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A Prospective Multicenter Study for Assessing MusiQoL Validity among Arabic-Speaking MS Patients Treated with Subcutaneous Interferon β-1a. Mult Scler Int 2021; 2021:6681431. [PMID: 33747564 PMCID: PMC7943271 DOI: 10.1155/2021/6681431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Few studies examine health-related quality of life (HRQoL) in Arabic-speaking multiple sclerosis (MS) patients. However, HRQoL tools such as the Short Form-36 QoL instrument (SF-36) and the Multiple Sclerosis International QoL (MusiQoL) questionnaire have been validated in other languages. The primary objective of this study was to prospectively assess HRQoL using the MusiQoL questionnaire among Arabic-speaking MS patients treated with subcutaneous interferon (sc IFN β-1a) over 12 months, as part of a prospective, multinational, multicenter cohort study. Patients' clinical parameters and HRQoL were assessed at baseline, 6 months, and 12 months. Changes in MusiQoL total and subdomain scores were compared using a Friedman test. Correlation between MusiQoL total score and Expanded Disability Status Score (EDSS) was also evaluated. In total, 439 patients from four Arabic-speaking countries were included. The mean age was 32.44 (±0.34) years, 71.5% were female, and 63.1% had an education level of university or above. The mean MS duration was 4.13 (±0.12) years, mean age at first attack was 27.35 (±0.26) years, and mean baseline EDSS score was 2.05 (±0.04). MusiQoL total score significantly improved at 6 months; however, this diminished at 12 months (65.67 ± 0.8 at baseline vs. 67.21 ± 0.79 at 6 months and 65.75 ± 0.8 at 12 months; p = 0.0015). Several aspects of patients' HRQoL including activity of daily living, physical well-being, symptoms, and coping improved. Overall HRQoL measured using SF-36 remained generally unchanged over time (p = 0.215). There was a statistically significant inverse relationship between change in EDSS score over time and change in overall MusiQoL score over time. In summary, findings confirm the utility of using MusiQoL for assessing changes in HRQoL during treatment with sc IFN β-1a in Arabic-speaking patients with MS.
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Dymecka J, Bidzan M. Biomedical Variables and Adaptation to Disease and Health-Related Quality of Life in Polish Patients with MS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122678. [PMID: 30486508 PMCID: PMC6313333 DOI: 10.3390/ijerph15122678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 02/03/2023]
Abstract
The aim of this research was to assess the level of adaptation to multiple sclerosis (Sclerosis multiplex; MS) and health-related quality of life (HRQoL) of the study population as well as to determine the relationship between biomedical factors related to the course of multiple sclerosis, adaptation to the disease, and HRQoL. Analysis of medical records, clinical and psychological interviews, the Extended Disability Status Scale (EDSS), Guy’s Neurological Disability Scale (GNDS), the Acceptance of Illness Scale (AIS), and the Multiple Sclerosis Impact Scale 29 (MSIS-29) were collected from 137 patients with MS. It was found that there was a relation between motor impairment, neurological disability, adaptation to illness, and HRQoL; it was also found that there were negative correlations between adaptation to illness and the severity of lower-limb disability, fatigue, mood disorders, other problems related to MS, and upper-limb disability. Of all the symptoms, lower-limb disability, fatigue, and mood disorders had the strongest relation with adaptation. All of the analysed symptoms were found to correlate with HRQoL. Of all the symptoms, HRQoL was most affected by lower- and upper-limb disability, fatigue, other MS problems, and mood disorders.
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Affiliation(s)
- Joanna Dymecka
- Institute of Psychology, University of Opole, 45-052 Opole, Poland.
| | - Mariola Bidzan
- Institute of Psychology, University of Gdansk, 80-309 Gdansk, Poland.
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Fernández O, Baumstarck-Barrau K, Simeoni MC, Auquier P. Patient characteristics and determinants of quality of life in an international population with multiple sclerosis: Assessment using the MusiQoL and SF-36 questionnaires. Mult Scler 2017; 17:1238-49. [DOI: 10.1177/1352458511407951] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Multiple sclerosis (MS) can have psychological and socioeconomic consequences that affect patients’ health-related quality of life (HRQoL) as much as physical disability. Objective: To determine the clinical and sociodemographic factors affecting HRQoL in a large international study using the MS International QoL (MusiQoL) questionnaire. Methods: Patients aged >18 years with a diagnosis of MS for >6 months or clinically isolated syndrome (CIS) were enrolled. Sociodemographic and clinical data were recorded, and patients completed the MusiQoL and 36-item short form (SF-36) health survey questionnaires. Results: In total, 1992 patients from 15 countries were enrolled (mean [standard deviation] age: 42.3 [12.5] years; 70.5% women; 70.4% with relapsing–remitting MS). Multivariate multiple regression analyses identified lower educational level, higher Expanded Disability Status Scale (EDSS) score, cognitive impairment, being single and shorter time since last relapse as significant predictors of lower MusiQoL global index scores ( p < 0.05). Older age, female sex, higher EDSS score, shorter time since last relapse and receiving current MS treatment were significant predictors of lower SF-36 physical component summary scores ( p < 0.05). The SF-36 mental component summary score was linked to occupational status, inpatient/outpatient status, time since last relapse, and whether the patient was receiving MS treatment ( p < 0.05). Conclusion: Sociodemographic and clinical factors are linked to HRQoL in patients with MS. Interventions that affect these factors might be expected to influence HRQoL.
