Preference-based Health status in a German outpatient cohort with multiple sclerosis

Jens Peter Reese,Axel John,Ulrich Otto Mueller,Christian Eienbröker,Alexandra Linnemann,Gabriele Wienemann,Richard Dodel,Monika Balzer-Geldsetzer,Björn Tackenberg

doi:10.1186/1477-7525-11-162

Jens Peter Reese, Axel John + Show 7 more

Open Access

https://doi.org/10.1186/1477-7525-11-162

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Abstract

BackgroundTo prospectively determine health status and health utility and its predictors in patients with multiple sclerosis (MS).MethodsA total of 144 MS patients (mean age: 41.0 ±11.3y) with different subtypes (patterns of progression) and severities of MS were recruited in an outpatient university clinic in Germany. Patients completed a questionnaire at baseline (n = 144), 6 months (n = 65) and 12 months (n = 55). Health utilities were assessed using the EuroQol instrument (EQ-5D, EQ VAS). Health status was assessed by several scales (Expanded Disability Severity Scale (EDSS), Modified Fatigue Impact Scale (M-FIS), Functional Assessment of MS (FAMS), Beck Depression Inventory (BDI-II) and Multiple Sclerosis Functional Composite (MSFC)). Additionally, demographic and socioeconomic parameters were assessed. Multivariate linear and logistic regressions were applied to reveal independent predictors of health status.ResultsHealth status is substantially diminished in MS patients and the EQ VAS was considerably lower than that of the general German population. No significant change in health-status parameters was observed over a 12-months period. Multivariate analyses revealed M-FIS, BDI-II, MSFC, and EDSS to be significant predictors of reduced health status. Socioeconomic and socio-demographic parameters such as working status, family status, number of household inhabitants, age, and gender did not prove significant in multivariate analyses.ConclusionMS considerably impairs patients’ health status. Guidelines aiming to improve self-reported health status should include treatment options for depression and fatigue. Physicians should be aware of depression and fatigue as co-morbidities. Future studies should consider the minimal clinical difference when health status is a primary outcome.

Highlights

Multiple sclerosis (MS) is a demyelinating autoimmune disease and a common cause of severe neurological disability in young adults in the Western world, presenting with diverse and often unpredictable symptoms and an uncertain course of progression
The subtypes are defined by their pattern of progression; approximately 10-20% of multiple sclerosis (MS) patients suffer from primary progressive disease (PPMS), which has a slightly later onset compared to the other subtypes
Most of the patients lived with partners (76.1%); 45% had a secondary school education; and 38% stated that their career advancement was impaired by MS

Summary

Introduction

Multiple sclerosis (MS) is a demyelinating autoimmune disease and a common cause of severe neurological disability in young adults in the Western world, presenting with diverse and often unpredictable symptoms and an uncertain course of progression. The subtypes are defined by their pattern of progression; approximately 10-20% of MS patients suffer from primary progressive disease (PPMS), which has a slightly later onset compared to the other subtypes. Predictors of health status reveal that physical and psychological symptoms are interrelated and that both are important. Depression is one of the strongest psychiatric predictors of poor health, as well as cognitive impairment and fatigue To prospectively determine health status and health utility and its predictors in patients with multiple sclerosis (MS)

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