Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis

IntroductionFew studies have evaluated the contribution of individual symptoms and impairments to the burden of multiple sclerosis (MS). This article reviews the contribution of walking impairment, fatigue, spasticity, depression, and pain, to quality of life (QOL) of the patient and economic burden of MS.MethodsStudies for inclusion were chosen from the literature that reported on QOL and costs in patients with MS, identified through PubMed searches (main search terms: “multiple sclerosis” combined with “quality of life,” “costs,” or “burden”). Articles were selected based on whether the analyses included evaluation of symptoms and impairments as contributory factors to QOL or costs.ResultsImpaired mobility was ranked to be of high concern, and was suggested to be an important contributory factor to QOL, having a greater impact on physical components than mental components. Fatigue was associated with QOL, with effects on both physical and mental components of QOL, independent of disability level. Depression was inversely associated with QOL. Spasticity may affect physical components of QOL, and daily activities may be impacted in as many as 44% of patients with MS. Pain, occurring in up to 86% of patients with MS, impacts daily function and QOL across the range of physical and mental domains. The contribution of these impairments and symptoms to the economic burden has been less well characterized, although the importance of mobility to employment and productivity has been suggested by several studies.ConclusionsEvidence suggests that impaired mobility and symptoms such as fatigue, pain, depression, and spasticity are important contributory factors to the observed reduction in QOL, and in some cases, increased costs, associated with MS. There is a need for greater recognition of the presence and effects of these disabilities, and effective targeted treatment options for specific impairments, potentially resulting in improved QOL and reduced indirect costs.

[1]  D. Ehde,et al.  Chronic pain in a large community sample of persons with multiple sclerosis , 2003, Multiple sclerosis.

[2]  C Allyson Jones,et al.  The burden of multiple sclerosis: A community health survey , 2008, Health and quality of life outcomes.

[3]  H. J. Hansen,et al.  Sensory function and quality of life in patients with multiple sclerosis and pain , 2005, Pain.

[4]  Stefan Merkelbach,et al.  IS THERE A DIFFERENTIAL IMPACT OF FATIGUE AND PHYSICAL DISABILITY ON QUALITY OF LIFE IN MULTIPLE SCLEROSIS? , 2002, The Journal of nervous and mental disease.

[5]  H M Baum,et al.  Employment in individuals with multiple sclerosis , 1986, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[6]  Deborah M. Miller,et al.  Using the Short Form-36 with Multiple Sclerosis Patients in Five Countries: A Cross-Cultural Comparison , 1999, Psychological reports.

[7]  J. De Keyser,et al.  The impact of disabilities on quality of life in people with multiple sclerosis , 2008, Multiple sclerosis.

[8]  B. Saletu,et al.  Depression and quality of life in multiple sclerosis , 2001, Acta neurologica Scandinavica.

[9]  L. von Koch,et al.  Health-related quality of life in a population-based sample of people with multiple sclerosis in Stockholm County , 2006, Multiple sclerosis.

[10]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[11]  R. Bakshi,et al.  Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change , 2005, Journal of the Neurological Sciences.

[12]  A. Williams.  EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[13]  N. Larocca,et al.  Multiple sclerosis; earning a living. , 1980, New York state journal of medicine.

[14]  B. Cohen.  Identification, causation, alleviation, and prevention of complications (ICAP) , 2008, Neurology.

[15]  P. Dorman,et al.  Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis , 1997, BMJ.

[16]  T. Vollmer,et al.  Prevalence and treatment of spasticity reported by multiple sclerosis patients , 2004, Multiple sclerosis.

[17]  D. Mohr,et al.  Employment in multiple sclerosis , 2008, Journal of Neurology.

[18]  L. Kalia,et al.  Severity of chronic pain and its relationship to quality of life in multiple sclerosis , 2005, Multiple sclerosis.

[19]  K Whetten-Goldstein,et al.  A comprehensive assessment of the cost of multiple sclerosis in the United States , 1998, Multiple sclerosis.

[20]  K. Myhr,et al.  Pain and sensory complaints in multiple sclerosis , 2004, European journal of neurology.

[21]  E. Troisi,et al.  Pain in multiple sclerosis: a clinical and instrumental approach , 2008, Multiple sclerosis.

[22]  G. W. Ellison,et al.  A health-related quality of life measure for multiple sclerosis , 1995, Quality of Life Research.

[23]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[24]  G. Cutter,et al.  Persistent pain and uncomfortable sensations in persons with multiple sclerosis , 2007, Pain.

[25]  Jeffrey A. Cohen,et al.  Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls , 2008, Multiple sclerosis.

[26]  E. Leskinen,et al.  Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis. , 2007, Archives of physical medicine and rehabilitation.

[27]  A. While,et al.  Health problems and health-related quality of life in people with multiple sclerosis , 2006, Clinical rehabilitation.

[28]  R. Swingler,et al.  The morbidity of multiple sclerosis. , 1992, The Quarterly journal of medicine.

