Quality Of Life In Multiple Sclerosis Patients Research Articles

Ketogenic diet may improve sleep quality and daytime somnolence in patients affected by multiple sclerosis. Results of an exploratory study

Objective/backgroundPatients with multiple sclerosis (MS) frequently report sleep complaints. The ketogenic diet (KD) is safe and tolerable in MS patients. Our aim was: 1) to investigate the effects of KD on sleep complaints in patients affected by relapsing-remitting MS and 2) to verify if sleep changes can positively impact on psychological status and quality of life (QoL) in these patients. Patients/methodsFrom January 2020 to November 2022, we consecutively enrolled 21 non-disabled or minimally disabled MS patients. We collected information regarding: 1) anthropometric measures; 2) psychological status by the Depression Anxiety Stress Scale-21; 3) QoL by the Multiple Sclerosis Quality of Life-54 (MSQOL-54); 4) subjective sleep complaints, i.e. sleep quality, by the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness (EDS), by the Epworth Sleepiness Scale (ESS). ResultsAfter 6 months of KD therapy, anthropometric measures considerably changed, psychological status significantly improved, and almost all the MSQOL-54 subscales ameliorated. Regarding sleep, we observed that the global PSQI (T0: 7.7 ± 3.1 versus T1: 4.4 ± 3.1, p = 0.002) and the ESS (T0: 7.5 ± 3.9 versus T1: 4.9 ± 3.2, p = 0.001) scores significantly decreased after KD therapy. At T1, only the global PSQI score was an independent predictor of anxiety, stress, and mental health. ConclusionsFor the first time, we demonstrated that KD may improve sleep complaints in MS patients. In addition, KD seems to have a positive impact on psychological status and QoL of MS patients, mainly through improving sleep quality. Further controlled studies with larger sample sizes are needed to confirm these preliminary results.

The quality of life in patients with multiple sclerosis - Association with depressive symptoms and physical disability: A prospective and observational study.

Patients with multiple sclerosis (MS) experience disabilities which significantly affect their quality of life (QOL) and mental health. Mood disorders and depressive symptoms are one of the most common psychiatric conditions in MS patients. This study aimed to evaluate the level of QOL in MS patients and to assess the influence of depressive symptoms and physical disability on QOL. This prospective and observational study was conducted among 100 MS patients (mean age of 36.23 ± 11.77) recruited from the Lower Silesian Unit of the Polish Association for Multiple Sclerosis. This study used a questionnaire designed by the authors, which contained questions about sociodemographic and clinical data, as well as the following standardized questionnaires: the Activities of Daily Living questionnaire (ADL), the Instrumental Activities of Daily Living questionnaire (IADL), the Expanded Disability Status Scale (EDSS), the Beck Depression Inventory (BDI) and Multiple Sclerosis International Quality of Life Questionnaire (MusiQOL). The average EDSS score among patients was 3.13 ± 2.38 points. More than half of the respondents (68%) suffered from depression of varying severity. The univariate linear regression models showed that the independent (p < 0.05) QOL predictors (total MusiQOL) were as follows: the number of complaints, IADL results, BDI results, EDSS score, higher education, and material status >2000 PLN. In addition, the multiple linear regression model showed that the BDI result was a significant predictor of QOL (p < 0.005). Depressive symptoms significantly affect the QOL of MS patients.

The impact of therapeutic education programs on the quality of life of patients with multiple sclerosis: Protocol of a systematic review.

The quality of life (QOL) of patients with multiple sclerosis (MS) is estimated to be poor compared to the general population. Its management is complex thus requiring openness to non-pharmacological approaches such as therapeutic education (TPE). However, there is an abundance of educational programs with several components and varying degrees of effectiveness. This protocol is developed with the objective to determine the impact of TPE programs on the QOL of MS patients. We will undergo research in PubMed, Web of Science, and Scopus to identify all eligible articles published between January 1st, 2007, and February 2022 evaluating the QOL. We will include any quantitative study design: Randomized Controlled Trials (RCTs), non-randomized controlled trials, non-randomized uncontrolled trials, and observational studies. The quality of these studies will be assessed by recommended tools. Two investigators will independently perform the data extractions and any disagreements will be resolved by other reviewers. A narrative synthesis will report results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guidelines to draw conclusions based on the totality of the evidence. These results will be summarized by characteristics of studies and programs and by effects on the QOL. This systematic review will provide practice guidance and evidence to effectively target the features and components of TPE programs, to effectively meet the specific needs of MS patients and thereby improve their QOL, and on the other hand to facilitate the appropriation of these programs by clinicians and researchers to optimize the management of MS. Systematic review registration: PROSPERO CRD42022338651.

