ارائه مدل علّی خودآگاهی در بیماران مبتلا به مولتیپل اسکلروزیس بر اساس تحول دیداری‌فضایی، ذهن‌آگاهی ورزشی و آمادگی بدنی ادراک شده؛ نقش واسطه‌ای تعادل ذهنی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه آموزش تربیت بدنی، دانشگاه فرهنگیان، تهران، ایران

2 گروه آموزش روانشناسی و مشاوره، دانشگاه فرهنگیان، تهران، ایران

چکیده

هدف مطالعه حاضر ارائه مدل خودآگاهی در مبتلایان به ام­اس بر اساس تحول دیداری­فضایی، ذهن­آگاهی ورزشی و آمادگی بدنی ادراک شده با نقش واسطه­ای تعادل ذهنی بود.
روش پژوهش
طرح پژوهش کمی از نوع همبستگی بود. جامعه آماری کلیه مبتلایان به ام­اس شهر بروجرد در سال 1403-1402 بودند که با استفاده از جدول کرجسی­مورگان 300 نفر برای نمونه به روش نمونه­گیری در دسترس انتخاب شدند. از مقیاس­های تحول دیداری­فضایی، ذهن­آگاهی ورزشی، آمادگی بدنی ادراک شده و تعادل ذهنی استفاده شد. داده­های بدست آمده با استفاده از نرم­افزارهایSPSS24  و AMOS تجزیه و تحلیل شدند. بنابراین و بر اساس نتایج بدست آمده پیشنهاد می­شود، مسولین ذیربط به نقش پیش­بینی کنندگی متغیرهای تحول دیداری­فضایی، ذهن­آگاهی ورزشی و آمادگی بدنی ادراک شده و نقش میانجی تعادل ذهنی در ارتقای خودآگاهی بیماران مبتلا به ام­اس توجه بیشتری داشته باشند.
یافته‌ها
یافته­ها نشان داد که ضرایب استاندارد مسیر تحول دیداری­فضایی(67/0=β)، آمادگی بدنی ادراک­شده(52/0=β)، ذهن­آگاهی ورزشی(51/0=β) و تعادل ذهنی(57/0=β) به خودآگاهی معنی­دار شده است(001/0>P). یافته­ها همچنین نشان داد که 34 درصد از واریانس تعادل ذهنی و 42 درصد از واریانس خودآگاهی با مدل حاضر تبیین گردید. علاوه بر این استفاده از روش بوت­استراپ نشان داد که تعادل ذهنی در رابطه بین متغیرهای برون­زا با خودآگاهی نقش واسطه­ای دارد.
نتیجه گیری
یافته­ها نشان داد که ضرایب استاندارد مسیر تحول دیداری­فضایی(67/0=β)، آمادگی بدنی ادراک­شده(52/0=β)، ذهن­آگاهی ورزشی(51/0=β) و تعادل ذهنی(57/0=β) به خودآگاهی معنی­دار شده است(001/0>P). یافته­ها همچنین نشان داد که 34 درصد از واریانس تعادل ذهنی و 42 درصد از واریانس خودآگاهی با مدل حاضر تبیین گردید. علاوه بر این استفاده از روش بوت­استراپ نشان داد که تعادل ذهنی در رابطه بین متغیرهای برون­زا با خودآگاهی نقش واسطه­ای دارد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Presenting a causal model of self-awareness in patients with multiple sclerosis based on visuospatial development, sports mindfulness, and perceived physical fitness; the mediating role of mental balance

نویسندگان [English]

  • Gholamreza Anari 1
  • Mehdi Yousefvand 2
1 Department of Physical Education, Farhangian University, Tehran, Iran
2 Department of Psychology and Counselling, Farhangian University, Tehran, Iran
چکیده [English]

