MS-related Fatigue Identified as Main Factor Affecting Work Ability
Fatigue, whether alone or in combination with depression or anxiety, is the main influencing factor of self-reported working ability among people with relapsing-remitting multiple sclerosis (RRMS) and mild disability, according to a study in the Netherlands.
Notably, contrary to the researchers’ expectations, personality traits were found to have no effect on a patient’s working difficulties, when corrected for known MS-related influencing factors.
These findings highlight the importance of managing fatigue and mood to optimize RRMS patients’ ability to work, the researchers said, noting that such symptoms “can potentially be treated or dealt with” to improve work ability.
Still, future studies using both subjective and objective measures of occupational functioning, and looking at other factors, would likely add some relevant insights on these associations, they noted.
Research shows that the rates of unemployment among people living with MS are as high as 80%. Those who continue to work may “experience various work difficulties due to physical, psychological, cognitive and external work barriers,” the investigators wrote.
As such, identifying the main factors affecting MS patients’ employment is key for the development of appropriate and effective strategies to overcome the working difficulties these individuals face.
One previous study identified patients’ personality traits as an influencing factor of unemployment risk in MS.
The main personality traits cited include neuroticism — a negative or anxious personality — extraversion, defined as having a social and positive personality, and openness, or an open-minded and creative personality. Agreeableness, or having a cooperative and friendly personality, and conscientiousness, defined as a responsible and organized personality, were the other key traits cited.
According to previous research, MS patients exhibit higher levels of neuroticism and lower levels of extraversion and conscientiousness — similar to the distressed personality type (type D) — than their healthy peers.
Type D personality is characterized by the tendency to experience negative emotions, while simultaneously showing the tendency not to express these emotions.
This type of personality or its corresponding traits have been linked not only to several negative health-related outcomes, such as worse quality of life, depression, anxiety, and fatigue, but also to unemployment.
Now, a team of researchers from institutes across the Netherlands evaluated the effects of the five personality traits in several self-reported occupational outcomes of 241 adults with RRMS and 60 healthy adults, who served as controls.
Occupational outcomes included work status, number of hours absent due to MS, the influence of MS symptoms in work productivity, the time that physical and emotional problems impact work, work ability compared with lifetime best, work difficulties, and consideration to reduce work hours.
The team hypothesized that type D-associated personality traits would be linked with worse occupational outcomes in RRMS patients and that personality would explain additional variability in these outcomes over known disease-related and demographic influencing factors.
Evaluated influencing factors included MS-related disability, the use of immunomodulatory treatment, fatigue (or its impact on daily activities), depression, anxiety, cognitive processing speed, age, and gender.
The MS patients involved in the study had a median age of 42 and showed mild disability. They were recruited from 16 MS outpatient clinics in the context of the [email protected] study, a three-year study of work participation in adults with RRMS in the Netherlands.
All of the participants underwent neuropsychological and neurological examinations and completed validated questionnaires.
The results showed that RRMS patients reported significantly fewer working hours, poorer productivity and work ability, and more work difficulties relative to healthy individuals. They also had significantly more personality traits suggestive of type D, more depression, anxiety, and fatigue, and slower cognitive processing speed, consistent with previous findings.
To the researchers’ surprise, however, personality traits were not significantly associated with occupational functioning among the RRMS patients when accounting for MS-related disability, the impact of fatigue, depression, anxiety, and cognitive processing speed.
The fact that the current study included only RRMS patients, who had shorter disease duration and milder disability than participants in previous studies —which included individuals with progressive MS — may help explain the absence of such associations, the team hypothesized.
They noted that further studies should evaluate the potential influence of personality traits in these work outcomes among MS patients with more advanced and/or progressive disease and also include more objective measures of these work-related outcomes.
Notably, the perceived impact of fatigue was found to be the main and most significant influencing factor of patients’ work outcomes, “explaining most variance in occupational functioning,” the researchers wrote.
Worse fatigue was significantly associated with a higher chance of missing work, greater impact of MS symptoms on work productivity, and lower work ability.
In addition, in combination with higher levels of fatigue, more symptoms of depression were linked to not having a paid job and a higher chance of considering reducing work hours. Meanwhile, more symptoms of anxiety were associated with more work difficulties.
No other factors were found to significantly contribute to patients’ working difficulties.
These findings suggest that, in people living with RRMS, “the impact of fatigue and mood contribute more in explaining occupational functioning than age, gender, use of immunomodulatory treatment, MS-related disability and information processing speed,” the team wrote.
These results are “clinically relevant, in that the management of fatigue and mood are of the utmost importance in optimizing occupational functioning in persons with MS,” and as these symptoms “can potentially be treated or dealt with during personalized rehabilitation and coaching,” the researchers wrote.
Still, the evaluated factors could not totally explain the variability in work outcomes in RRMS patients, “emphasizing the need to additionally examine other (contextual) factors when considering occupational challenges in MS,” the researchers wrote.