Quality of life of patients with multiple sclerosis receiving medical care at Palestinian Ministry of Health Directorates in the West Bank, occupied Palestinian territory, and associated factors: a cross-sectional survey

Abstract

BackgroundMultiple sclerosis is a neurological disease in which the immune system attacks the myelin sheath of axons, leading to symptoms that include loss of function, fatigue, blindness, and loss of balance. It is more common in women than in men. The disease has detrimental effects on patients’ health-related quality of life (QOL), physically, socially, and emotionally. This study assessed the QOL of patients with multiple sclerosis receiving medical care at Palestinian Ministry of Health directorates. MethodsIn this cross-sectional study, we approached all patients with multiple sclerosis receiving medical care in Ministry of Health clinics in all districts of the West Bank. In total, 150 patients were willing to participate. Participants were aged between 20 and 65 years and receiving treatment in ten directorates in the West Bank. We collected data from patients when they visited the clinics to collect medicines. The multiple sclerosis quality of life-54 (MSQOL-54) instrument is a self-administered questionnaire that is divided into two sections, the first comprising questions on basic demographic and socioeconomic characteristics, and the second focusing on the patient's QOL by assessing physical, mental, and emotional health factors. The MSQOL-54 scale scores were created using the Likert method by averaging items within the scales, then row scores were linearly transformed into 0–100 scales. The physical health composite score encompassed physical function health perceptions, energy and fatigue, and role limitations (relating to physical pain, sexual function, social function, and health distress). The mental health composite score encompassed health distress, overall QOL, emotional wellbeing, and role limitations (relating to emotional and cognitive function). These constructed variables were multiplied by the weight given to each variable to give the subtotal for each composite. Univariate analyses were initially performed using frequencies for categorical variables. Mean and SD were calculated for continuous variables. FindingsPatients had a mean age of 35 years (SD 10·90), and 103 (69%) were women. 43 (29%) lived in the north of the West Bank, 68 (45%) lived in the middle, and 39 (26%) in the south. 78 (52%) had a university degree, and 101 (67%) were married. 114 (76%) had a monthly income equal to the average wage in the occupied Palestinian territory. 77 (51%) were unemployed and 82 (55%) lived in cities. 109 (73%) were diagnosed with multiple sclerosis in the first year of the appearance of symptoms, and 127 (85%) took medication regularly. 76 (51%) benefitted from medication. 149 (99%) were diagnosed as having relapsing remitting multiple sclerosis. The overall mean QOL score was 58·71 (SD 22·06). For role limitation, the mean QOL scores relating to physical and emotional problems were 32 (SD 39·51) and 32 (40·11), to physical function was 35·8 (20·82), to emotional wellbeing was 45·94 (17·88), to fatigue was 40·74 (17·91), to health perception was 42·86 (21·80), and to health distress was 3·19 (1·38). The mean physical and mental health composite scores were 40·94 (38·97) and 39·91 (36·67), respectively. Similar physical and mental components of the QOL scores were found in patients with multiple sclerosis in studies from Bosnia and Herzegovina, Slovenia, and Italy. InterpretationThis study highlights the importance of assessing the QOL of patients with multiple sclerosis in the occupied Palestinian territory. All patients had low physical and mental health-related QOL scores. For the participants in this study, the most affected components of QOL were those related to role limitations due to physical and emotional problems, physical function, emotional wellbeing, fatigue, and health perception. Health distress was found to be the most powerful predictor of QOL of patients with multiple sclerosis. The results could potentially assist the Palestinian Ministry of Health in developing plans to improve the QOL of patients with multiple sclerosis. FundingNone.