Demographic and condition-specific factors influencing how symptoms are experienced over time: results of the MOMENT study
Authors: Riegel B , Page S , Aryal S , Lee C S , Belfiglio A , Freedland K , Wiebe D , Stromberg A , Westland H , Vellone E , Vanrijn M , Pettersson S , Jaarsma T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Australian Catholic University

Background
Adults with chronic illness (e.g., heart disease, diabetes) commonly experience intractable symptoms. The response to symptoms is often delayed until hospitalization is required. Acute symptoms prompt treatment-seeking, but variability in severity and bothersomeness of chronic symptoms may contribute to a delay in response.

Purpose
The purpose of this study was to describe symptom severity, bothersomeness, and variability over time and how explore these differ by demographic and clinical groups.

Methods
We conducted a longitudinal observational study, consenting and enrolling a convenience sample of adults ≥ 18 years with one or more symptomatic chronic conditions living in Italy, the Netherlands, Sweden, or the United States. Recruitment was done through social media. Inclusion criteria were ≥ 3 months experience with heart failure (HF), diabetes mellitus (DM), arthritis, asthma, and/or chronic obstructive pulmonary disease (COPD) and experiencing symptom(s) ≥ 3 times weekly. Symptoms characteristics were assessed twice daily on smartphones using ecological daily assessment methods to minimize recall bias. Data were analyzed using descriptive statistics, and Cohen’s d as an effect size when not significant.

Results
Eighty people completed the study. Most participants were middle-aged, female, and well-educated. Most lived in the EU. Variability in symptom severity and bothersomeness over time were strongly associated (r = 0.62, p&lt;0.001) but this variability was not associated with either average symptom severity or bothersomeness (all p&gt;0.05). There was a significant association between age and variability in symptom bothersomeness, with less variability and more stability in symptom bothersomeness over time as age increased (r = -0.29, p = 0.011). Women had lower average symptom severity and average bothersomeness than men (d = 0.33), but the differences were not significant. Comparing respondents with and without various conditions, in HF, there was a slight but non-significant difference in variability in symptom bothersomeness over time (d = 0.55). In DM, average symptom severity over time was less in persons with DM (t=-2.0, p = 0.024). Average symptom bothersomeness over time was less in DM (t=2.2, p = 0.007). In asthma, variability in symptom severity was greater over time (t=2.3, p = 0.012). In COPD, average symptom bothersomeness over time was greater (t=3.2, p = 0.001), variability in symptom bothersomeness over time was less (t=-1.9, p = 0.034), and the average symptom severity over time was greater (t=3.7, p&lt;0.001). In arthritis, bothersomeness was higher and there was a slight but non-significant difference in average bothersomeness over time (d = -0.44).

Conclusion
There are both demographic (age, gender) and condition-specific factors that influence how symptoms are experienced over time in adults with chronic illness. Understanding of these patterns can be useful in designing interventions for chronic illness groups.