Objective: The aim of the present study was to present a model of self-awareness in patients with MS based on visual-spatial development, sports mindfulness, and perceived physical fitness with the mediating role of mental balance.
Method: The research design was a quantitative correlational type. The statistical population was all patients with MS in Boroujerd in 1402-1403, and 300 people were selected for the sample using the Krejci-Morgan table using the available sampling method. The questionnaires of visual-spatial development, sports mindfulness, perceived physical fitness, and mental balance were used. The obtained data were analyzed using SPSS24 and AMOS software.
Results: The findings showed that the standard path coefficients of visual-spatial development (β=0.67), perceived physical fitness (β=0.52), sports mindfulness (β=0.51), and mental balance (β=0.57) were significantly related to self-awareness (P<0.001). The findings also showed that 34% of the variance in mental balance and 42% of the variance in self-awareness were explained by the present model. In addition, the use of the bootstrap method showed that mental balance has a mediating role in the relationship between exogenous variables and self-awareness.
Conclusions: Therefore, based on the results obtained, it is suggested that relevant authorities should pay more attention to the predictive role of visual-spatial development variables, sports mindfulness, and perceived physical fitness and the mediating role of mental balance in promoting self-awareness in patients with MS.

کلیدواژه‌ها [English]

  • Perceived physical fitness
  • visual-spatial development
  • mental balance
  • self-awareness
  • sports mindfulness

Introduction

Self-awareness in people with MS has been defined as a realistic examination of one’s beliefs, values, feelings, and abilities and their use in controlling negative emotions and increasing positive emotions (21). In self-awareness, a person with MS is well informed about their physical and psychological states and characteristics and uses them to grow and overcome the disease (22).

Researchers have shown that exercise training has positive effects on the level of self-awareness (23) and mindfulness (24) as well as psychological health (25) of patients with MS (26). On the other hand, researchers in the field of central nervous system injuries have shown in their studies that one of the cognitive variables that undergoes significant negative changes in patients with MS is visual-spatial development (27), such that affected individuals, due to physical injuries that are mainly psychological in origin, become involved in psychosomatic diseases (28) and experience many problems in terms of visual-spatial perception (29). Visual-spatial development is one of the most important foundations of development that plays the role of the primary function of all learning and communication and forms mental representations about the outside world (30), which unfortunately is severely disrupted in patients with MS (31). Research has shown that people with visual-spatial processing problems often have difficulty understanding the larger picture (31) and are easily lost in details, and they also have difficulty understanding complex designs and assembling pieces (32). Research has also shown that deficits in visual ability and perception are directly related to reduced visuomotor function in patients with MS, such that the lower the level of visual ability and perception in a person with MS, the lower the visuomotor performance and perception will be (33).

Some studies have shown that patients with MS have poor perceived physical fitness (34), such that they evaluate their social, emotional, and physical abilities at a lower level than healthy individuals (8)(35). In addition, other studies have reached interesting and, of course, different results, such that the self-control construct mediates the relationship between influential and predictive variables of self-awareness such as visuospatial development, perceived physical fitness, and sports mindfulness in patients with MS (36-37-38). Researchers have recently highlighted the importance of mental balance in the process of performing mindfulness techniques to accelerate the psychological health of patients with MS (39). Therefore, considering the stated issues and the study gaps that exist in previous research and considering the importance of addressing the psychological health of patients with MS, the aim of the present study was to present self-awareness in patients with MS is based on visual-spatial development, sports mindfulness, and perceived physical fitness with the mediating role of mental balance.

 

Method: The research method was as follows: after obtaining the necessary permits, the researchers went to a comprehensive health center in Boroujerd that was dedicated to providing services to patients with MS. At the beginning of the work, a list of all patients with MS was provided to the researchers. Then, the researchers selected 300 people from that list using a convenience method. In the next step, they were contacted based on their psychiatric and medical records, which included their ID card details, address, and phone number. After the contact was made, a full explanation of the study objectives was provided and their consent was obtained, and the process of presenting and filling out the instruments used in the present study began. The questionnaires were filled out in two ways: in person and virtually via email or ETA and SHAD messengers. Seven people withdrew from cooperation with the researchers for personal reasons and did not return the questionnaires, which the researchers considered as missing data. In the analysis of statistical findings, data related to 293 people were analyzed. In the present study, descriptive statistics (mean, standard deviation, and Pearson correlation coefficients) and inferential statistics (confirmatory factor analysis and path analysis) were used to analyze the collected data using SPSS24 and AMOS24 software.

