Exploring the Psychometric Properties of the Life Orientation Test-Revised Among Multiple Sclerosis Patients, Insights into Optimism

doi:10.21203/rs.3.rs-5314161/v1

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Exploring the Psychometric Properties of the Life Orientation Test-Revised Among Multiple Sclerosis Patients, Insights into Optimism

https://doi.org/10.21203/rs.3.rs-5314161/v1

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Introduction: Optimism, defined as the tendency to expect positive outcomes and view challenges as manageable, plays a vital role in the lives of individuals with chronic illnesses, including multiple sclerosis. Given its potential benefits, measuring optimism through validated tools like the Life Orientation Test-Revised (LOT-R) is essential for both research and clinical practice.

Objective: This study aims to validate the LOT-R within a sample of MS patients, assessing its psychometric properties and exploring its potential utility in clinical settings.

Methods: This study included 179 patients with Relapsing-Remitting Multiple Sclerosis (PwMS). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the LOT-R. Model fits were evaluated by the χ2/df value, comparative fit index (CFI), and root mean square error of approximation (RMSEA).

Results: The LOT-R showed good psychometric characteristics in our sample of PwMS. The CFA's two-factor model (optimism/pessimism) yielded a good model fit. Cronbach's alpha and McDonald’s omega were acceptable. Optimism was significantly correlated with quality-of-life scores, resilience, and fear of relapse scale.

Conclusions: The LOT-10 has satisfactory psychometric properties and is suitable for measuring dispositional optimism in Spanish-speaking patients with multiple sclerosis.

Optimism

multiple sclerosis

resilience

quality of life

validation

Orientation Test-Revised

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, leading to a variety of physical and cognitive impairments (Kimoff, Kaminska, & Trojan, 2022). The unpredictable nature of MS often results in significant psychological and emotional challenges for patients, including increased vulnerability to anxiety and depression (Hanna & Strober, 2020). Understanding how patients perceive their situation and their outlook on life is critical for both clinical interventions and improving quality of life.

Optimism defined as the tendency to expect positive outcomes and view challenges as manageable (Carver, Scheier, & Segerstrom, 2010), plays a vital role in the lives of individuals with chronic illnesses, including MS (Fournier, de Ridder, & Bensing, 2002). Research has shown that a more optimistic outlook is associated with better-coping strategies, enhanced resilience, and improved health-related quality of life. For multiple sclerosis patients (PwMS), fostering optimism can lead to more effective management of symptoms, greater adherence to treatment regimens, and a stronger capacity to face the uncertainties of their condition.

Numerous studies have demonstrated that optimism is associated with better health outcomes across a variety of chronic conditions, including cardiovascular diseases, diabetes, and cancer (David, Montgomery, & Bovbjerg, 2006). Individuals with a more optimistic outlook tend to engage in healthier behaviors, adhere more closely to treatment regimens, and report higher levels of life satisfaction (Scheier & Carver, 2018).

Research has shown that optimistic individuals are less likely to develop cardiovascular issues (Boehm et al., 2020) and had a lower risk of cardiovascular events and all-cause mortality (Rozanski, Bavishi, Kubzansky, & Cohen, 2019). This positive correlation is believed to stem, in part, from healthier lifestyle choices and improved stress management. Similarly, in patients with diabetes, optimism has been linked to enhanced self-management behaviors and better glycemic control (Zhao, Suhonen, Katajisto, & Leino-Kilpi, 2020). Optimistic individuals are more likely to engage in regular physical activity and adhere to dietary recommendations, ultimately resulting in better health outcomes. Additionally, studies on cancer patients reveal that those with higher levels of optimism often report lower levels of distress and an improved quality of life (Gallagher, Long, Richardson, & D'Souza, 2019). Optimism may enhance coping strategies, enabling patients to navigate the challenges of diagnosis and treatment more effectively.

