Pandemic’s Negative Aspects Tied to Worse Disability in MS Patients

Worsening disability was associated with worry about COVID-19 in people with multiple sclerosis (MS) living in the U.S. and Italy, a study evaluating the pandemic’s impact has found.

In both countries, MS patients with greater psychological disabilities, such as depression, were more likely to have worrying thoughts, while those with fewer mobility issues reported more post-traumatic growth, meaning they had a higher sense of gratitude, faith, and social connection.

Findings also suggested that patients in the U.S. with more disabilities were more concerned with protecting themselves against COVID-19.

The study, “The impact of COVID-19 on people with multiple sclerosis: A comparison of Italian and United States cohorts,” was published in the journal Multiple Sclerosis and Related Disorders.

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The COVID-19 pandemic has negatively affected the well-being and health of vulnerable groups, particularly those with pre-existing medical conditions. In fact, an Italian study reported that MS patients were twice as likely to be hospitalized compared with the general population after being diagnosed with COVID-19.

In the U.S., progressive forms of MS, which are characterized by symptoms that gradually worsen over time, have also been linked to poorer COVID-19 outcomes.

Several studies have also attempted to assess the pandemic’s mental and emotional impact. One such study found that depression, anxiety, and overall quality of life did not worsen for MS patients with progressive disease. However, the number of study participants was too low to reach a robust conclusion.

According to researchers, studies are lacking that have adequately evaluated the differences in how people with MS living in different countries have dealt with the pandemic. To address this gap in knowledge, researchers investigated the relationship between three specific pandemic-related concepts — worry, protection, and post-traumatic growth — and disability outcomes in MS patients living in Italy and in the U.S.

Between late spring and midsummer of 2020, 708 patients were asked to complete an online survey. Questions and topics under “worry” included “How often do you feel isolated from others?”; “I am stressed around other people because I worry I’ll catch the coronavirus”; and “Thoughts about the pandemic distract me or keep me from being able to concentrate.”

The concept “protection” discussed items such as “Washing hands and/or using sanitizer after returning home”; “Staying at least 6 feet away from others outside the home”; “Wearing a face mask in public”; and “Wiping down surfaces with disinfectant.”

“Post-traumatic growth” covered content such as, “I have a greater appreciation for the value of my own life”; “I more clearly see that I can count on people in times of trouble”; “I have a greater sense of closeness with others”; and “I have a stronger religious faith.”

MS disability was determined using performance scales, a self-reported health status measure that includes 11 domains: mobility, hand function, vision, fatigue, cognitive, bladder/bowel, sensory, spasticity (muscle tightness), pain, depression, and tremor/coordination.

A total of 292 patients in Italy and 416 in the U.S. participated in the study. MS patients in the U.S. were older and had a higher body mass index (a body fat measure) than the Italian group.

U.S. patients also had more comorbidities, or simultaneous health conditions. While in the U.S., back pain, depression, and arthritis were the comorbidities most commonly reported, in Italy, back pain, insomnia, and depression were the most frequent complaints.

Next, researchers conducted a statistical analysis to study the relationship between MS disability and the concepts of worry, protection, and post-traumatic growth.

In the U.S., all three concepts were found to be associated with MS disability. Worry was linked to higher mental and depression disability, while protection was associated with greater mobility, sensory, spasticity, and pain disability. Lower mobility disability was associated with post-traumatic growth.

In Italian patients, worry was associated with greater vision, fatigue, cognitive, and depression disability, while post-traumatic growth was associated with less mobility, vision, bladder/bowel, and spasticity disability.

“In summary, the pandemic’s negative aspects were associated with worse disability in both countries, and with more aspects of disability in Italy. In the [U.S.], however, MS-related disabilities were also associated with greater self-protection against COVID-19,” the authors wrote.

“Individuals’ post-traumatic growth [… was] associated with lesser disability. This finding may suggest directions for clinical intervention,” they wrote.