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Affiliation(s)
| | - Karine Baumstarck-Barrau
- EA3279, Self-Perceived Health Assessment Research Unit, Mediterranée University School of Medicine, France
| | - Marie-Claude Simeoni
- EA3279, Self-Perceived Health Assessment Research Unit, Mediterranée University School of Medicine, France
| | - Pascal Auquier
- EA3279, Self-Perceived Health Assessment Research Unit, Mediterranée University School of Medicine, France
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Morales-Gonzáles JM, Benito-León J, Rivera-Navarro J, Mitchell AJ. A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study. Mult Scler 2016; 10:47-54. [PMID: 14760952 DOI: 10.1191/1352458504ms967oa] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To describe a holistic and comprehensive approach to the assessment of sufferer’s perceptio ns of health-related quality of life (HRQ oL) in a cohort of multiple sclerosis (MS) patients. Methods: The G EDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functio nal A ssessment of Multiple Sclerosis quality of life instrument. Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. Results: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9 ± 0.9 years. A ge, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Q ualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. O n the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients’ physical disability. Furthermore, primary caregivers described the influence of MS on their own occupatio nal status, their nonacceptance of the disease, a perceptio n of a lack of support by other members of the family as well as a ‘selfish and intransigent’ attitude of the patients themselves. Conclusions: The analysis of the G EDMA cohort provides valuable information that helps clarify the impact of MS on patients’ HRQ oL.
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Baumstarck K, Pelletier J, Boucekine M, Auquier P. Predictors of quality of life in patients with relapsing-remitting multiple sclerosis: A 2-year longitudinal study. Rev Neurol (Paris) 2015; 171:173-80. [DOI: 10.1016/j.neurol.2014.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/04/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Moore F, Wolfson C, Alexandrov L, Lapierre Y. Do General and Multiple Sclerosis-Specific Quality of Life Instruments Differ? Can J Neurol Sci 2014; 31:64-71. [PMID: 15038473 DOI: 10.1017/s0317167100002857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background:Quality of life instruments provide information that traditional outcome measures used in studies of multiple sclerosis do not. It is unclear if longer, disease-specific instruments provide more useful information than shorter, more general instruments, or whether patients prefer one type to another.Methods:We conducted a cross-sectional study of quality of life in a multiple sclerosis clinic population using a mailed questionnaire that combined three different quality of life instruments; the SF-36, the Multiple Sclerosis Quality of Life Instrument-54, and the EuroQol EQ-5D. We assessed the feasability of using each instrument and patient preference for each, calculated correlation coefficients for the summary scores of each instrument and other measures of disease severity, and calculated odds ratios from proportional odds models comparing each instrument with the Expanded Disability Status Scale.Results:We did not find substantial differences between the three instruments. All were well-received by patients, and over 75% felt that the combination of the three instruments best assessed their quality of life. For each instrument there was substantial variability between patients with similar quality of life scores in terms of their disability (as assessed by the Expanded Disability Status Scale and their own perception of their disease severity and quality of life (on simple 1-10 scales).Conclusion:Quality of life instruments are easy to use and well-received by patients, regardless of their length. There do not appear to be clinically important differences between general and disease-specific instruments. Each instrument appears to measure something other than a patient’s disability or perception of their own disease severity or quality of life.
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Affiliation(s)
- Fraser Moore
- Department of Neurology, Jewish General Hospital, Montreal, QC, Canada
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Contribution of symptom clusters to multiple sclerosis consequences. Qual Life Res 2014; 24:617-29. [DOI: 10.1007/s11136-014-0804-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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Kohn CG, Baker WL, Sidovar MF, Coleman CI. Walking speed and health-related quality of life in multiple sclerosis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:55-61. [PMID: 24078332 DOI: 10.1007/s40271-013-0028-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between slower walking and health-related quality of life (HRQoL) in multiple sclerosis (MS) patients. METHODS We used North American Research Committee on Multiple Sclerosis data to conduct a study of participants completing both the regular semiannual and supplemental spring 2010 surveys. Question 10 of the 12-item Multiple Sclerosis Walking Scale ("How much has your MS slowed down your walking?") was used to assess patient-perceived impact of walking speed on HRQoL.HRQoL assessments included the Short Form-12 (SF-12),EuroQoL-5 Dimension (EQ-5D), Short Form-6 Dimension(SF-6D), and a visual analog scale (VAS). RESULTS A total of 3,670 registrants completed both surveys and were included. Unadjusted analyses showed that compared with those classifying the impact of MS on walking speed as "not at all" (n = 661), participants stating MS impacted their walking speed "a little" (n = 722), "moderately" (n = 486), "quite a bit" (n = 714), and "extremely" (n = 1,087) reported poorerSF-12 physical component scale (PCS) (r = -0.69,p\0.001), mental component scale (MCS) (r = -0.16,p\0.001), and health status index scores (r = -0.50 to-0.51 for the EQ-VAS, EQ-5D and SF-6D, p\0.001 for all). After adjustment for demographics and additional MS related disability and symptoms, the impact of walking speed remained significant, although less profound for the PCS (reductions of 3.59 –12.31 across walking speed classifications)and index scores (reductions ranging from 1.98 to 14.06, 0.04 to 0.13, and 0.02 to 0.07 for the EQ-VAS,EQ-5D, and SF-6D). Reduction in walking speed was no longer associated with a worse MCS (p[0.05 all classifications of walking speed). CONCLUSION Incremental decrements in HRQoL were observed as patients perceived greater levels of reduction in their walking speed.