In the realm of neurodegenerative diseases, such as Parkinson’s disease, optimism holds particular significance (Anzaldi & Shifren, 2018). In Parkinson’s disease, optimism has been linked to improved overall quality of life and greater resilience to the psychological stresses associated with the condition (Shifren, 1996). Optimistic patients often exhibit more proactive approaches to managing their symptoms, including seeking support and participating in rehabilitation programs (Anzaldi & Shifren, 2018).

Given its potential benefits, measuring optimism through validated tools like the Life Orientation Test-Revised (LOT-R) is essential for both research and clinical practice. Validating such instruments within specific populations, including those with MS and other neurodegenerative diseases, ensures that clinicians can effectively assess and address the psychological needs of their patients.

The Life Orientation Test-Revised (LOT-R) is a widely used instrument designed to measure dispositional optimism and pessimism (Carver et al., 2010; Scheier & Carver, 2018; Scheier, Carver, & Bridges, 1994). This construct is essential in psychological research, as optimism has been associated with better coping strategies, higher life satisfaction, and improved health outcomes (Conversano et al., 2010). However, the applicability of the LOT-R in specific populations, such as individuals with MS, requires thorough validation to ensure its reliability and relevance.

This study aims to validate the LOT-R within a sample of MS patients, assessing its psychometric properties and exploring its potential utility in clinical settings. By evaluating the test’s factor structure, reliability, and validity in this unique population, we seek to contribute to the growing body of literature that emphasizes the importance of psychological assessment in managing chronic illnesses. Understanding the role of optimism in the lives of PwMS may facilitate the development of targeted interventions that enhance psychological resilience and overall well-being.

Study Design and Participants

This study utilized a secondary data analysis approach, drawing from the "Positive Modulatory Variables of Perceived Quality of Life in Patients with Multiple Sclerosis" (MS-POSITIVE) project (Broche-Pérez, Jiménez-Morales, Monasterio-Ramos, & Bauer, 2022; Broche-Pérez, Jiménez-Morales, Monasterio-Ramos, Vázquez-Gómez, & Fernández-Fleites, 2022; Broche-Pérez, Jiménez-Morales, Vázquez-Gómez, Bauer, & Fernández-Fleites, 2023). This original research provided a comprehensive dataset that included variables relevant to our research questions regarding optimism and quality of life among patients with multiple sclerosis. The dataset comprised 214 patients with multiple sclerosis, all over 18 years of age. Participants were from 11 Spanish-speaking countries: Argentina, Mexico, the Dominican Republic, Chile, Spain, Cuba, Colombia, Uruguay, Paraguay, Peru, and El Salvador. In this study, only the patients diagnosed with Relapsing-Remitting Multiple Sclerosis were included (n = 179).

Measures

Demographic and Clinical Information: The demographic variables analyzed included age, gender, education level, marital status, and country of residence.

The Revised Life Orientation Test-Revised (LOT-R): Originally developed by Scheier et al. (1994) and adapted into Spanish by Otero, Luengo, Romero, Gómez-Fraguela, and Castro (1998), consists of two scales: Optimism and Pessimism. The LOT-R includes 10 items, with three items measuring optimism (items 1, 4, and 10), three assessing pessimism (items 3, 7, and 9), and four serving as fillers. Respondents indicate their level of agreement with each item using a 5-point Likert scale, ranging from "strongly agree" to "strongly disagree." The internal consistency of the LOT-R, as measured by Cronbach’s alpha, has been reported to range from .74 to .78 (Schou et al., 2004).

Connor-Davidson Resilience Scale (CD-RISC-10): The 10-item version of the CD-RISC, adapted from the original 25-item scale (Connor & Davidson, 2003), was utilized (Campbell-Sills & Stein, 2007). Patients rated each item on a 5-point Likert scale, ranging from 0 (not true at all) to 4 (true nearly all the time). The total score for the CD-RISC-10 can range from 0 to 40, calculated by summing the responses to all 10 items. A higher score reflects greater resilience. This study used the validated version for Spanish-speaking patients with multiple sclerosis (Broche-Pérez, Jiménez-Morales, Monasterio-Ramos, & Bauer, 2022).