 

Results: As Table 4 shows, the standard coefficients of the path of visual-spatial development to self-control (P<0.001, β=0.54), the standard coefficients of the path of visual-spatial development to mental balance (P<0.001, β=0.60), the standard coefficients of the path of visual-spatial development to self-awareness (P<0.001, β=0.67), the standard coefficients of the path of perceived physical fitness to self-control (P<0.001, β=0.59), the standard coefficients of the path of perceived physical fitness to mental balance (P<0.001, β=0.46), the standard coefficients of the path of perceived physical fitness to self-awareness (P<0.001, β=0.52), the standard coefficients of the path of sports mindfulness to self-control (P<0.001, β=0.50), the standard coefficients of the path of The standardized coefficients of the path of sports mindfulness to mental balance (P < 0.001, β = 0.59), the standardized coefficients of the path of sports mindfulness to self-awareness (P < 0.001, β = 0.51), the standardized coefficients of the path of self-control to self-awareness (P < 0.001, β = 0.47), the standardized coefficients of the path of mental balance to self-awareness (P < 0.001, β = 0.57), and the standardized coefficients of the path of mental balance to self-control (P < 0.001, β = 0.63) are significant.

 

Conclusion: The results showed that the direct effect of visual-spatial development on mental balance is significant. This result is consistent with the findings of studies (14-18-22-23). ​​In these studies, the emphasis on visual-spatial development of the individual causes the affected person to have better and higher mental balance due to the peace of mind and inner satisfaction he has. Therefore, it is because higher visual-spatial development and perception increase the level of mental balance in the person with MS. Another reason for explaining this finding is that in the concept of visual-spatial development there is a subcomponent called awareness and body sensation, which makes the person have a better understanding of his mental and physical conditions. On the other hand, in the concept of mental balance there is a subcomponent of perceptual and sensory acceptance, which makes the person accept his negative feelings and emotions and try to change them into positive emotions. Therefore, it can be said that the reason why visual-spatial transformation can have a positive and significant effect on mental balance is the existence of a common concept and sub-component called body perception and awareness. The results showed that the direct effect of visual-spatial transformation on self-control is significant. This finding is consistent with the results of studies (26-31). The self-control construct in Clinton et al.'s theory means controlling arousal levels in order to perform maximally in difficult situations and refrain from destructive responses such as anger. Also, the concept of self-control is generally understood as the ability to change or adapt oneself to the surrounding world so that better compatibility between the individual and the world arises. On the other hand, the concept of visual-spatial transformation has an important sub-component called the relationship of the individual with the environment. Therefore, one of the important reasons for explaining why the direct effect of visuospatial development on self-control was significant is the existence of a common element of trying to optimally connect the individual with the environment, which exists in both the concept of visuospatial development and the construct of self-control, and therefore this issue is also consistent with theoretical foundations. These findings can be said to indicate that visuospatial development makes the individual feel empowered, which creates the basis for creating and increasing self-awareness. On the other hand, since mental balance also improves the level of visuospatial development and increases self-awareness in people with MS, we conclude that mental balance plays a mediating role between visuospatial development and self-awareness. On the other hand, people who have higher perceived physical fitness and better visuospatial development also have higher self-awareness because high perceived physical fitness and higher visuospatial development allow people to better control their emotions and have more optimal arousal levels. So, in general, and based on theoretical and empirical foundations, it can be said that the existence of common elements in the concepts of perceived physical fitness, visuospatial development, and mental balance has caused them to have a mediating and positive role in the relationship between perceived physical fitness and visuospatial development with self-awareness.

 

Keywords: Mental Balance, Perceived Physical Fitness, Self-Awareness, Sports Mindfulness, Visual-Spatial Development.

 

Ethical Considerations

 

Compliance with ethical guidelines

Ethical considerations have been taken into account in carrying out this research in accordance with the guidelines of the Ethics Committee of Islamic Azad University.

 

Funding

This study was extracted from the Ph.D. thesis of first author at Department of Sport Psychology of University.

Authors' contribution

All authors contributed equally to the conceptualization of the article and writing of the original and subsequent drafts.