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Beier M, Bombardier CH, Hartoonian N, Motl RW, Kraft GH. Improved physical fitness correlates with improved cognition in multiple sclerosis. Arch Phys Med Rehabil 2014; 95:1328-34. [PMID: 24607835 DOI: 10.1016/j.apmr.2014.02.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/19/2014] [Accepted: 02/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether there is an association between improvements in objective measures of physical fitness and performance on cognitive tests in people with multiple sclerosis (MS). DESIGN Post hoc correlational analysis in which people demonstrating physical improvement were compared with those not demonstrating physical improvement. SETTING Individuals with MS residing in the community. PARTICIPANTS Adults with clinically confirmed MS (N=88) who participated in a controlled trial of a telephone-based health promotion intervention, chose to work on exercise, and completed the pre- and postintervention assessments. INTERVENTIONS Participants were measured for strength (isokinetic dynamometer), aerobic fitness (bicycle ergometer), and cognition (Paced Auditory Serial Addition Test [PASAT], Trail Making Test [TMT]) at baseline and 12 weeks later. Change in fitness was calculated by subtracting each participant's baseline score from the outcome score, and then transforming the difference to a z score. Individuals with a z score ≥1 on any fitness measure were placed in the physically improved group (n=25). All others were in the physically not improved group (n=57). MAIN OUTCOME MEASURES TMT, PASAT RESULTS After controlling for covariates (age, sex, ethnicity, education, disease activity, MS type), there was a significant group-by-time interaction, suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group demonstrated improved performance on measures of executive functioning after 12 weeks of exercise. CONCLUSIONS The results of this study lend support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS.
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Affiliation(s)
- Meghan Beier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Narineh Hartoonian
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL
| | - George H Kraft
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Effect of Aquatic Exercise Training on Fatigue and Health-Related Quality of Life in Patients With Multiple Sclerosis. Arch Phys Med Rehabil 2012; 93:1701-8. [DOI: 10.1016/j.apmr.2012.05.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 04/24/2012] [Accepted: 05/07/2012] [Indexed: 11/18/2022]
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Benito-León J, Morales JM, Rivera-Navarro J, Mitchell A. A review about the impact of multiple sclerosis on health-related quality of life. Disabil Rehabil 2009; 25:1291-303. [PMID: 14617435 DOI: 10.1080/09638280310001608591] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE There is increasing recognition that the global wellbeing of patients with chronic neurological disease is an important outcome in research and clinical practice alike. Many studies involving individuals with multiple sclerosis have demonstrated that the overall wellbeing is not a simple manifestation of impairment or disability. The strongest correlations with health-related quality of life appear to be patient rated emotional adjustment to illness and patient rated handicap. In recent years, health-related quality of life questionnaires that measure the physical, social, emotional, and occupational impact of illness have been developed and validated in populations with MS. Most questionnaires are now available in a range of languages. This development is likely to lead to increasing recognition of neuropsychiatric complications of MS in clinical practice and better quantification of treatment responses in clinical trials. CONCLUSION Further work is required to decide which scale is most suited to which purpose. Assessment of multiple sclerosis-specific health-related quality of life should be included in future clinical trials to provide a complete picture of patients' health status.