Multiple Sclerosis Quality of Life (MSQOL-29): The MSQOL-29 is a shortened version of the original 54-item inventory (MSQOL-54) (Rosato et al., 2016) This scale includes seven multi-item subscales: ‘physical function,’ ‘sexual function,’ ‘bodily pain,’ ‘emotional well-being,’ ‘energy,’ ‘cognitive function,’ ‘health distress,’ ‘social function,’ ‘health perceptions,’ ‘overall quality of life,’ and ‘change in health.’ It also comprises two composite scores: the physical health composite (PHC) and the mental health composite (MHC).

Fear of Relapse Scale: The Fear of Relapse Scale, developed by Khatibi, Moradi, Rahbari, Salehi, and Dehghani (2020), consists of 26 items divided into three factors: ‘Fear of disability following a relapse,’ ‘Fear of the psychological and physiological consequences of a relapse,’ and ‘Limitations resulting from fear.’ Each item is rated on a five-point Likert scale, with responses ranging from 1 (never) to 5 (always). In this study, the validated version for Spanish-speaking patients with multiple sclerosis was used (Broche-Pérez, Jiménez-Morales, Monasterio-Ramos, Vázquez-Gómez, et al., 2022).

Procedure

The study protocol received approval from the ethics committee of the Department of Psychology at Universidad Central 'Marta Abreu' de Las Villas. All procedures conducted in this study adhered to the ethical standards outlined in the 1964 Helsinki Declaration. Informed consent was obtained from all participants involved in the study.

Data Analysis

The data were processed using SPSS for Windows (version 21) and AMOS (version 22). Descriptive statistics were employed to explore the characteristics of the patients, while confirmatory factor analysis (CFA) was conducted to evaluate the factor structure of the LOT-R (Spanish version). In this study, CFA was utilized to test the two-factor structure proposed by Cano-García et al. (2015). Model fit was assessed using the χ²/df ratio (with a value < 3), comparative fit index (CFI) (≥ 0.90), and root mean square error of approximation (RMSEA) (value ≤ 0.10) ((Cavanaugh & Neath, 2019; Lei & Wu, 2007). The Pearson correlation coefficient was calculated to assess the convergent validity of the LOT-R (Spanish version). Additionally, we examined the reliability of the scale using Cronbach’s alpha and McDonald’s omega (ω) coefficients. Multiple linear regression was performed to evaluate the effects of perceived quality of life, resilience, and fear of relapse on optimism.

Characteristics of the sample

Table 1 summarizes the demographic information for 179 individuals with multiple sclerosis (PwMS). The average age of participants was 39.9 years, ranging from 18 to 66 years. The sample was primarily female, accounting for 82.7%. Most participants (58.7%) had attained a university-level education, and 41.3% were married. The sample was predominantly composed of patients from Argentina (29.6%), followed by Mexico (21.2%) and Uruguay (14.0%).

Table 1

Participant demographic data (n = 179)
Demographic variable	Mean ± SD or n(%)
Age	39.9 ± 10.8
Gender
Female	148(82.7)
Male	31(17.3)
Education
Primary education	3(1.7)
Middle School	18(10.1)
High School	53(29.6)
University Degree	105(58.7)
Marital status
Single	70(39.1)
Married/Consensual Union	74(41.3)
Divorced	39(19)
Widowed	1(.6)
Country
Argentina	53(29.6)
Mexico	38(21.2)
Uruguay	25(14.0)
Spain	17(9.5)
Dominican Republic	16(8.9)
Cuba	13(7.3)
Colombia	9(5.0)
Chile	3(1.7)
Paraguay	1(0.6)
Peru	1(0.6)
El Salvador	1(0.6)
Note. SE(Standard Deviation)

