Review Study Examines Factors That Affect MS Patients’ Quality of Life

Disability, fatigue, depression, cognitive impairment, and unemployment are primary risk factors for a poor quality of life in people with multiple sclerosis (MS), according to a recent review study.

Conversely, higher self-esteem, self-efficacy, resilience, and social support were identified as protective factors for quality of life (QoL).

Review findings also showed that most psychological interventions, such as mindfulness, cognitive-behavioral therapy, self-help groups, and self-management, successfully improved QoL in these patients. 

The review study, “Quality of life in adults with multiple sclerosis: a systematic review,” was published in the journal BMJ Open.

MS is characterized by a range of symptoms and an unpredictable prognosis that have the potential to severely impact patients’ QoL. MS disabilities can interfere with one’s ability to work or go to school, as well as with family and social dynamics. As such, people with MS tend to report a lower QoL, compared to people from the general population. 

Identification of protective and detrimental risk factors is needed to implement strategies to improve MS patients’ QoL. This also will provide healthcare professionals with useful information on the impact of symptoms and therapy on patients’ life. 

While there is a growing number of studies investigating QoL in MS patients, some findings have been inconsistent. Thus, a review of the current literature is needed to clarify which factors affect QoL. 

Researchers at the University of Seville in Spain, along with collaborators at the University Hospital Bonn in Germany, conducted a systematic review by searching three medical databases for articles published between Jan. 1, 2014, and Jan. 31, 2019, using the keywords “multiple sclerosis” and “quality of life” or “health-related quality of life” or “well-being” or “life satisfaction.” 

A total of 4,886 articles were found after the initial search. Of those, 106 studies that focused strictly on assessing risk factors and psychological interventions used to improve QoL in adults with a confirmed MS diagnosis were selected to be included in the analyses.

Analyses revealed that a higher level of disability, as measured by the Expanded Disability Status Scale (EDSS), was one of the leading causes of low QoL in MS patients. Other contributing factors included disease duration and onset, having a progressive MS type, and relapses in the past three months.

Several studies also found a link between the severity and number of MS symptoms and a decline in patients’ QoL. Fatigue was identified as one of the major risk factors for QoL, along with motor problems, including paralysis, difficulty walking, balance issues, and spasms, more specifically pain and muscle stiffening (spasticity).

Moreover, bladder and bowel impairment, as well as sexual and sleeping issues, were found to contribute to QoL deterioration. 

A range of cognitive impairments, such as cognitive fatigue, memory loss, planning and organizational difficulties, also were recognized as risk factors.

In contrast, one study showed that maintaining executive functioning — a set of mental skills that include working memory, flexible thinking, and self-control — was protective. “This was also the only study on the important subject of cognitive reserve and QoL,” the scientists wrote. 

The beneficial effect of emotional stability and the negative impact of emotional problems on QoL were reported in some studies.

Depression was the most-studied psychological symptom, followed by anxiety, both of which were later found to be risk factors for QoL in MS. In addition to those, high levels of perceived stress, anger expression, and apathy were found to have a negative impact on patients’ QoL.

In general, studies included in the analyses agreed that active coping, problem resolution, planning problem-solving, cognitive restructuring, emotional and instrumental social support, emotional expression, acceptance, and growth were coping strategies related to a higher QoL. 

In contrast, lower QoL was linked to problem avoidance, social withdrawal, behavioral disengagement, self-distraction, denial, emotion-focused coping strategies, wishful thinking, self-criticism, and self-controlled coping.

Ilness acceptance and resilience were identified as protective factors for QoL by some studies included in the analyses. Likewise, high levels of self-esteem, self-efficacy, illness identity, and sense of coherence were associated with higher QoL in MS patients. 

Employment was the leading sociodemographic factor influencing QoL, with several studies reporting an association between unemployment and lower QoL, as well as low economic status and financial problems. Conversely, some studies reported a positive correlation between high QoL and jobs that accommodate disabilities, job match and satisfaction, and high employment status. 

One study reported the lack of access to adequate medicines affected QoL, while another found a positive treatment experience was a protective factor.

Lower QoL was more common in males with MS, older patients, and those who were unmarried or did not live with their significant other, and less frequent in patients with higher levels of education. 

According to one study, QoL decreased in the first year following diagnosis, while another reported that younger patients tended to have worse QoL.

Problem-solving and avoidance coping strategies were both associated with QoL improvements in the years following MS diagnosis. In contrast, fatigue and depression predicted worse QoL in early years. 

All mindfulness-based therapies were linked to QoL improvements, as well as body-affective and community-based mindfulness interventions. 

Several cognitive-behavioral interventions also were found to be associated with increased QoL, including positive journaling, those focused on emotion regulation, depressive symptoms, and acceptance and commitment therapy.

Social support and group interventions also improved QoL, such as supportive-expressive therapy programs, social-cognitive wellness programs, self-help group sessions, fatigue self-management group therapy, and positive psychology programs. 

“The findings show the importance of clinical, psychosocial, and demographic variables as QoL risk and protective factors. A variety of psychological interventions ranging from mindfulness-based and cognitive behavioural approaches to self-help groups addressing these factors were identified as promising options for improving QoL,” the authors wrote.

The findings have important implications to clinical practice, according to investigators.

“A sound biopsychosocial assessment of patients with MS in daily clinical practice is necessary to ensure the possibility of early identification of QoL risk factors and evidence-based psychological intervention is recommended to improve or stabilise QoL,” they wrote.