Health Locus of Control from a Physical Perspective in Patients with Multiple Sclerosis

Background: Locus of control (LOC) is the patient’s belief in the location of the control over the results of his/her behavior that is a strategy in order to attribute the cause of their own disease. Multiple sclerosis (MS) is a chronic disease with a progressive course, and a high prevalence of accompanying disabilities. Because it has a deep impact on patient’s life, LOC has a fundamental importance in order to manage MS patients properly. External beliefs of LOC could reduce the extent of personal efforts towards rehabilitation and internal beliefs could increase the effects of rehabilitation with motivation and adherence. However, surprisingly, LOC in patients with MS (pwMS) has not been extensively investigated in particular from a physical perspective.

Objectives: The objective was to investigate the relationship between health LOC and physical status in pwMS.

Methods: 108 clinically defined pwMS were randomly included in this cross-sectional study. LOC was measured with Multidimensional Health Locus of Control Scale (MHLC) which includes three subscales to asses internal, powerful others external, and chance external LOC. Disability levels were determined with Expanded Disability Status Scale (EDSS) by the same neurologist and with Patient Determined Disease Steps (PDDS) by the patients. Perceived walking quality was evaluated with the 12-Item Multiple Sclerosis Walking Scale (MSWS-12). The effect of fatigue on physical functioning was measured with Fatigue Impact Scale (FIS) – Physical Subscale (PS).

Results: There were 82 female (75.9%) and 26 male (24.1%) pwMS with mean age 39.96±11.02 years. EDSS scores were between 0 and 6.5 with mean 2.19±1.87. Chance LOC was correlated with all variables; EDSS (r=0.27, p<0.05), PDDS (r=0.32, p<0.05), MSWS-12 (r=0.29, p<0.05), FIS-PS (r=0.27, p<0.05) and FIS-Total (r=0.22, p<0.05). Internal and powerful others LOC were not correlated with any variables (p>0.05).

Conclusions: Increased disability level and worse physical status were associated with more chance LOC. It means pwMS tend to attribute their physical health status to chance rather than to the events under their own and the other persons such as health professionals’ control. These results suggest that modifications of control beliefs should be done to promote better rehabilitation effects and health outcomes.