Quality of Life of Children and Adolescents with Multiple Sclerosis-A Literature Review of the Quantitative Evidence.

Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that also develops in patients under 18 years of age. The disease negatively affects the quality of life (QoL) of children and adolescents. We conducted a literature review. The aim of the review was to identify the QoL of pediatric patients with MS and assess the factors determining their QoL. Methods: We analyzed studies published between 2000 and 2020 in PubMed, Scopus, Science Direct, Web of Science, and EBSCO databases. Results: In all, 17 studies were included in the review. The most common tool in assessing QoL was the generic module PedsQL. The range of mean/median global score of QoL was 53.8–81.7. The worst QoL was dominantly reported in the school and emotional spheres, on the contrary, the disease’s least determined area of QoL was the social and physical dimension. In particular, disability and fatigue were important predictors of QoL. Conclusions: MS negatively affects the school and emotional spheres in particular, so it is important to pay greater attention to these spheres of life of MS patients. As the review studies pay insufficient attention to the analysis of positive factors and their impact on the QoL of MS patients, research should integrate these phenomena. The use of MS-targeted tools in future research in the pediatric MS population is also appropriate.

The Relationship Between Sensitivity to Anxiety and Executive Functions and Quality of Life of MS Patients: Path Analysis Pattern

Background: Multiple Sclerosis (MS) is affected by cognitive and emotional factors. The aim of this study was to investigate the relationship between sensitivity to anxiety and executive functions and the Quality of Life (QoL) of MS patients using path analysis. Methods: This descriptive correlational research was done on all patients with MS in Gorgan MS Association in 2020. The sample size was considered to be 290 people according to the sample selection formula and based on the values obtained from the previous study selected by simple random sampling. To collect data, the Executive Functions Questionnaire of Nejati (2013), QoL questionnaire of McGuigan &amp; Hutchinson (2004), and Sensitivity to Anxiety Questionnaires of Taylor and Cox (1998) were used. Path analysis with SPSS v. 18 and AMOS v. 23 software was used to analyze the data. Results: The results showed that the executive functions had a positive relationship with QoL in MS patients and sensitivity to anxiety had a negative relationship with QoL in MS patients. Also, mediating role of the anxiety sensitivity variable in the relationship between executive functions with QoL in MS patients was confirmed (P≤0.01). Conclusion: The present study indicated the importance of cognitive factors, such as executive functions, and emotional factors, such as sensitivity to anxiety in explaining the QoL in MS patients.

Self-Care Practices and Related Factors in Patients with Multiple Sclerosis (MS) Based on the Health Belief Model.

Introduction: Self-care programs can raise health in patients with Multiple Sclerosis (MS). This study aimed to identify the self-care behaviors and determinants in patients with MS according to the Health Belief Model (HBM).Methods: In this cross-sectional study, we included 280 MS patients through convenience sampling method. The collection tool was a self-administered questionnaire based on HBM. The participants were the members of MS society in Kerman, Iran. The data were analyzed using descriptive statistics, path analysis, and multivariable linear regression in SPSS software Version 22.Results: The mean (SD) score for self-care practices was 2.86 (0.64), and medication adherence was the most conducted practice. The perceived benefits and cues to action exerted positive influence on self-care practices. The most frequent symptoms experienced by the participants were fatigue (82.5%), visual impairment (76.4%), headaches (72.1%), and muscle weakness (71.4%). The most important cues to action for self-care behavior were the physician (77%), media (52%), and other MS patients (32%).Conclusion: The quality of life (QOL) of MS patients is heavily influenced by self-care behaviors. In this study, only about half of the patients accomplished self-care behaviors, which seems to be insufficient. Since the perceived benefits and cues to action are the main predictors of self-care practices, intervention based on these two constructs can be utilized to promote self-care programs and QOL in MS patients. Health-care providers should pay more attention to these factors for promoting self-care behaviors.