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Ytterberg C, Johansson S, Holmqvist LW, Koch LV. Longitudinal variations and predictors of increased perceived impact of multiple sclerosis, a two-year study. J Neurol Sci 2008; 270:53-9. [DOI: 10.1016/j.jns.2008.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/23/2008] [Accepted: 01/24/2008] [Indexed: 11/16/2022]
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Simeoni MC, Auquier P, Fernandez O, Flachenecker P, Stecchi S, Constantinescu CS, Idiman E, Boyko A, Beiske AG, Vollmer T, Triantafyllou N, O'Connor P, Barak Y, Biermann L, Cristiano E, Atweh S, Patrick DL, Robitail S, Ammoury N, Beresniak A, Pelletier J. Validation of the Multiple Sclerosis International Quality of Life questionnaire. Mult Scler 2007; 14:219-30. [DOI: 10.1177/1352458507080733] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to validate the Multiple Sclerosis (MS) International Quality of Life (MusiQoL) questionnaire, a multi-dimensional, self-administered questionnaire, available in 14 languages, as a disease-specific quality of life scale that can be applied internationally. A total of 1992 patients with different types and severities of MS from 15 countries were recruited. At baseline and day 21 ± 7, each patient completed the MusiQoL, a symptom checklist and the short-form (SF)-36 QoL questionnaire. Neurologists also collected socio-demographic, MS history and outcome data. The database was randomly divided into two subgroups and analysed according to different patient characteristics. For each model, psychometric properties were tested and the number of items was reduced by various statistical methods. Construct validity, internal consistency, reproducibility and external consistency were also tested. Nine dimensions, explaining 71% of the total variance, were isolated. Internal consistency and reproducibility were satisfactory for all the dimensions. External validity testing revealed that dimension scores correlated significantly with all SF-36 scores, but showed discriminant validity by gender, socio-economic and health status. Significant correlations were found between activity in daily life scores and clinical indices. These results demonstrate the validity and reliability of the MusiQoL as an international scale to evaluate QoL in patients with MS. Multiple Sclerosis 2008; 14: 219—230. http://msj.sagepub.com
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Affiliation(s)
- MC Simeoni
- Department of Public Health, Timone University Hospital, Marseille, France
| | - P. Auquier
- Department of Public Health, Timone University Hospital, Marseille, France, -mrs.fr
| | - O. Fernandez
- Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - P. Flachenecker
- Department of Neurology, University of Würzburg, Würzburg, Germany, Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Würzburg, Germany
| | - S. Stecchi
- Centro SM, Villa Mazzacorati, Bologna, Italy
| | - CS Constantinescu
- Division of Clinical Neurology, University Hospital, University of Nottingham, Nottingham, UK
| | - E. Idiman
- Dokuz Eylül Üniversity, Department of Neurology, Izmir, Turkey
| | - A. Boyko
- Department of Neurology, Russian State Medical University, Moscow, Russia
| | - AG Beiske
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - T. Vollmer
- Van Denburgh Chair, Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - N. Triantafyllou
- Department of Neurology, Aiginition Hospital, University of Athens, Greece
| | - P. O'Connor
- St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Y. Barak
- SHEBA MC, Tel-HaShomer and the Sackler School of Medicine, Tel Aviv, Israel
| | | | - E. Cristiano
- Department of Neurology, University of Buenos Aires, Head Neurology Hospital Italiano de Buenos Aires, Argentina
| | - S. Atweh
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - DL Patrick
- Department of Neurology, University of Washington, Seattle, USA
| | - S. Robitail
- Department of Public Health, Timone University Hospital, Marseille, France
| | - N. Ammoury
- Serono International S.A., Geneva, Switzerland
| | - A. Beresniak
- Laboratory of Applied Health Economics LIRAES, University Paris 5, France
| | - J. Pelletier
- Department of Neurology, Timone University Hospital, Marseille, France
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Turpin KVL, Carroll LJ, Cassidy JD, Hader WJ. Deterioration in the health-related quality of life of persons with multiple sclerosis: the possible warning signs. Mult Scler 2007; 13:1038-45. [PMID: 17895295 DOI: 10.1177/1352458507078393] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Baseline data from a population-based study examining the health-related quality of life (HRQL) of MS patients about to begin disease modifying therapy was used to determine the factors associated with the HRQL of Saskatchewan adults with relapsing-remitting MS. Participants completed a self-report questionnaire regarding demographic and socioeconomic status, fatigue, comorbid medical conditions, disability level (EDSS), number of attacks in past 6 months, illness intrusiveness (Illness Intrusiveness Ratings Scale), depression (Beck Depression Inventory), and HRQL (SF-36 Health Status Survey). Multiple linear regression models were used to identify the factors associated with the physical and mental health summary scores of the SF-36. We found poorer physical HRQL in those who are female; older; not working; have musculoskeletal or respiratory problems; greater fatigue, higher disability scores, and more MS attacks. High illness intrusiveness; digestive system problems; genitourinary problems; and headaches were associated with poorer mental HRQL. Interestingly, we found an interaction between sex and age in mental HRQL, with worse mental health in older men but better mental health in older women. These findings may assist health care providers in identifying patients who may be at risk for decline in their HRQL, permitting appropriate and timely interventions. Multiple Sclerosis 2007; 13: 1038—1045. http://msj.sagepub.com
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Affiliation(s)
- K V L Turpin
- Northern Alberta Multiple Sclerosis Patient Care and Research Clinic, Division of Neurology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Mohr DC, Hart SL, Julian L, Tasch ES. Screening for depression among patients with multiple sclerosis: two questions may be enough. Mult Scler 2007; 13:215-9. [PMID: 17439887 DOI: 10.1177/1352458506070926] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression among patients with multiple sclerosis (MS) is common and has a significant impact on quality of life. As many as two-thirds of depressed MS patients receive no treatment for their depression. While guidelines for depression management suggest screening, the only validated screening tools are questionnaires, which have not been widely implemented in practice. This is the first study on the effectiveness of using two questions assessing mood and anhedonia (loss of interest or pleasure) in screening for major depressive disorder (MDD) in MS. METHODS MS patients under the care of neurologists were recruited from a large health maintenance organization (HMO). The MDD module of the Structured Clinical Interview for the DSM-IV and screening questions was administered. RESULTS Of the 260 participants, 26% met the criteria for MDD. Among patients with MDD, 67% received no anti-depressant medication. The MDD screen identified 99% (95% CI: 91-100%) of cases. DISCUSSION A brief, two question screen is reliable in identifying MS patients with MDD. This suggests that asking these two brief questions could identify almost all MS patients meeting MDD criteria, with minimal numbers of false positives.
