# Illness acceptance and quality of life in amyotrophic lateral sclerosis: the role of health and environmental factors

## TL;DR

This study explores how accepting their illness affects the quality of life for people with amyotrophic lateral sclerosis (ALS), considering health and environmental factors.

## Contribution

The study identifies illness acceptance as a significant, independent factor influencing health-related quality of life in ALS patients.

## Key findings

- Illness acceptance positively correlates with all domains of health-related quality of life in ALS patients.
- Percutaneous endoscopic gastrostomy is associated with lower physical and environmental quality of life scores.
- Respiratory status and living conditions significantly influence psychological and environmental quality of life.

## Abstract

To determine the extent to which illness acceptance accounts for variability in health-related quality of life (HRQoL) among adults with amyotrophic lateral sclerosis (ALS) attending a hospital-based outpatient clinic, after controlling for sociodemographic and health variables.

We conducted a single-center, cross-sectional study in a hospital outpatient clinic. Adults with ALS completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Acceptance of Illness Scale (AIS), plus a sociodemographic and health questionnaire.

Forty-five patients were analyzed (mean age 52 ± 14 years; 58% women). WHOQOL-BREF domain means were: physical 46.9 ± 14.1, psychological 51.2 ± 16.9, social 53.0 ± 24.6, environment 58.4 ± 18.4. Mean AIS was 20.4 ± 8.1. AIS correlated positively with all domains (r = 0.40–0.52, all p ≤ 0.006). In age- and sex-adjusted models, AIS independently predicted higher scores: physical β = 0.96 (p = 0.003), psychological β = 0.94 (p = 0.013), social β = 1.47 (p = 0.003), environment β = 1.10 (p = 0.025). Percutaneous endoscopic gastrostomy (PEG) was associated with lower physical and environment scores than oral feeding. Respiratory status differentiated physical and psychological scores. Better living conditions related to higher psychological and environment scores. Time from first symptoms to diagnosis correlated with AIS (ρ = 0.37, p = 0.014).

Illness acceptance is a robust, independent correlate of HRQoL across domains in ALS. Care should pair symptom control with brief acceptance-focused, educational, and family communication interventions, and address environmental needs. Decisions on PEG and non-invasive ventilation (NIV) should include routine dietetic, psychological, and speech–language input. Longitudinal studies should test AIS as a mediator of somatic and environmental interventions on HRQoL.