The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients.

Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system that involves different neurological areas. In addition to lower urinary tract symptoms (LUTS), sexual dysfunction (SD), and psychopathological effects, MS sometimes seriously impairs the quality of life (QoL). We hypothesize that the pelvic floor exercise program (PFEP) could improve bladder, sexual function, depression, and QoL in MS patients. Patients diagnosed with MS completed the Incontinence Questionnaire Short Form (ICIQ-SF), the Beck Depression Inventory (BDI), the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire, and either the Female Sexual Function Index (FSFI) or the Sexual Health Inventory for Men (SHIM). Maximum bladder volumes (MBV) and post-voiding residual (PVR) volumes were measured using ultrasonography. The patients who regularly completed the PFEP for 12weeks were asked to fill out the questionnaires again, and their MBV and PVR were remeasured. Seventy-two patients with relapsing-remitting multiple sclerosis (RRMS) were included in the study. Forty-two (58.3%) RRMS patients reached the end of the study. The patients' post-PFEP average MBV statistically increased (p = 0.01). In contrast, no statistically significant difference was found in the PVR (p = 0.2). After exercise, the FSFI values in women increased (p = 0.02), and ICIQ-SF and BDI values in all the RRMS patients statistically decreased (p = 0.004, p = 0.01, respectively), but there was no improvement in the MSQoL-54 score (p > 0.05). PFEP, which causes a reduction in LUTS by enhancing the MBV of RRMS patients, can be seen as an investment in the future in terms of reducing depression in MS patients and preventing or delaying SD in women.

Comparison of Cognitive Rehabilitation versus Donepezil Therapy on Memory Performance, Attention, Quality of Life, and Depression among Multiple Sclerosis Patients.

Background Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that affects cognitive performance and leads to depression and decreased quality of life (QOL). The current study aims to assess the effects of cognitive rehabilitation versus donepezil therapy on memory, attention, depression, and QOL in MS patients compared to placebo and control groups. Methods Eighty MS patients were randomly selected from parallel randomized trials and divided into four groups: A: cognitive rehabilitation (10 sessions of 120 minutes), B: control (no intervention), C: donepezil (10 mg daily), and D: placebo. Patients received the intervention for three months. They were assessed for cognitive status, depression, and QOL prior to the intervention and immediately after that using abbreviated mental test (AMT), prospective and retrospective memory questionnaire (PRMQ), everyday memory questionnaire (EMQ), digit span, MSQOL-54, and second edition Beck depression inventory (BDI). We compared scores between groups after the intervention, as well as the progression of scores in every single group. Results. The cognitive rehabilitation group showed improvement in EMQ, RPMQ, digit span, physical and mental health subscales of MSQOL54, and depression (P < 0.05). We observed the same effect for donepezil except for the digit span test (P = 0.15). Intergroup comparison of scores showed the superiority of cognitive rehabilitation over donepezil in digit span, depression, and mental health scores. Conclusion Both donepezil and cognitive rehabilitation effectively improve memory performance, attention, depression, and QOL in MS patients. Cognitive rehabilitation is superior altogether. This study is registered with the Iranian registry of clinical trials http://clinicaltrials.gov/ct2/show/IRCT2016042227522N1.

