0	0,010
	Moderate/ Severe/Total	48	10,8 (7,2)	9,5	0,3 - 26,0
Symptoms onset	Independent/Slight	36	7,9 (6,0)	7,0	0,3 - 20,0	0,001
	Moderate/Severe/Total	48	14,8 (8,3)	16,0	1,0 - 33,0
Outpatient follow-up	Independent/Slight	35	5,8 (5,3)	4,0	0,0 - 17,0	0,005
	Moderate/Severe/Total	47	10,4 (7,4)	9,0	0,0 - 26,0
EDSS^§ § EDSS = Kurtzke Expanded Disability Status Scale; score	Independent/Slight	36	2,1 (1,4)	2,0	0,0 - 6,0	< 0,001
	Moderate/Severe/Total	48	5,4 (1,7)	6,0	2,0 - 8,0
	LBS ^\|\| \|\| LBS = Lawton and Brody Scale;
Age	Independent	37	36,2 (9,2)	34,0	23,0 - 57,0	0,004
	Partially dependent	47	43,4 (12,6)	45,0	18,0 - 66,0
EDSS score	Independent	37	2,8 (1,9)	2,0	0,0 - 6,0	< 0,001
	Partially dependent	47	4,9 (2,1)	5,5	1,0 - 8,0
	AADL ^† † p-value = level of significance; ^† † p-value = level of significance;
Age	More active	72	38,8 (10,9)	37,0	18,0 - 62,0	0,014
	Less active	12	48,5 (13,0)	48,5	23,0 - 66,0
Income	More active	69	3702,9 (2500,5)	3000,0	700,0 - 12000,0	0,011
	Less active	12	3658,3 (6770,3)	1550,0	600,0 - 25000,0
Diagnosis	More active	72	8,4 (6,6)	7,0	0,0 - 26,0	0,018
	Less active	12	13,2 (6,6)	11,5	1,0 - 23,0
EDSS^§ § EDSS = Kurtzke Expanded Disability Status Scale; score	More active	72	3,7 (2,2)	3,2	0,0 - 8,0	0,020
	Less active	12	5,4 (2,1)	6,0	1,5 - 7,5

Variables	n	Mean (SD^* * SD = standard deviation; )	Median	Variation	p-value^† † p-value = level of significance;
BI ^‡ ‡ BI = Barthel Index;
Educational level
Elementary education	21	75,5 (20,8)	80,0	25,0 - 100,0	0,016
Secondary education	29	85,7 (14,7)	90,0	45,0 - 100,0
Higher education	34	87,9 (19,8)	95,0	5,0 - 100,0
Professional status
Active	25	90,8 (16,4)	100,0	45,0 - 100,0	0,003
Inactive	59	81,2 (19,4)	85,00	5,0 - 100,0	0,003
Cerebellar manifestation
Present	64	81,1 (19,5)	85,0	5,0 - 100,0	0,001
Absent	20	93,5 (13,5)	100,0	50,0 - 100,0	0,001
Vesical/intestinal manifestation
Present	41	75,8 (21,2)	80,0	5,0 -100,0	< 0,001
Absent	43	91,9 (12,4)	100,0	50,0 - 100,0	< 0,001
LBS ^§ § LBS = Lawton and Brody Scale;
Educational level
Elementary education	21	16,4 (4,9)	19,0	8,0 - 21,0	0,045
Secondary education	29	18,9 (2,6)	20,0	12,0 - 21,0
Higher education	34	19,3 (3,1)	21,0	8,0 - 21,0
Professional status
Active	25	19,9 (2,3)	21,0	11,0 - 21,0	0,007
Inactive	59	17,8 (3,9)	19,0	8,0 - 21,0	0,007
Cerebellar manifestation
Present	64	17,8 (3,8)	19,0	8,0 - 21,0	0,001
Absent	20	20,2 (2,3)	21,0	11,0 - 21,0	0,001
Vesical/intestinal manifestation
Present	41	17,5 (3,9)	19,0	8,0 - 21,0	0,003
Absent	43	19,3 (3,1)	21,0	8,0 - 21,0	0,003
AADL ^\|\| \|\| AADL = Advanced Activities of Daily Living
Educational level
Elementary education	21	4,9 (2,9)	5,0	1,0 - 10,0	0,008
Secondary education	29	6,9 (2,4)	7,0	2,0 - 10,0
Higher education	34	7,5 (2,9)	8,0	2,0 - 12,0
Professional status
Active	25	8,2 (2,5)	9,0	3,0 - 12,0	0,001
Inactive	59	5,9 (2,8)	6,0	1,0 - 12,0	0,001
Cerebellar manifestation
Present	64	6,2 (2,9)	6,0	1,0 - 12,0	0,020
Absent	20	7,9 (2,5)	8,5	2,0 - 11,0	0,020

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Ana Railka de Souza Oliveira-Kumakura. E-mail: arailka@unicamp.br