“Don’t walk in front of me… I may not follow
Don’t walk behind me… I may not lead
Walk beside me… just be my friend”
― Albert Camus
Since lock-down or ‘knock-down’ as I like to call it, I’ve succumbed to the reading club.
I have just completed the reading of ‘Motion of the body through space’ by Lionel Shriver, which in my haloed opinion is the most depressive book that I’ve had the displeasure to read…in like forever (you can tell that this wasn’t my pick). What’s even more disappointing is that this book is less titillating than a book I actually possess, entitled simply ‘Duck’ by Victoria de Rijke; chronicling all facts duck (don’t ask).
Why the torture? Not for inclusivitiy as some of you might think, but the said reading club comprises some of my closest friends. Hence, imagine my surprise that this study has found that wider social networks are more beneficial in MS than close-knit ones, particularly when it comes to physical function. This is a problem, especially, when as adults we tend to cull our useless friends. This is part of growing up.
According to this article those with close-knit social networks reported greater physical impairment.
Is this part of some weird enablement that exists in close-knit groups? Not sure. I believe it may reflect more the exclusionary nature of a physically disabling disorder, such as MS. Ergo, a reverse effect outcome.
“Patients inhabit dynamic networks, which serve as conduits for healthcare information and behaviors, thereby influencing cardiovascular outcomes, cancer prognosis, and overall mortality. Social networks range from small, close-knit cohorts of family and friends, to large clusters of loosely connected acquaintances. The latter groups are less constrained networks that enable the flow of novel information and exposure to different resources. Consequently, they may have a favorable impact on health outcomes in neurological diseases where early symptom recognition and access to new therapies are beneficial.”
The authors noted an inverse relationship between physical function (PROMIS physical T-score) and constraint; which is a measure of the tight-knit structure in a social network (see Figure below). According to the authors ‘social networks’ may in fact be a significant environmental factors in MS.
Definitely, as the authors point out, a longitudinal study is needed to dissect this further. I believe this is where the MS societies have a role to play; set up the meet-ups, the exercise groups and reading clubs. Be inclusive.
Neurology. 2020 Aug 7;10.1212/WNL.0000000000010460. doi: 10.1212/WNL.0000000000010460. Online ahead of print.
Association of Social Network Structure and Physical Function in Patients With Multiple Sclerosis
Objective: To test the association between physical function and the social environment in multiple sclerosis (MS), we quantified personal social networks.
Methods: In this cross-sectional study, we analyzed data from two academic MS centers, with center one serving as a discovery group, and center two as the extension group. We performed a meta-analysis of the centers to extend the analysis. We used responses from a questionnaire to map the structure and health habits of participants’ social networks, and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scale (0-100, mean 50 for US general population) as the primary outcome. We applied multivariable models to test the association between network metrics and physical function.
Results: The discovery cohort included 263 MS patients: 81% were women, 96% non-Hispanic European, 78% relapsing MS, average age 50 (12.4) years, and mean disease duration 17 (12.3) years. The extension group included 163 patients, who were younger, more racially diverse, less physically disabled, and had shorter disease duration. In the meta-analysis, higher network constraint, a measure of tightly-bound networks, was associated with worse physical function (β=-0.163+0.047, p<0.001), while larger network effective size, a measure of clustered groups in the network, correlated with better physical function (β=0.134+0.046, p=0.003).
Conclusions: Our study highlights personal networks as an important environmental factor associated with physical function in MS. Patients with close-knit networks had worse function than those with more open networks. Longitudinal studies are warranted to evaluate a causal relationship between network structure and physical impairment.