Comparing the Quality of Life among Patients with Relapsing Remitting Multiple Sclerosis in Iraq Using Different Disease Modifying Therapies

Multiple sclerosis (MS) is a chronic, inflammatory, immune mediated disease of the central nervous system, mostly affecting young adults with mean age of 30 years, twice as high in women compared to men. The etiology of MS is not fully elucidated. MS symptoms are directly related to demyelination and axonal loss, along with other psychological symptoms, can result in functional limitations, disability and reduced quality of life (QoL). The QoL assessments in patients with a chronic disease may contribute to improving treatment and could even be of prognostic value. The goals of this study were to compare the QoL of Iraqi patients with relapsing remitting multiple sclerosis (RRMS),using three different diseases modifying therapies(DMTs) administered orally, subcutaneously, and by slow infusion; namely, fingolimod,interferonB-1b, and natalizumab, respectively. And to assess the role of disability status, educational status, occupational status, MS duration, and treatment duration as a predictor for the QoL. Functional Assessment of Multiple Sclerosis (FAMS) questionnaire version 4 was used to assess QoL. Sociodemographic and clinical characteristics were tested by univariate and multivariate regression analyses to assess the contribution of these predictors to QoL. No significant differences were found in symptoms, thinking/fatigue subscales and FAMS total scores among the three DMTs. In conclusion: Iraqi MS patients using InterferonB-1b, fingolimod or natalizumab have a comparable low level of QoL. The expanded disability status scale (EDSS) is negatively associated with QoL of MS patients in all of the three therapies, while other predictors such as occupational status, educational status, smoking habit and MS duration have different impact in different treatments.

Long-term endurance training improves general health perception in multiple sclerosis patients with fatigue: results of an exploratory study

To determine if long-term endurance exercise improves quality of life (QOL) in patients with multiple sclerosis (MS). 89 patients with relapsing–remitting MS and an EDSS of <3.5 participated in a prospective non-randomized controlled exploratory trial. The exercise program comprised a walking exercise three times weekly for 30 min (“interval training” twice weekly, “endurance training” once weekly) for 12 months. Participants were tested every 3 months on a treadmill according to a modified Naughton protocol. Fatigue was assessed by the Fatigue Severity Scale (FSS) and QOL by a German version of the Short Form Health Survey (SF-36). Data were analyzed using analysis of variance (ANOVA) with repeated measurements. 20 patients without and 24 with fatigue completed the program. QOL was reduced in several subscales of the SF-36 in MS patients with fatigue at baseline: physical functioning (p < 0.001), physical role functioning (p < 0.002), bodily pain (p ≤ 0.04), vitality (p ≤ 0.001), social role functioning (p ≤ 0.004), emotional role functioning (p ≤ 0.03), mental health (p ≤ 0.006). Exercise training resulted in a significant improvement of the subscale general health perceptions (p ≤ 0.01). Fatigue contributes significantly to QOL in MS patients. A significant improvement in the subscale general health perceptions was demonstrated by a 12-month endurance walking program in MS patients with fatigue.

Self-reported quality of life of patients with multiple sclerosis with mild disability

Background The quality of life (QoL) of the patient is a reflection of the severity of multiple sclerosis (MS) and predicts its prognosis; it is related to various factors that vary across cultures. Objective The aim of the current study was to evaluate the QoL of ambulatory and mildly disabled patients with relapsing remitting multiple sclerosis (RRMS), and explore the related factors and cultural characteristics. Patients and methods Sixty Egyptian patients with a definitive diagnosis of RRMS were recruited and assessed for disability using Expanded Disability Status Scale, their QoL using Multiple Sclerosis Quality of Life Inventory (MSQLI), and depression using the Beck Depression Inventory scale. Patients’ QoL was compared with that of 30 matched controls. Results The QoL of MS patients was significantly impaired in all domains compared with that of controls (P<0.001), except for Social Functioning. Most of the physical components of the QoL were strongly correlated with Expanded Disability Status Scale, fatigue, and perceived cognitive impairment, and mental components were correlated with depression (P<0.001), fatigue, and perceived cognitive impairment. An overall 81% of MS patients had depression that correlated with disability (P=0.012) and fatigue (P=0.001), and correlated moderately with perceived cognitive impairment. Women reported more anxiety (P=0.038) and less perceived social support (P=0.012), whereas men stated more sexual dissatisfaction (P=0.001). Conclusion Mildly disabled Egyptian patients with RRMS have a high prevalence of depression and considerable impairment of mental and physical components of the QoL, such as disease disability, depression, fatigue, and perceived cognitive impairment.

'Hidden' factors influencing quality of life in patients with multiple sclerosis.

