Transcending Self Therapy-Virtual Reality (TST-VR) and Substance Use Disorder (SUD) Treatment Completion in Veterans.

Health-related quality of life (HRQOL) is an umbrella term that encompasses a person’s perception of the physical and psychological components of health status (; ; ; ), and the manifestations of neurological diseases including body function, activities, and participation may have a significant impact on disease-specific physical and psychological quality of life (). For example, multiple sclerosis (MS) is a prevalent, immune-mediated disease of the central nervous system, and the damage and its location manifest as loss of cognitive and physical function as well as symptoms such as fatigue, pain, depression, drop foot, and spasticity (; ). Those aforementioned outcomes of MS may result in lower levels of physical activity, higher levels of sedentary behavior, and compromised HRQOL consistent with the International Classification of Functioning, Disability and Health model (). Physical activity has been associated with better HRQOL in persons with MS (; ). Physical activity is defined as a behavior that consists of bodily movement produced by contraction of skeletal muscles resulting in increased energy expenditure above resting levels (). One cross-sectional study of 292 persons with MS reported that higher physical activity levels were positively associated with better HRQOL (). One longitudinal study of 269 persons with MS demonstrated that naturally-occurring increases (or decreases) in physical activity were associated with better (or worse) HRQOL across a one-year period (), and fatigue, depressive symptoms, pain, social support, and self-efficacy mediated the association between physical activity and HRQOL (; ). Sedentary behavior too may be associated with HRQOL among persons living with MS. Unlike physical activity, sedentary behavior represents the other end of the activity spectrum and is defined as any waking activity performed while sitting or lying that does not increase energy expenditure above 1.5 metabolic equivalents (METs; one MET is equivalent to a person’s resting metabolic rate) (; ). Sedentary behavior has been associated with health outcomes independently of physical activity, including all-cause mortality, type 2 diabetes, and metabolic syndrome, in the general population (). There is consistent evidence that persons with MS are more sedentary than the general population (; ), yet there is limited information on why this difference exists between MS and controls. There further is limited information on sedentary behavior and its possible outcomes in this population (). To date, researchers have reported that the volume of sedentary behavior may be associated with hypertension, MS type, mobility disability in MS (; ; ), and these are possible determinants of HRQOL in MS (). However, these are non-modifiable factors, and we aimed to identify modifiable factors that future interventions may target to improve HRQOL in MS.