[29]  D. Radice,et al.  Health status of people with multiple sclerosis: a community mail survey , 2001, Neurological Sciences.

[30]  R. Schwendimann.  Treatment of symptoms in multiple sclerosis , 2006, Neurological research.

[31]  G. Nagels,et al.  Origin of Fatigue in Multiple Sclerosis: Review of the Literature , 2008, Neurorehabilitation and neural repair.

[32]  P. Rieckmann,et al.  Symptomatic Treatment of Multiple Sclerosis , 2006, European Neurology.

[33]  H. J. Hansen,et al.  Pain in patients with multiple sclerosis: a population-based study. , 2003, Archives of neurology.

[34]  M. Amato,et al.  Quality of life in multiple sclerosis: the impact of depression, fatigue and disability , 2001, Multiple sclerosis.

[35]  J. Prescott,et al.  Descriptive Analysis of the Direct Medical Costs of Multiple Sclerosis in 2004 Using Administrative Claims in a Large Nationwide Database , 2007, Journal of managed care pharmacy : JMCP.

[36]  T. Vollmer,et al.  Fatigue characteristics in multiple sclerosis: the North American Research Committee on Multiple Sclerosis (NARCOMS) survey , 2008, Health and quality of life outcomes.

[37]  R. Dworkin,et al.  Pain associated with multiple sclerosis: Systematic review and proposed classification , 2008, PAIN®.

[38]  Jeffrey A. Cohen,et al.  Multiple sclerosis symptom management , 2007, Expert review of neurotherapeutics.

[39]  J. Opara,et al.  Quality of life in multiple sclerosis. , 2010 .

[40]  P Lindgren,et al.  Costs and quality of life of patients with multiple sclerosis in Europe , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[41]  Rohit Bakshi,et al.  Quality of life in patients with multiple sclerosis The impact of fatigue and depression , 2002, Journal of the Neurological Sciences.

[42]  R. Nixon,et al.  Costs and quality of life of multiple sclerosis in the United Kingdom , 2006, The European Journal of Health Economics.

[43]  D. Hoaglin,et al.  Disease-modifying agents in the Sonya Slifka Longitudinal Multiple Sclerosis Study , 2008, Multiple Sclerosis.

[44]  S. Rao,et al.  Cognitive dysfunction in multiple sclerosis. , 1991, Neurology.

[45]  H Nazirah,et al.  THE APPLICATIONS OF INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) BY WORLD HEALTH ORGANIZATION(WHO) IN REHABILITATION MEDICINE PRACTICE , 2007 .

[46]  F. Khan,et al.  Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. , 2007, The journal of pain : official journal of the American Pain Society.

[47]  B. Phillips,et al.  Gait and balance impairment in early multiple sclerosis in the absence of clinical disability , 2006, Multiple sclerosis.

[48]  J. Holmes,et al.  What drives quality of life in multiple sclerosis? , 2004, QJM : monthly journal of the Association of Physicians.

[49]  F. Guillemin,et al.  Fatigue in multiple sclerosis is related to disability, depression and quality of life , 2006, Journal of the Neurological Sciences.

[50]  Jenny Berg,et al.  Costs and quality of life in multiple sclerosis , 2006, Neurology.

[51]  M. Power,et al.  Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment , 1998 .

[52]  J. Fisk,et al.  The Impact of Fatigue on Patients with Multiple Sclerosis , 1994, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[53]  T. Riise,et al.  Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction , 2001, Multiple sclerosis.

[54]  G. Samsa,et al.  Cost of multiple sclerosis by level of disability: a review of literature , 2005, Multiple sclerosis.

[55]  T. Riise,et al.  Quality of life in multiple sclerosis , 1999, Neurology.

[56]  Kenneth P. Johnson,et al.  Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation , 2000 .

[57]  R. Nixon,et al.  The effect of disease, functional status, and relapses on the utility of people with multiple sclerosis in the UK. , 2007, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[58]  S. Martínez-Yélamos,et al.  An approach to estimating the intangible costs of multiple sclerosis according to disability in Catalonia, Spain , 2007, Multiple sclerosis.

[59]  Jan Hillert,et al.  High concurrent presence of disability in multiple sclerosis , 2007, Journal of Neurology.

[60]  P. Tappenden,et al.  A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models. , 2002, Health technology assessment.

[61]  David C Hoaglin,et al.  Quality of Life in People with Multiple Sclerosis: Data from the Sonya Slifka Longitudinal Multiple Sclerosis Study , 2007, Journal of health and human services administration.

[62]  A Thompson,et al.  The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. , 2001, Brain : a journal of neurology.

[63]  T. Riise,et al.  Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis , 2007, Multiple sclerosis.

[64]  J. Kurtzke.  Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[65]  T. Einarson,et al.  Pain due to multiple sclerosis: analysis of the prevalence and economic burden in Canada. , 2007, Pain research & management.

[66]  T. Riise,et al.  Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension , 2001, Multiple sclerosis.

[67]  S. Gold,et al.  Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable , 2008, Multiple sclerosis.