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Affiliation(s)
- D C Mohr
- University of California, San Francisco, VAMC, San Francisco, CA 94121, USA.
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Mohr DC, Hart SL, Fonareva I, Tasch ES. Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult Scler 2006; 12:204-8. [PMID: 16629424 DOI: 10.1191/135248506ms1265oa] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED The objective of this study was to examine the adequacy of antidepressant pharmacotherapy in a sample of patients with multiple sclerosis (MS) treated by neurologists. METHODS MS patients under the care of neurologists were recruited from a large health maintenance organization. Major depressive disorder (MDD) was diagnosed using a structured telephone interview. Antidepressant treatment data were obtained from the HMO pharmacy database. RESULTS Study participants included 260 patients with MS treated by 35 neurologists. A total of 67 (25.8%) patients met the criteria for MDD. Among the patients with MDD, 65.6% received no antidepressant medication, 4.7% received subthreshold doses from their neurologists, 26.6% received doses at threshold, and 3.1% received doses exceeding threshold. DISCUSSION Depression was undertreated by the neurologists treating this sample of patients with comorbid MS and MDD. Potential solutions are discussed.
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Affiliation(s)
- D C Mohr
- University of California, Veterans Administration Medical Center, San Francisco 94121, USA.
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Mitchell AJ, Benito-León J, González JMM, Rivera-Navarro J. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol 2005; 4:556-66. [PMID: 16109362 DOI: 10.1016/s1474-4422(05)70166-6] [Citation(s) in RCA: 323] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQoL) has been more intensively studied in multiple sclerosis (MS) than in any other neurological disorder. Traditional medical models of impairment and disability are an incomplete summary of disease burden. Quality of life can be thought of as the sum of all sources of satisfaction (including anticipated sources) minus all threats (including anticipated threats). Many psychosocial factors-including coping, mood, self-efficacy, and perceived support-influence the quality of life of patients with MS more than biological variables such as weakness or extent of MRI lesions. Neuropsychiatric complications such as cognitive impairment and fatigue are also important predictors, even in those patients in the early stages of the disease. We review generic and specific HRQoL measures to help clinicians choose the most appropriate therapies. Subjective (self-report) HRQoL measures may serve to alert clinicians to areas that would otherwise be overlooked. Studies of new interventions should include an assessment of HRQoL not just impairment or disability alone.
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Affiliation(s)
- Alex J Mitchell
- Department of Liasion Psychiatry, Brandon Mental Health Unit, Leicester General Hospital, Leicester, UK.
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Garcia J, Finlayson M. Mental Health and Mental Health Service Use Among People Aged 45+ with Multiple Sclerosis. ACTA ACUST UNITED AC 2005; 24:9-22. [PMID: 16774132 DOI: 10.7870/cjcmh-2005-0011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is a chronic neurological disease with numerous symptoms and consequences that does not typically reduce life expectancy. Mental health issues are common in this population, yet few investigations have targeted people aging with this disease (i.e., people aged 45+). This study examined factors contributing to mental health challenges among 1282 people with MS aged 45 to 90 and the extent of mental health service use among those who reported problems. Findings showed that functional abilities, age, years since diagnosis, presence of a helper, and self-rated health are related to mental health challenges. Less than 16% of people with mental health challenges were receiving services.