Traditional outcome measures for patients with multiple sclerosis (MS), whether in clinical trials or clinical practice, are currently in question. The combination of relapses, physical disability progression and magnetic resonance imaging (MRI) disease activity reflect only part of the impact that MS has on a patient's daily life. Quality of life (QoL) is considered by many to be the ideal outcome measure. Since it captures the patient's own perspective of well-being, QoL should be the primary focus when evaluating a patient and the main objective of MS management. Nevertheless, whilst numerous instruments to measure QoL in MS patients are available or proposed, there is no current consensus regarding which is the best tool to use and under what circumstances. QoL in patients with MS is determined by several factors beyond the more obvious; these include coping with the MS diagnosis, understanding the disease and the disease process, dealing with so-called 'hidden' symptoms such as fatigue, cognitive impairment and sexual disturbances, and managing the many associated personal challenges such as social isolation, family issues and working difficulties. Evidence is emerging that psychological interventions may be beneficial in MS patients although more research is required to confirm their utility. This article examines some factors that influence QoL in MS patients which may be overlooked in the general busyness of routine clinical practice.

Treatment compliance with first line disease-modifying therapies in patients with multiple sclerosis. COMPLIANCE Study

IntroductionNon-adherence to disease-modifying therapies (DMTs) in multiple sclerosis may be associated with reduced efficacy. We assessed compliance, the reasons for non-compliance, treatment satisfaction, and quality of life (QoL) of patients treated with first-line therapies. MethodsA cross-sectional, multicenter study was conducted that included relapsing multiple sclerosis patients. Compliance in the past month was assessed using Morisky-Green test. Seasonal compliance and reasons for non-compliance were assessed by an ad-hoc questionnaire. Treatment satisfaction and QoL were evaluated by means of TSQM and PRIMUS questionnaires. ResultsA total of 220 patients were evaluated (91% relapsing-remitting); the mean age was 39.1 years, 70% were female, and the average time under treatment was 5.4 years. Subcutaneous interferon (IFN) β-1b was used in 23% of the patients, intramuscular IFN β-1a in 21%, subcutaneous IFN β-1a in 37%, and with glatiramer acetate in 19%. The overall compliance was 75%, with no significant differences related to the therapy, and 81% did not report any seasonal variation. Compliant patients had significantly lower disability scores and time of diagnosis, and greater satisfaction with treatment and its effectiveness. Discomfort and flu-like symptoms were the most frequent reasons for non-compliance. The satisfaction and QoL were associated with less disability and number of therapeutic switches. ConclusionsThe rate of compliance, satisfaction and QoL in multiple sclerosis patients under DMTs is high, especially for those newly diagnosed, less disabled, and with fewer therapeutic switches. Discomfort and flu-like symptoms associated with injected therapies significantly affect adherence.

Caregiver burden, quality of life and walking ability in different disability levels of multiple sclerosis

The caregivers of Multiple Sclerosis (MS) individuals are usually burdened with a wide range of MS-related caregiving tasks which may result in damages of their daily life and quality of life (QOL). This study was designed to compare according to the disability level (1) the walking ability, quality of life (QOL), and disease impact of the MS patients (2) and the burden, QOL, self-efficacy and life satisfaction of their caregivers; (3) to determine the relationship between these outcome results, disease duration and caregivers' age. 772 MS patients were recruited, 47 MS patients and their 47 caregivers finished the study. Disability, walking ability, QOL, disease impact of the MS participants; the burden, QOL, self-efficacy, life satisfaction of the caregivers were evaluated. MS Patients with higher disability had significantly worse scores on the MSWS-12, MUSIQOL, MSIS-29, and PDSS (p < 0.01). The caregivers facing with higher disability had significantly worse scores on CBI and CAREQOL (p < 0.01). The impairments on disability level, walking and QOL of MS patients were related to OQL declines and increased burden of their caregivers. Therefore, it may be important to provide acceptable education and support strategies with individual intervention while defining the needs and goals of the MS patients and their caregivers to improve the rehabilitation success.