(Insert Table 1 here)

Confirmatory Factor Analysis, Internal Consistency and Concurrent Validity

We conducted a confirmatory factor analysis using Amos 22 software. The two-factor model in the CFA yielded a good model fit [χ2(8, N = 179) 1.78, p = .098; χ2/df = 0.22, CFI = 1.00, TLI = 1.04, RMSEA = 0.00]. (Fig. 1). Cronbach's alpha of the LOT-R was .79, and McDonald’s omega (ω) coefficient was .80. The first factor (Optimism) showed good internal consistency (α = .80; ω = .81). The second factor (Pessimism) showed an acceptable internal consistency (α = .65; ω = .67). A concurrent validity analysis was also conducted. There was a statistically significant, and positive correlation, between the LOT-R scale with resilience and perceived quality of life (high levels of optimism are related to high levels of resilience and perceived quality of life). On the other hand, we also found a strong (negative) correlation between the LOT-R and fear of relapses, showing that, in our sample, patients with high levels of optimism tend to have lower levels of fear of relapses (Table 2).

Table 2

Correlation between LOT-R with resilience, quality of life, and fear of relapses.
	Variables	1		2		3
1	LOT-R	—
2	Resilience	0.449	***	—
3	Quality of Life	0.428	***	0.319	***	—
4	Fear of Relapse	-0.424	***	-0.377	***	-0.293	***	—
Note. * p < .05, p < .01, * p < .001

(Insert Table 2 and Fig. 1 here)

Regression Analysis

A multiple regression analysis was run to explore the effects of quality of life, resilience, and fear of relapse over optimism. (Table 3). The overall regression model was significant [F(3.175) = 30.12, p < 0.001], accounting for 32.9% of the variance in LOT-R scores.

Table 3

Regression analysis
Variables	B	SE	β	t	Sig.
(Constant)	15.545	1.821		8.536	< .001
Quality of life	0.065	0.016	0.270	4.084	< .001
Resilience	1.268	0.040	0.272	3.982	< .001
Fear of relapse	0.537	0.018	-0.243	-3.594	< .001
Note. Dependent Variable: LOT-R; SE(Standard Error)

(Insert Table 3 here)

The present study aimed to evaluate the validity and reliability of the Life Orientation Test-Revised (LOT-R) among patients with multiple sclerosis (MS). Our findings confirm that the LOT-R is a valid and reliable measure of optimism/pessimism in this population. Specifically, the results support the two-factor model of the Spanish version of the LOT-R, aligning with previous research conducted in diverse populations (Cano-García et al., 2015; Lyrakos, Damigos, Mavreas, Georgia, & Dimoliatis, 2010; Pan et al., 2017; Zenger et al., 2013). The internal consistency of the LOT-R in our sample of PwMS was good (α = .79, and ω = .80). Other validation studies of the LOT-R in diverse populations have also reported good internal consistency (Hinz et al., 2022; Schou-Bredal et al., 2017) ranging between .74 to .78, especially when Cronbach’s alpha is used (Schou, Ekeberg, Ruland, Sandvik, & Kåresen, 2004).

Our findings suggest that higher levels of optimism are associated with high levels of resilience, perceived quality of life, and less fear of relapses. Optimism has been shown to play a critical role in the psychological adjustment of individuals with chronic illnesses, including MS (Fournier et al., 2002). For example, PwMS with positive outcome expectancies (“optimistic patients”) display engagement in dealing with their health, even when they are confronted with adversity (Fournier et al., 2002). In a study conducted by Calandri, Graziano, Borghi, and Bonino (2018) the authors aimed to assess the levels of depression, positive and negative affect, optimism, and health-related quality of life among a group of recently diagnosed multiple sclerosis (MS) patients (within three years of diagnosis). The results showed that the patients who engage themselves in a process of identity redefinition following the diagnosis and who elaborate a new self-image, including the chronic illness, were more likely to experience not only higher optimism but also lower depression, and higher positive affect. However, in this study optimism did not correlate with physical health variables such as MS course, symptom severity, and level of disability (Calandri et al., 2018).

