Self-efficacy appears to partially mediate the relationship between symptom clusters and quality of life in patients with myasthenia gravis (MG), however, worsening of symptoms remains the factor with the most impact on patient quality of life, a study found.

Although immunotherapy leads to complete symptom remission in over 20% of patients, a significant percentage of patients with MG present with multiple symptoms after therapy. These symptoms are often related to 1 another, occur simultaneously, and are defined as symptom clusters.

These data were recently published in the Journal of Clinical Nursing.

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Several authors hypothesize that symptom clusters have a greater impact on the quality of life than single symptoms; however, there are scarce studies regarding their impact on MG, the authors noted.

Self-efficacy describes how the patients perceive their ability to perform certain tasks, and their expectations for desired outcomes, the researchers said. Studies including patients with varied chronic conditions have shown that a high self-efficacy is directly correlated with a higher quality of life and better response to treatment, they added.

The authors aimed to assess the impact of self-efficacy on the quality of life of patients with MG and its role as a mediator between symptom clusters and quality of life. In doing so, the researchers performed a cross-sectional survey including 382 patients with MG who answered standardized quality of life and self-efficacy questionnaires. Structural equation modeling (SEM) was used to assess the mediating impact of self-efficacy.

“In contrast to conventional regression analysis, SEM employs a covariance matrix that allows for measurement errors and multiple dependent parameters, which is superior to traditional regression analysis,” the authors wrote.

The study included more patients with generalized MG than patients with ocular MG, in a proportion of 3:2. The cohort’s median age was 45 years. 

SEM analysis revealed that both symptom clusters and self-efficacy exert a significant impact on patient quality of life and that self-efficacy partially impacted the relationship between symptom clusters and quality of life.

The authors noted that although self-efficacy plays a role in mediating between symptom clusters and quality of life, a measure to increase self-efficacy would not necessarily increase patient quality of life if appropriate symptom control is not in place.

“Only when the symptoms are effectively under control does an improvement in self-efficacy have an impact on quality of life,” the authors wrote.

The authors recommend nurses and caregivers focus on enhancing self-efficacy in patients with adequate symptom control.


Shen F, Huang HS, Li L. Effects of symptom clusters on quality of life mediated by self‐efficacy among individuals with myasthenia gravis: a structural equation modeling analysis. J Clin Nurs. Published online November 29, 2022. doi:10.1111/jocn.16569