Cumplimiento terapéutico con terapias modificadoras de la enfermedad de primera línea en pacientes con esclerosis múltiple. Estudio COMPLIANCE

IntroductionNon-adherence to disease-modifying therapies (DMTs) in multiple sclerosis may be associated with reduced efficacy. We assessed compliance, the reasons for non-compliance, treatment satisfaction, and quality of life (QoL) of patients treated with first-line therapies. MethodsA cross-sectional, multicenter study was conducted that included relapsing multiple sclerosis patients. Compliance in the past month was assessed using Morisky-Green test. Seasonal compliance and reasons for non-compliance were assessed by an ad-hoc questionnaire. Treatment satisfaction and QoL were evaluated by means of TSQM and PRIMUS questionnaires. ResultsA total of 220 patients were evaluated (91% relapsing-remitting); the mean age was 39.1 years, 70% were female, and the average time under treatment was 5.4 years. Subcutaneous interferon (IFN) β-1b was used in 23% of the patients, intramuscular IFN β-1a in 21%, subcutaneous IFN β-1a in 37%, and with glatiramer acetate in 19%. The overall compliance was 75%, with no significant differences related to the therapy, and 81% did not report any seasonal variation. Compliant patients had significantly lower disability scores and time of diagnosis, and greater satisfaction with treatment and its effectiveness. Discomfort and flu-like symptoms were the most frequent reasons for non-compliance. The satisfaction and QoL were associated with less disability and number of therapeutic switches. ConclusionsThe rate of compliance, satisfaction and QoL in multiple sclerosis patients under DMTs is high, especially for those newly diagnosed, less disabled, and with fewer therapeutic switches. Discomfort and flu-like symptoms associated with injected therapies significantly affect adherence.

Use of the PRIMUS scale to assess quality of life in a Spanish population of multiple sclerosis patients

Abstract Introduction Symptoms of multiple sclerosis (MS) are associated with significant and progressive functional disability and have a profound impact on patients’ quality of life (QoL). QoL and daily life activities are two areas that suffer major changes during the course of MS and there are currently no questionnaires specifically designed to evaluate these areas in MS patients. Purpose To evaluate QoL of MS patients using the PRIMUS questionnaire and determine the possible relationship between QoL, duration of disease, and disability measured on the EDSS. Patients and methods Multi-centre epidemiological and cross-sectional study including 261 patients with relapsing remitting MS (RRMS) or secondary progressive MS (SPMS) treated with interferon beta-1b for at least 6 months. The validated version of the PRIMUS questionnaire was used for patient reporting of changes in QoL and life activities. Results Mean age of patients was 41.7 ± 10.3 years; 61.3% were women. Most had RRMS (83.9%). Mean time since MS diagnosis was 7.6 ± 5.8 years, and longer in the SPMS group (11.2 ± 7.4 vs 6.9 ± 5.2, P 5], P Conclusions QoL in MS patients varies according to the disease type, and it worsens progressively over time and with increasing disability. The PRIMUS questionnaire is a good tool for assessing QoL and activity in patients with MS.

Bowel management related quality of life in people with multiple sclerosis: Psychometric evaluation of the QoL-BM measure

BackgroundBowel dysfunction affects quality of life (QoL) of multiple sclerosis (MS) patients. Existing QoL measures specific to MS disease contain little or no assessment of bowel dysfunction. The Quality of Life Scoring Tool Relating to Bowel Management (QoL-BM) developed for spinal cord injured patients may be relevant for MS patients. ObjectiveDetermine reliability and validity of the QoL-BM scale with MS patients. MethodThe North American Research Committee on Multiple Sclerosis randomly selected 700 MS patients from their registry resulting in 502 respondents who completed the QoL-BM scale, Bowel Function Questionnaire for MS persons (Constipation, Fecal Incontinence, both Constipation and Fecal Incontinence), Patient Derived Disease Steps (mild, moderate, severe disability), MS classification (Relapsing-Remitting MS, Secondary Progressive MS), and demographic sheet. ResultsFactor analysis of the QoL-BM scale resulted in two subscales: Management and Relationships. Reliability coefficients for total and subscales were: .90, .86, and .83, respectively. Known-group validity was demonstrated as QoL-BM total scale and subscale scores differed significantly according to type of bowel dysfunction and disability level. ConclusionThe QoL-BM scale provides information on current bowel status and its impact on QoL for MS patients.