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Ostberg A, Pittas F, Taylor B. Use of low-dose mitozantrone to treat aggressive multiple sclerosis: a single-centre open-label study using patient self-assessment and clinical measures of multiple sclerosis status. Intern Med J 2005; 35:382-7. [PMID: 15958106 DOI: 10.1111/j.1445-5994.2005.00862.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is significant evidence supporting the use of mitozantrone in the treatment of multiple sclerosis (MS) but few data on the subtypes of MS that respond or which measures of disease status are most useful. AIMS To assess the efficacy of low-dose (5 mg/m2 3 monthly) mitozantrone using patient self-assessment questionnaire (SAQ), expanded disability status score (EDSS), multiple sclerosis functional composite score (MSFC), and the fatigue severity scale (FSS). Then, to compare the responses of a subgroup of relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) patients to treatment, and to assess which measures of MS disease status are the most useful in a study of this type. METHOD Thirty-one patients with definite (McDonald criteria) active MS were commenced on mitozantrone 5 mg/m2 every 3 months. EDSS, MSFC and FSS data collected before treatment and after 12 months were analysed. The SAQ was administered after at least 12 months of therapy. RESULTS RRMS patients showed significantly more response to mitozantrone than SPMS patients in terms of MSFC (P = 0.02) and SAQ (P = 0.01). CONCLUSIONS Low-dose mitozantrone was well tolerated and useful in active RRMS in the short term; however, mitozantrone did not display any useful activity in SPMS patients over this time interval or at the mitozantrone dose used. Patient perception of treatment is a worthwhile outcome measure and the MSFC is the most useful objective measure of MS status change in this type of study.
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Affiliation(s)
- A Ostberg
- Department of Neurology and Multiple Sclerosis Research Centre, Royal Hobart Hospital, Hobart, Tasmania, Australia
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20
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Abstract
Measuring quality of life (QOL) has made essential contributions for the management of patients with multiple sclerosis (MS). QOL measures may be used for helping to assess the complex changes which patients with MS have to go through during the disease trajectory, and they may be used for pharmacoeconomic research. The large number of tests available includes generic ones such as Short Form SF-36 and Sickness Impact Profile, health-related ones such as MSQOL-54, FAMS, or HAQUAMS, and patient generated measures such as the Patient Generated Index and SEIQOL-DW. Depression, cognitive impairment, and fatigue are important factors influencing QOL. Since the different tests measure quite different facets of QOL, this review intends to help the reader select a tool suited to the aim and specific question. It is hoped that QOL measures may help to better understand patients, to become a more helpful medical partner, to assist patients to develop perspectives for their future, and to decide about therapies or even palliative interventions.
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Benedict RHB, Wahlig E, Bakshi R, Fishman I, Munschauer F, Zivadinov R, Weinstock-Guttman B. Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci 2005; 231:29-34. [PMID: 15792817 DOI: 10.1016/j.jns.2004.12.009] [Citation(s) in RCA: 360] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 11/04/2004] [Accepted: 12/10/2004] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HQOL) is poor in multiple sclerosis (MS) but the clinical precipitants of the problem are not well understood. Previous correlative studies demonstrated relationships between various clinical parameters and diminished HQOL in MS. Unfortunately, these studies failed to account for multiple predictors in the same analysis. We endeavored to determine what clinical parameters account for most variance in predicting HQOL, and employability, while accounting for disease course, physical disability, fatigue, cognition, mood disorder, personality, and behavior disorder. In 120 MS patients, we measured HQOL (MS Quality of Life-54) and vocational status (employed vs. disabled) and then conducted detailed clinical testing. Data were analyzed by linear and logistic regression methods. MS patients reported lower HQOL (p<0.001) and were more likely to be disabled (45% of patients vs. 0 controls). Physical HQOL was predicted by fatigue, depression, and physical disability. Mental HQOL was associated with only depression and fatigue. In contrast, vocational status was predicted by three cognitive tests, conscientiousness, and disease duration (p<0.05). Thus, for the first time, we predicted HQOL in MS while accounting for measures from these many clinical domains. We conclude that self-report HQOL indices are most strongly predicted by measures of depression, whereas vocational status is predicted primarily by objective measures of cognitive function. The findings highlight core clinical problems that merit early identification and further research regarding the development of effective treatment.
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Affiliation(s)
- Ralph H B Benedict
- Department of Neurology, School of Medicine, State University of New York at Buffalo, Buffalo General Hospital, Neurology, Suite D-6, 100 High Street, Buffalo, NY 14203, USA.
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22
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Gruenewald DA, Higginson IJ, Vivat B, Edmonds P, Burman RE. Quality of life measures for the palliative care of people severely affected by multiple sclerosis: a systematic review. Mult Scler 2005; 10:690-704. [PMID: 15584496 DOI: 10.1191/1352458504ms1116rr] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although there is increasing interest in measuring the quality of life (QoL) of people with multiple sclerosis (MS), relatively little is known about the issues of importance to people severely affected by MS. In the first of two systematic reviews, we searched the literature to identify measures that have been used to assess health-related QoL in people with MS, and described their measurement properties in terms of validity, reliability, responsiveness to change, and appropriateness for QoL assessment in people severely affected by MS. In the second review, we identified care domains important to people with MS, by reviewing survey, focus group and interview studies involving people with MS and/or their caregivers. Forty-six studies evaluating 12 disease-specific and ten generic QoL measures for patients, and one disease-specific measure for caregivers, satisfied all inclusion criteria. Sixteen focus group or interview studies and 51 questionnaire-based studies evaluated domains of care important to people with MS, and seven qualitative and 11 questionnaire-based studies assessed domains of care important to their caregivers. From these studies, we identified 15 domains of care important to people with MS and 12 domains important to caregivers. QoL measures differed markedly in their coverage of these care domains. Moreover, each measure fulfilled some but not all criteria of validity, reliability, responsiveness, and appropriateness. Further work is needed to clarify the domains of care relevant to people with severe MS, and to measure health-related QoL in this population.
