Early Factors Identified That Predict Health-related Quality of Life

Researchers have identified early factors that can affect the trajectory of a patient’s long-term health-related quality of life (HRQoL) after a multiple sclerosis diagnosis.

These factors include older age, worse physical impairment, and more severe fatigue at diagnosis, which were predictive of worse long-term physical HRQoL. In addition, low annual incomes (at or below $50,000) and a lack of post-secondary education were linked to consistently low mental HRQoL.

“There are early risk factors for those who will end up in the groups with the worst health-related quality of life that are easily identifiable by doctors and other health professionals,” Julia O’Mahony, PhD, a postdoctoral researcher at the Health Sciences Centre Winnipeg in Winnipeg, Canada, and the study’s first author, said in a press release.

“This could provide an opportunity for early interventions that could help people with MS live better lives,” O’Mahony added.

The study, “Physical and Mental Health-Related Quality of Life Trajectories Among People With Multiple Sclerosis,” was published in the journal Neurology. 

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What is health-related quality of life?

HRQoL measurements assess the impact of health on a person’s physical and mental well-being.

“People with multiple sclerosis report a lower quality of life when compared to people without the disease, and even those with other chronic conditions,” O’Mahony said.

However, most studies evaluating HRQoL have been cross-sectional, meaning they took a snapshot at a given time. As such, the understanding of how HRQoL changes over time, and what factors might contribute to its different trajectories, is lacking.

“There are several factors that may play a role. Our research sought to identify such factors so they can be addressed early in the course of the disease,” O’Mahony said.

The study involved 4,888 adults with confirmed MS — 81% women — who participated in the North American Research Committee on MS registry from 2004–2020. Eligible participants lived in the U.S., had enrolled in the registry within three years of diagnosis, and had completed an HRQoL questionnaire at least three times.

In total, 57,564 questionnaires were completed between one and 27 years after MS diagnosis, with an average of 12 questionnaires per participant.

HRQoL was evaluated with the RAND-12, which generates two aggregate scores — one summarizing physical HRQoL and one encompassing mental HRQoL.

The team identified five distinct physical HRQoL trajectories over time.

The first, occurring in 26.4% of patients, included people with consistently low physical HRQoL, while the second group (29.2%) had consistently moderately low HRQoL. Another 13.4% had moderate-to-low physical life quality in the first 10 years which improved to normal thereafter. Others (17.1%) experienced an early decline in the first eight years after diagnosis, which increased to moderate or normal after that. The last group included 13.9% of participants who had persistently normal physical HRQoL for the first 20 years, followed by a decline.

When evaluating predictors of low physical HRQoL, the researchers found that patients who were older at diagnosis, and had greater physical impairments and worse fatigue within three years of diagnosis were at a higher risk of having consistently low physical HRQoL compared with any of the other four groups in final statistical analyses.

Specifically, the median age of those in the lowest HRQoL group was 46 at diagnosis, compared to 38 in those with the best HRQoL trajectory. Those patients also tended to have moderate gait disability and fatigue, compared with normal physical function and minimal fatigue in the highest HRQoL group.

“Both physical impairments and fatigue are responsive to disease modifying MS therapies, emphasizing the need for early initiation of treatments among those with these risk factors,” the researchers wrote.

For mental HRQoL, four distinct trajectories were identified: those with chronically low HRQoL (18.6%), moderately low (32.9%), moderately low in the first 10 years followed by normal HRQoL thereafter (22.2%), and normal mental HRQoL (26.4%).

In final statistical analyses, having an annual income of $50,000 or less or no post-secondary education were most strongly associated with increased odds of having chronically low mental HRQoL compared with any of the other three groups.

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Overall, 62% of those with chronically low HRQoL made $50,000 or less compared with 44% of those with normal HRQoL. Similarly, 38% in the lowest group lacked post-secondary education compared with 22% in the high group.

Interventions that target social determinants of mental health, such as income supplements, tax credits, and green spaces around homes and workplaces, have all been shown to improve mental well-being and could be effective for MS patients, the team noted.

The study overall identifies measurable factors at MS diagnosis that can influence the trajectory of a patient’s physical and mental HRQoL.

“There are early risk factors for membership in the groups with the worst HRQoL that are easily identifiable by clinicians, providing an opportunity for early interventions,” the researchers wrote.