The four self-efficacy trajectories among people with multiple sclerosis: Clinical associations and implications

Background: Longitudinal studies among people with Multiple Sclerosis (pwMS) have shown that self-efficacy is linked to physical, cognitive and psychological functioning. Objectives: To determine the distribution of self-efficacy in a large sample of pwMS, examining whether there are distinct groups which show different self-efficacy trajectories over time, and the health status characteristics of any groups identified. Methods: Participants completed serial questionnaire packs, including Unidimensional Self-efficacy-MS (USE-MS) scale, for the Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) study over an average 46 month period. The resulting longitudinal data were analysed by a group-based trajectory model. Results: 5887 pwMS were studied: mean age 50.2 years (SD 12.0); 73.6% female; Relapsing Remitting MS (61.8%), Secondary Progressive (22.9%), Primary Progressive (11.1%), Rapidly Evolving Relapsing Remitting MS (4.2%). Four distinct self-efficacy trajectories emerged, with declining, slightly declining, stable or improving self-efficacy, each showing different patterns of health status indicators such as EQ-5D-5L, disability and depression. USE-MS < 18 at baseline detected all participants in the two declining groups. Conclusion: Future trials on interventions for self-efficacy should assume a priori that those with low levels of self efficacy (USE-MS < 18 at baseline) are likely to be on a declining trajectory and may need different interventions from those with stable self-efficacy.