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Affiliation(s)
- D A Gruenewald
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
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23
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Kern RZ, Brown AD. Disease adaptation may have decreased quality-of-life responsiveness in patients with chronic progressive neurological disorders. J Clin Epidemiol 2004; 57:1033-9. [PMID: 15528054 DOI: 10.1016/j.jclinepi.2004.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We hypothesized that disease adaptation could be measured in chronic progressive neurological disorders (CPND) through paired longitudinal comparisons of quality of life (QOL) and health status (HS) and of the mental health (MH) and physical health (PH) domains of QOL instruments. STUDY DESIGN AND SETTING We identified 193 quantitative studies of QOL and HS in a systematic review of episodic (END) and chronic progressive (CPND) neurological disorders. Effect size or other responsiveness measures were analyzed in 31 studies that included paired longitudinal comparisons of QOL-HS, MH-PH, or both. Responsiveness means were compared using the paired-sample t-test or sign test. RESULTS In 12 paired comparisons, QOL responsiveness was significantly lower than HS (P=.05, sign test). In 53 paired MH-PH effect-size comparisons, MH responsiveness was lower than PH (P=.02, t=2.48, paired sample). Significantly lower MH responsiveness was observed in 28 paired CPND comparisons (P < .01, t=3.86, paired sample) but not in 25 paired END comparisons (P=.50, t=0.68, paired sample). CONCLUSION Lower responsiveness of QOL in CPND may be related to disease adaptation. Further prospective studies are needed to confirm our findings and to investigate the importance of disease adaptation in the evaluation of neurological disease and in health resource allocation.
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Affiliation(s)
- Ralph Z Kern
- Mount Sinai Hospital and The University Health Network, Toronto, Ontario, Canada
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Effects of an Aquatics Exercise Program on Quality of Life Measures for Individuals with Progressive Multiple Sclerosis. J Neurol Phys Ther 2004. [DOI: 10.1097/01.npt.0000281186.94382.90] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In multiple sclerosis, evaluation of quality of life is important because the patients are usually confronted with a decrease in physical, cognitive and social functioning. Apart from the personal suffering, the financial consequences for these patients and their family and the economic burden for society are enormous. Measurement of health related quality of life is important for the understanding of disease burden and the impact of specific MS treatments. Rising costs associated with new treatments and spending limits have prompted a search for gratter efficiency. Although health economics research can suggest ways to maximize health benefits within fixed budgets it is currently underused in MS. The purpose of this review of the literature is to explain some of the basic principles underlying both quality of life and economic evaluations, and analyse their contribution to understanding and managing patients with MS. Neurologists should not underestimate how dramatic their contributions can be to this maturing field that will influence the future of MS patients care.
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Affiliation(s)
- J Grimaud
- Laboratoire d'Analyse des Systèmes de Santé, Université Claude-Bernard, Bâtiment du Doyen Braconnier, 27-29 Boulevard du 11 Novembre 1918, 69622 Villeurbanne cedex.
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Thorne S, Con A, McGuinness L, McPherson G, Harris SR. Health care communication issues in multiple sclerosis: an interpretive description. QUALITATIVE HEALTH RESEARCH 2004; 14:5-22. [PMID: 14725173 DOI: 10.1177/1049732303259618] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.
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Affiliation(s)
- Sally Thorne
- University of British Columbia School of Nursing, Vancouver, Canada
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Acquadro C, Lafortune L, Mear I. Quality of life in multiple sclerosis: translation in French Canadian of the MSQoL-54. Health Qual Life Outcomes 2003; 1:70. [PMID: 14636427 PMCID: PMC317365 DOI: 10.1186/1477-7525-1-70] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Accepted: 11/24/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neurodegenerative disease which runs its course for the remainder of the patient's life frequently causing disability of varying degrees. Negative effects on Health-related quality of life (HRQOL) are well documented and a subject of clinical study. The Multiple Sclerosis QOL 54 (MSQOL-54) questionnaire was developed to measure HRQOL in patients with MS. It is composed of 54 items, and is a combination of the SF-36 and 18 disease-specific items. OBJECTIVE The objective of this project was to translate the MSQOL-54 into French Canadian, and to make it available to the Canadian scientific community for clinical research and clinical practice. METHODS Across all French speaking regions, there are occurrences of variation. They include the pronunciation, sentence structure, and the lexicon, where the differences are most marked. For this reason, it was decided to translate the US original MSQOL-54 into French Canadian instead of adapting the existing French version. The SF-36 has been previously validated and published in French Canadian, therefore the translation work was performed solely on the 18 MS specific items. The translation followed an internationally accepted methodology into 3 steps: forward translation, backward translation, and patients' cognitive debriefing. RESULTS Instructions and Items 38, 43, 45 and 49 were the most debated. Problematic issues mainly resided in the field of semantics. Patients' testing (n = 5) did not reveal conceptual problems. The questionnaire was well accepted, with an average time for completion of 19 minutes. CONCLUSION The French Canadian MSQOL-54 is now available to the Canadian scientific community and will be a useful tool for health-care providers to assess HRQOL of patients with MS as a routine part of clinical practice. The next step in the cultural adaptation of the MSQOL-54 in French Canadian will be the evaluation of its psychometric properties.
