RT Journal Article
SR Electronic
T1 Health-related quality of life in multiple sclerosis
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1417
OP 1424
DO 10.1212/WNL.0000000000002564
VO 86
IS 15
A1 Lindsay I. Berrigan
A1 John D. Fisk
A1 Scott B. Patten
A1 Helen Tremlett
A1 Christina Wolfson
A1 Sharon Warren
A1 Kirsten M. Fiest
A1 Kyla A. McKay
A1 Ruth Ann Marrie
A1 For the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS)
YR 2016
UL http://n.neurology.org/content/86/15/1417.abstract
AB Objective: To evaluate the direct and indirect influences of physical comorbidity, symptoms of depression and anxiety, fatigue, and disability on health-related quality of life (HRQoL) in persons with multiple sclerosis (MS).Methods: A large (n = 949) sample of adults with MS was recruited from 4 Canadian MS clinics. HRQoL was assessed using the patient-reported Health Utilities Index Mark 3. Expanded Disability Status Scale scores, physical comorbidity, depression, anxiety, and fatigue were evaluated as predictors of HRQoL in a cross-sectional path analysis.Results: All predictors were significantly associated with HRQoL and together accounted for a large proportion of variance (63%). Overall, disability status most strongly affected HRQoL (β = −0.52) but it was closely followed by depressive symptoms (β = −0.50). The direct associations of physical comorbidity and anxiety with HRQoL were small (β = −0.08 and −0.10, respectively), but these associations were stronger when indirect effects through other variables (depression, fatigue) were also considered (physical comorbidity: β = −0.20; anxiety: β = −0.34).Conclusions: Increased disability, depression and anxiety symptoms, fatigue, and physical comorbidity are associated with decreased HRQoL in MS. Disability most strongly diminishes HRQoL and, thus, interventions that reduce disability are expected to yield the most substantial improvement in HRQoL. Yet, interventions targeting other factors amenable to change, particularly depression but also anxiety, fatigue, and physical comorbidities, may all result in meaningful improvements in HRQoL, as well. Our findings point to the importance of further research confirming the efficacy of such interventions.CFI=Comparative Fit Index; CI=confidence interval; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, 4th edition; EDSS=Expanded Disability Status Scale; HADS=Hospital Anxiety and Depression Scale; HADS-A=Hospital Anxiety and Depression Scale anxiety subscale; HADS-D=Hospital Anxiety and Depression Scale depression subscale; HRQoL=health-related quality of life; HUI3=Health Utilities Index Mark 3; MS=multiple sclerosis; NARCOMS=North American Research Committee on Multiple Sclerosis; RMSEA=root mean square error of approximation