Conflict of interest

The authors declared no conflict of interest.

 

Acknowledgements

The researcher considers it his duty to acknowledge and appreciate the cooperation of all participants in this study who provided the necessary cooperation in carrying out this research.

  1. Mazancieux A. Metacognition and self-awareness in multiple sclerosis. Cortex 2019; 15(4): 238 -255.
  2. Rogers KA, Megan MD. Therapeutic yoga: symptom management for multiple sclerosis. The Journal of Alternative and Complementary Medicine2015: 10(67): 655-659.
  3. Naisby J. Yoga and Multiple Sclerosis: Maintaining engagement in physical activity. PloS one2023; 18(7): 238-250.
  4. Gontkovsky ST. Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination. International Journal of Neuroscience2023; 13(6): 636-641.
  5. Nguyen J. Visual pathway measures are associated with neuropsychological function in multiple sclerosis. Current eye research2018; 43(7): 941-948.
  6. Jakimovski D. Visual deficits and cognitive assessment of multiple sclerosis: confounder, correlate, or both. Journal of Neurology2021; 268(43): 2578-2588.
  7. Simpson R. Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis–a systematic review and meta-analysis. Multiple sclerosis and related disorders2020; 38(12):101-193.
  8. Han A. Mindfulness-and acceptance-based interventions for symptom reduction in individuals with multiple sclerosis: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation2021; 102(10): 2022-2031.
  9. Jia-Fong J, Yuan-Hong J, Hann-Chorng K. Discriminating Different Bladder and Bladder Outlet Dysfunctions by Urinary Biomarkers in Women with Frequency–Urgency Syndrome. Biomedicines 2023; 11(3): 673-685.
  10. Herson M, Kulkarni J. Hormonal agents for the treatment of depression associated with the menopause. Multiple sclerosis and related disorders2022; 39(8): 607-618.
  11. Gomelsky A, Ann S, William PA. Pathophysiology of Female Micturition Disorders. Female Genitourinary and Pelvic Floor Reconstruction 2023; 10(3): 1-14.
  12. Burschka JM. Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC neurology 2014; 14(7): 1-9.
  13. Simpson R. Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery & Psychiatry 2019; 90(9): 1051-1058.
  14. Mayo CD. The relationship between physical activity and symptoms of fatigue, mood, and perceived cognitive impairment in adults with multiple sclerosis. Journal of clinical and experimental neuropsychology 2019; 41(7): 715-722.
  15. Carletto S. Mindfulness-based interventions for the improvement of well-being in people with multiple sclerosis: a systematic review and meta-analysis. Psychosomatic medicine82(6): 600-613.
  16. Bogosian A. Potential treatment mechanisms in a mindfulness‐based intervention for people with progressive multiple sclerosis. British journal of health psychology 2016; 21(4): 859-880.
  17. Kalron Physical activity in mild multiple sclerosis: contribution of perceived fatigue, energy cost, and speed of walking. Disability and rehabilitation 2020; 42(9): 1240-1246.
  18. Sadridamirchi E, Aghazadehasl M. The effectiveness of cognitive-behavioral group therapy on coping and self-control styles in multiple sclerosis patients. Armaghane danesh 2018; 22(6): 792-803. (Persian)
  19. Dietmaier JM. Personality and its association with self-management in multiple sclerosis. Multiple Sclerosis and Related Disorders 2022; 31(8): 103-114.
  20. Gil-Gonzalez I. Quality of life in adults with multiple sclerosis: a systematic review. BMJ open 2020; 10(11): 41-49.
  21. Toolar J. Exercise effects on multiple sclerosis quality of life and clinical-motor symptoms. Medicine and science in sports and exercise 2020; 52(5): 1007-1014.
  22. Cameron MH, Ylva N. Balance, gait, and falls in multiple sclerosis. Handbook of clinical neurology 2018; 159(6): 237-250.
  23. Abbasiyanik Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions. Multiple sclerosis and related disorders 2020; 43(19): 102-139. (Persian)