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28
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Abstract
Quality of life research contributes knowledge essential to the health and healthcare of multiple sclerosis (MS) patients. This article reviews 83 MS studies in English that have presented data on quality of life. The studies may be classified into three categories, according to the application and the main focus: 1) evaluating the development and validity of quality of life questionnaires and clinical scales (n = 27); 2) evaluating factors that might influence the quality of life or comparing the quality of life among various groups (n = 37); and 3) using quality of life questionnaires as outcome measures in medical trials and other interventions (n = 19). The studies have shown that quality of life questionnaires more broadly measure the impact of MS than do the most frequently used measures of disease activity and effects. Using quality of life measures provides additional information in evaluating the effects of treatment and in studying the development of the disease. Such information is crucial in planning interventions for MS patients. A challenge in this field is to improve the study designs, including reaching some agreement on how to measure the quality of life.
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Affiliation(s)
- M W Nortvedt
- Department of Public Health and Primary Health Care, University of Bergen, Ulriksdal 8C, N-5009 Bergen, Norway.
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29
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Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 2002; 205:51-8. [PMID: 12409184 DOI: 10.1016/s0022-510x(02)00312-x] [Citation(s) in RCA: 315] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality of Life (QOL) is impaired in multiple sclerosis (MS) in part due to physical disability. MS-associated fatigue (MSF) and depression (MSD) are common and treatable features of MS, which could also impact on QOL, independent of physical disability. We prospectively studied 60 consecutive patients with MS. QOL was assessed using Multiple Sclerosis Quality of Life (MSQOL)-54. Group differences in QOL scores were assessed after adjusting for Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS) and Hamilton Depression Inventory scores. MS patients were grouped into relapsing-remitting (RR) or secondary-progressive (SP), MSF (FSS> or =5) or MS-nonfatigue (MSNF) (FSS< or =4), and MSD or MS-nondepression (MSND). After accounting for disability and depression, fatigue was associated with impaired QOL with respect to health perception (p=0.03) and limitations due to physical dysfunction (p=0.008). After accounting for disability and fatigue, depression was associated with lower QOL with respect to health perception (p=0.02), sexual dysfunction (p=0.03), health distress (p=0.03), mental health (p=0.006), overall QOL (p=0.006), emotional dysfunction (p=0.04), and limitations due to emotional dysfunction (p=0.03). This study demonstrates that fatigue and depression are independently associated with impaired QOL in MS, after accounting for physical disability, suggesting that their recognition and treatment can potentially improve QOL.
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Affiliation(s)
- Vallabh Janardhan
- Department of Neurology, Boston University Medical Center, Boston, MA, USA
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Pozzilli C, Brunetti M, Amicosante AMV, Gasperini C, Ristori G, Palmisano L, Battaglia M. Home based management in multiple sclerosis: results of a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002; 73:250-5. [PMID: 12185154 PMCID: PMC1738043 DOI: 10.1136/jnnp.73.3.250] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness. OBJECTIVES To compare the effectiveness and the costs of multidisciplinary home based care in multiple sclerosis with hospital care in a prospective randomised controlled trial with a one year follow up. METHODS 201 patients with clinically definite multiple sclerosis were studied. They were randomised in a ratio 2:1 to an intervention group (133) or a control group (68). They were assessed at baseline and one year after randomisation with validated measures of physical and psychological impairment and quality of life (SF-36 health survey). The costs to the National Health Service over the one year follow up were calculated by a cost minimisation analysis. RESULTS There were no differences in functional status between the home based care group and the hospital group. There was a significant difference between the two groups favouring home based management in four SF-36 health dimensions-general health, bodily pain, role-emotional, and social functioning (all p < or = 0.001). The cost of home based care was slightly less (822 euros/patient/year) than hospital care, mainly as a result of a reduction in hospital admissions. CONCLUSIONS Comprehensive planning of home based intervention implemented by an interdisciplinary team and designed specifically for people with multiple sclerosis may provide a cost-effective approach to management and improve the quality of life.
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Affiliation(s)
- C Pozzilli
- Dipartimento di Scienze Neurologiche, Università "La Sapienza", Rome, Italy.
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