Optimism has also been linked to positive outcomes in other neurodegenerative diseases, such as Parkinson's disease (PD) (Anzaldi & Shifren, 2018). In a study involving 70 PD patients, researchers examined the relationships between optimism, pessimism, coping strategies, and depressive symptoms. The results indicated that participants utilized similar amounts of both problem-focused and emotion-focused coping strategies while demonstrating higher levels of optimism than pessimism. Importantly, the findings showed that optimism and pessimism fully mediated the relationship between coping strategies and depressive symptoms (Anzaldi & Shifren, 2018). Furthermore, another study suggested that greater optimism and reduced pessimism are generally associated with better mental health and quality of life in patients with Parkinson's disease (Gruber-Baldini, Ye, Anderson, & Shulman, 2009).

In general terms, it has been demonstrated that in the presence of severe pathological conditions, optimistic patients adapt better to stressful situations compared to pessimists, with positive repercussions on their quality of life (Conversano et al., 2010). In this context, promoting optimism among patients with multiple sclerosis (MS) is crucial for several reasons. First, optimism fosters resilience (Carver et al., 2010), enabling MS patients to better cope with the uncertainties and challenges associated with their condition. Second, optimistic patients are more likely to adhere to treatment regimens and lifestyle modifications. When individuals believe in the possibility of positive outcomes, they are more motivated to engage in their healthcare actively (Millstein et al., 2016). Additionally, research has demonstrated that optimism is associated with various health benefits, including improved immune function and lower levels of stress-related hormones (Solberg Nes, 2016). For MS patients, these physiological benefits can be particularly significant, as they may contribute to better disease management and overall health.

While our study provides valuable contributions, it is important to acknowledge certain limitations. The sample was relatively homogeneous, which may affect the generalizability of our findings. Additionally, the cross-sectional design limits our ability to draw causal inferences about the relationship between optimism and mental health outcomes over time. Future research should consider longitudinal designs and more diverse samples to better understand the dynamics of optimism within the MS population.

Furthermore, there is a need for studies that explore the effectiveness of interventions aimed at enhancing optimism among MS patients. Understanding how optimism can be fostered may lead to improved adherence to treatment and better health outcomes. Longitudinal studies could also provide insights into how optimism changes over the course of the disease and in response to therapeutic interventions.

Finally, a limitation to address in future studies is the exploration of the relationship between optimism and clinical variables such as fatigue, cognitive functioning, and level of disability. These variables can significantly influence the quality of life of patients with multiple sclerosis, and understanding how they interrelate with optimism could provide valuable insights for developing more effective interventions. Including these variables in future research will allow for a more comprehensive understanding of how optimism can impact the overall well-being of patients and could help identify specific strategies that promote a more positive approach to the challenges of the disease.

In conclusion, the LOT-R serves as a reliable instrument for measuring optimism in patients with MS, offering significant implications for clinical practice and future research. By fostering a deeper understanding of optimism and its effects, we can improve the psychological well-being and overall quality of life for individuals living with multiple sclerosis.

Author Contribution

Conceptualization: Yunier Broche-Pérez, Rodneys M. Jiménez-Morales; Methodology: Yunier Broche-Pérez, Rodneys, M. Jiménez-Morales Diego D. Díaz-Guerra; Validation: Yunier Broche-Pérez, Rodneys, M. Jiménez-Morales Diego D. Díaz-Guerra, Writing—original draft preparation: Yunier Broche-Pérez. All authors have read and agreed to the published version of the manuscript.

Data Availability

The dataset for this study is available at Mendeley Repository https://10.17632/fsszjfv3zs.1

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Exploring the Psychometric Properties of the Life Orientation Test-Revised Among Multiple Sclerosis Patients, Insights into Optimism

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