The Big Picture: 26 Years of Longitudinal Findings About Health Promotion and Quality of Life in Multiple Sclerosis.

Background/Objectives: In recent decades, health care for those living with chronic and disabling conditions has expanded beyond symptom and disease management to include efforts to promote health and quality of life. This narrative review synthesizes insights from a 26-year longitudinal study examining health promotion and quality of life among persons living with the chronic and disabling condition of multiple sclerosis (MS). Methods: The longitudinal study, launched in 1999, included a sample of 621 community-residing persons with MS. Our longitudinal research design allowed us to investigate unique issues related to the speed, sequence, direction, and duration of changes in a wide range of MS outcomes. Guided by Braun and Clarke's thematic analysis framework, we have critically reviewed the more than 100 peer-reviewed publications and presentations generated by the study, in which we have identified overarching "Big Picture" themes, and we have contextualized them in relation to other MS research. Results: Five major themes were supported by the findings in this narrative review: (1) Strong interest in health promotion behaviors; (2) Positive view of overall health; (3) Mediation of the impact of functional limitations on quality of life; (4) Physical activity impacts the trajectory of functional limitations over time; and (5) Association of health behaviors with quality of life and health outcomes. Conclusions: Interventions that recognize and incorporate the positive health behaviors and perceptions of persons living with a long-term chronic condition can assist persons aging with chronic conditions to adjust to changes in their environment and the demands of self-management.