Patients with multiple sclerosis (MS) report moderate scores in mental and physical health, as measured by three, well-established quality-of-life scales, according to an analysis of published literature.
The study, “Global, regional and national quality of life in patients with multiple sclerosis: a global systematic review and meta-analysis,” was published in the journal BMJ Supportive & Palliative Care.
As the symptoms of MS can vary in severity from patient to patient, researchers at the Iran University of Medical Sciences sought to analyze the health-related quality of life of MS patients globally.
To do so, the researchers conducted a systematic review and meta-analysis of articles referencing health-related quality of life in MS patients, published from January 2000 to April 2020.
In total, 54 published articles were selected. All studies measured quality of life with one of three scales — the 36-item Short Form Survey (SF-36), the MS Quality of Life-54 (MSQoL-54), or the MS International Quality of Life questionnaire (MusiQoL).
The SF-36 is a 36-question survey issued to the general public to evaluate health-related quality of life. Based on the answers, participants receive a score from zero to 100, with zero indicating the worst possible health status and 100 indicating the best health.
The MSQoL-54 is a modified version of the SF-36, featuring the original 36 general questions and an additional 18 questions that are specific to the symptoms of MS. The resulting scores also range from zero to 100.
Finally, the MusiQoL survey is specifically designed to evaluate quality of life in MS patients, with 31 items that focus on the multiple dimensions of the disease and scores also ranging from zero to 100.
From the 54 studies that utilized these three scales, a total of 22,212 patients with MS were surveyed.
The researchers considered scores on the three scales from 0–20 as very poor quality of life, 21–45 as poor, 46–55 as moderate, 56–65 as good, and 66–100 as very good.
The team assessed the total average scores for both physical and mental health-related quality of life, finding them to be 48.73 and 55.18, respectively — both in the moderate range.
“According to the results of this study, the total score for HRQOL [health-related quality of life] indicates moderate quality of life,” the researchers wrote.
Trends in quality-of-life scores based on patient characteristics were then analyzed.
The researchers found that MS patients in Europe reported the highest average mental quality-of-life score (57.1) compared to other continents (53.92 in America and 51.07 in Asia). Patients in Spain reported the highest average score (77.9) among European countries, while patients in France reported the lowest average (32.64).
The highest physical quality-of-life score was found in Asia (54.1) and lowest was reported in the Americas (46.57), according to the results.
The researchers also found a statistically significant correlation between mental quality of life and both age and duration of disease in MS patients, meaning that, as patients got older and had their disease for a longer time, their mental quality-of-life scores increased.
More specifically, for every one year, mental quality-of-life scores increased by 0.64, and by 1.08 per every year of disease duration.
In contrast, physical quality-of-life scores were found to decrease with age and with duration of disease, although the correlation was not statistically significant.
Depression was found to have a strong influence on quality-of-life scores.
Other factors analyzed, including gender, fatigue severity, and disability status — as measured by the expanded disability status scale — did not significantly correlate with mental or physical quality-of-life scores.
“Factors such as depression, age and duration of disease have the greatest impact on HRQOL, whereas factors such as fatigue and the Expanded Disability Status Scale score have less effects on HRQOL,” the researchers wrote.
Based on the results, the team suggested that depression and emotional support should be considered in the care of MS patients. “Friends, family and healthcare providers play a key role in providing emotional support to promote these people’s mental HRQOL,” they wrote.
Furthermore, as fatigue and EDSS do not significantly impact quality of life, patients should be encouraged to participate in daily activities as long as they are physically capable, the team suggested.
Overall, “the findings of this article can be a valid source to improve the decision-making process with regard to HRQOL in patients with MS and to provide better health services for them,” the researchers concluded.
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