  24. Barin L. The disease burden of multiple sclerosis from the individual and population perspective: which symptoms matter most? Multiple sclerosis and related disorders 2018; 25(17): 112-121.
  25. Ogunwale O. Mathematics Education: Reducing Effects of Dyscalculia in Children and Adults with Hearing Impairment. Rethinking the Teaching and Learning of Mathematics in the Pandemic Era2023; 209(40): 237-250.
  26. Kratz AL. Cross-sectional examination of the associations between symptoms, community integration, and mental health in multiple sclerosis. Archives of physical medicine and rehabilitation 2016; 97(3): 386-394.
  27. Erkorkmaz Ü. Balance performance in three forms of multiple sclerosis. 2006
  28. Grippa E. Multiple sclerosis reduces sensitivity to immediate reward during decision making. Behavioral Neuroscience 2017; 131(4): 325-310.
  29. Mertens J. Walking to beats in music and metronomes in persons with progressive MS. preliminary pilot study results 2023; 15(8): 299-310.
  30. Davis BE. Patient and provider insights into the impact of multiple sclerosis on mental health: a narrative review. Neurology and Therapy 2021; 10(99): 99-119.
  31. Lapin L. Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms—a narrative review. Neurology and therapy 2021; 10(17): 75-98.
  32. Silvira C. Neuropsychiatric symptoms of multiple sclerosis: state of the art. Psychiatry investigation 2019; 16(12): 877-896
  33. Ghasemi N, Razavi Sh, Nikzad E. Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy. Cell Journal (Yakhteh) 217; 19(1): 1-27. (Persian)
  34. Trovonen T. Treatment preferences in relation to fatigue of patients with relapsing multiple sclerosis: a discrete choice experiment. Multiple Sclerosis Journal–Experimental, Translational and Clinical 2021; 9(1): 123-140.
  35. Kang W. Understanding the Effect of Multiple Sclerosis on General and Dimensions of Mental Health. Journal of Clinical Medicine 022; 11(24): 74-83.
  36. Surulinathi MN, Prasanna K, Rajpal W. Covid-19 and Neurosciences: A Scientometric assessment of Global publications output during 2020–2021. International Journal of Information Dissemination and Technology 2021; 11(4): 181-188.
  37. Napier-Hemy, Timothy P. Prophylactic intravenous gentamicin with sedation-free cystoscopic injection of BoNT-A: No demonstrable adverse extravesical neuromuscular effects in a pilot safety study of 220 idiopathic overactive bladder patients. Journal of Clinical Urology 2023; 16(2): 91-95.
  38. Idiculla PS, Govindaraajan R. A Case of cervical spondylotic amyotrophy mimicking amyotrophic lateral sclerosis. Case Reports in Neurology 2021; 12(3): 314-320.
  39. Senders A. Association between pain and mindfulness in multiple sclerosis: a cross-sectional survey. International journal of MS care2018; 20(1): 28-34.
  40. Furth HG, Wachs H. Thinking goes to school: Piaget's theory in practice. Toronto. Oxford University Press; 1975.
  41. Zarezadeh KS, Amin Yazdi S, Ali S, Karsheki H. The Modeling of the Relationships of Motor and Visuospatial Development on Functional-Emotional Development with the Mediating of Mother-child Interaction. Quarterly Journal of Disability Studies 2018; 8(15): 22-39. (Persian)
  42. Rogers HT, Shires AG, Cayoun BA. Development and Validation of the Equanimity Scale -16. Mindfulness. Handbook of clinical neurology 2021; 12(1): 1 -14.
  43. Rashidian M, Dehghani Ashkezari E, Cayoun B, Farzinrad B. (2022). Psychometric Properties of the Persian Version of Equanimity Scale 16 (ES-16). Rooyesh2022; 11(6): 185-194. (Persian)
  44. Govern JM, Marsch LA. Development and validation of the situational self-awareness scale. Consciousness and cognition. Neurology and therapy, 2021; 10(3): 366-78.
  45. Irji Rad, Arsalan, Haji, Marzieh. Investigating the relationship between self-awareness and emotions arising from teaching in teachers (art students) of conservatories. Quarterly Journal of Educational Psychology, 2018; 14(50): 55-70. (Persian)