Cognitive function and quality of life in multiple sclerosis patients: a cross-sectional study

BackgroundNearly half of all patients diagnosed with multiple sclerosis (MS) will develop cognitive dysfunction. Studies highlighted from no/weak impact to a strong impact of cognitive impairment on quality of life (QoL). The aim of this study was to assess the impact of cognitive dysfunction on self-reported QoL in MS patients while considering key confounding factors.MethodsDesign: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, disease duration); MS disability (Expanded Disability Status Scale, EDSS); depression (Beck Depression Inventory); fatigue (Modified Fatigue Impact Scale); QoL (SF36 and MusiQoL); and neuropsychological performance (Brief Repeatable Battery of Neuropsychological Tests, BRB-N). Statistical analysis: multiple linear regressions (forward-stepwise selection).ResultsOne hundred and twenty-four patients were enrolled. Performance on BRB-N subtests varied widely (6% to 70% abnormal). The BRB-N classified 37-78% of the patients as cognitively impaired, depending on the definition of cognitive impairment. No links were found between the MusiQoL index and cognitive subtests, whereas marital status, EDSS, and depression were found to be independent predictive factors.ConclusionsThe present study demonstrated the weak and scarce association between cognitive impairment and QoL, when the key confounding factors were considered. These results need to be confirmed with larger samples and more accurate tests of cognitive function.

Patient-reported quality of life in multiple sclerosis differs between cultures and countries: a cross-sectional Austrian–German–Polish study

Background: Patient-reported quality of life (QOL) is an outcome measure in clinical trials in multiple sclerosis (MS), but translated QOL instruments may affect the actual comparability of data. Objectives: We aimed to investigate possible differences in QOL in MS between cultures and countries. We employed the Functional Assessment of Multiple Sclerosis (FAMS) Version 4 questionnaire, which is a state-of-the-art QOL instrument. Methods: Some 484 MS patients from Austria (145), Germany (144), and Poland (195) aged 20–60 years, and stratified for sex and disease severity as measured by the Expanded Disability Status Scale (EDSS) score completed the respective FAMS translation and a socio-demographic questionnaire. Results: Analysis of variance and post-hoc Scheffé-test showed that 64% of the FAMS items were answered significantly differently (p < 0.001) between the three countries. A multivariate regression analysis including all the available disease-related and socio-demographic variables revealed the factors age, EDSS score, employment, social contacts, MS course, and country to be significant predictors of both the total FAMS score and the score for items answered differently between the three countries. Conclusions: Differences exist in the QOL of MS patients from Austria, Germany, and Poland which seem to lie beyond the impact of disease severity. They appear to be related to culture or other country-specific factors, as country was an independent predictor of differently answered items of the FAMS and thus also of the whole FAMS. QOL instruments should consider this aspect to faithfully reflect subjective information such as patient-reported benefit of treatment in multinational clinical trials.

Quality of Life in Patients With Multiple Sclerosis in Turkey: Relationship to Depression and Fatigue

The purposes of this study were to assess the self-reported quality of life (QOL) in a group of Turkish patients with multiple sclerosis (MS) and to analyze whether the QOL was associated with fatigue and depression. The study used a descriptive design. A number of evaluation scales were administered to a study sample comprising 47 outpatients. The Short Form 36 for QOL, the Beck Depression Inventory for Depression, and the Visual Analogue Scale for Fatigue were used. The mean score for general QOL was 34.8 and indicated low QOL in MS patients. The results of our study have also shown that fatigue and depression strongly influence QOL in Turkish MS patients. Our findings may have important implications for the overall care of MS patients. The QOL of MS patients was affected negatively. Both fatigue and depression are common and treatable manifestations of MS, and these symptoms should be screened carefully in all MS patients. Care of MS patients requires the collaboration of all team members. Nurses have a key role as part of this team through the continuity of the care they provide and interaction with patients. Awareness of depression and fatigue can contribute to the nurses' ability to provide psychological support and enhance the QOL in MS patients.