Journal of Neurology

, 254:767

High concurrent presence of disability in multiple sclerosis

Associations with perceived health
  • Sverker Johansson
  • Charlotte Ytterberg
  • Ingrid M. Claesson
  • Jenny Lindberg
  • Jan Hillert
  • Magnus Andersson
  • Lotta Widén Holmqvist
  • Lena von Koch



(1) To explore functioning and concurrent presence of disabilities — concerning cognition, manual dexterity, walking, energy, mood, activities of daily living (ADL), and social/lifestyle activities — in persons with multiple sclerosis (PwMS) cared for at an outpatient MS clinic. 2) To describe the PwMS’ perceived physical and psychological impact and associations with the same disabilities.


A descriptive cross-sectional study was carried out in 219 PwMS at the MS Centre, Karolinska University Hospital. Logistic regression employing proportional odds models was used to identify the associations of the disabilities with the perceived physical and psychological impact.


In this sample the distribution with regard to disease severity as per Expanded Disability Status Scale was; mild 59.5%, moderate 17% and severe 23.5%. Despite the high proportion with mild disease severity disability regarding cognition was found in 49%, manual dexterity 76%, walking 43%, energy 67%, mood 29%, ADL 44% and social/lifestyle activities in 48%. Two or more disabilities were found in 80%, 24 % had six or seven disabilities. Disability regarding energy, mood, walking, manual dexterity and ADL was significantly associated with increase in the perceived physical impact, whereas disability in energy and mood was significantly associated with increase in the perceived psychological impact.


The presence of several concurrent disabilities, some significantly associated with high perceived physical and psychological impact, in the majority of PwMS in outpatient clinics highlights the importance to identify disabilities, in particular fatigue and depressed mood, in order to supply health care interventions aiming to improve the life situation of PwMS.

Key words

multiple sclerosis outpatient functioning disability perceived health 


  1. 1.
    Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L (2001) Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler 7:340–344PubMedGoogle Scholar
  2. 2.
    Asberg KH, Sonn U (1989) The cumulative structure of personal and instrumental ADL. A study of elderly people in a health service district. Scand J Rehabil Med 21:171–177PubMedGoogle Scholar
  3. 3.
    Aupperle RL, Beatty WW, Shelton Fde N, Gontkovsky ST (2002) Three screening batteries to detect cognitive impairment in multiple sclerosis. Mult Scler 8:382–389CrossRefPubMedGoogle Scholar
  4. 4.
    Beatty WW, Goodkin DE (1990) Screening for cognitive impairment in multiple sclerosis. An evaluation of the Mini-Mental State Examination. Arch Neurol 47:297–301PubMedGoogle Scholar
  5. 5.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedGoogle Scholar
  6. 6.
    Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100CrossRefGoogle Scholar
  7. 7.
    Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH (2002) Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 159:1862–1868CrossRefPubMedGoogle Scholar
  8. 8.
    Einarsson U, Gottberg K, von Koch L, Fredrikson S, Ytterberg C, Jin Y-P (2006) Andersson M, Widén Holmqvist L Cognitive, and motor function in people with multiple sclerosis in Stockholm County. Mult Scler 12:340–353CrossRefPubMedGoogle Scholar
  9. 9.
    Einarsson U, Gottberg K, Fredrikson S, von Koch L, Widén Holmqvist L (2006) Activities of daily living, and social activities in persons with multiple sclerosis in Stockholm County. Clin Rehabil 20:543–551CrossRefPubMedGoogle Scholar
  10. 10.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  11. 11.
    Goodkin DE, Hertsgaard D, Seminary J (1988) Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests. Arch Phys Med Rehabil 69:850–854PubMedGoogle Scholar
  12. 12.
    Gronwall DM (1977) Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills 44:367–373PubMedGoogle Scholar
  13. 13.
    Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A (2001) The Multiple Sclerosis Impact Scale (MSIS- 29): a new patient-based outcome measure. Brain 124:962–973CrossRefPubMedGoogle Scholar
  14. 14.
    Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB, Vollmer T, Weiner LP, Wolinsky JS, Copolymer 1 Multiple Sclerosis Study Group (2001) Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability. 1998. Neurology 57:S46–S53PubMedGoogle Scholar
  15. 15.
    Kaufman M, Moyer D, Norton J (2000) The significant change for the Timed 25- foot Walk in the multiple sclerosis functional composite. Mult Scler 6:286–290PubMedGoogle Scholar
  16. 16.
    Kersten P, George S, McLellan L, Smith JA, Mullee MA (2000) Disabled people and professionals differ in their perceptions of rehabilitation needs. J Public Health Med 22:393–399CrossRefPubMedGoogle Scholar
  17. 17.
    Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437PubMedGoogle Scholar
  18. 18.
    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123PubMedGoogle Scholar
  19. 19.
    Krupp LB, Rizvi SA (2002) Symptomatic therapy for underrecognized manifestations of multiple sclerosis. Neurology 58(Suppl 4):S32–39PubMedGoogle Scholar
  20. 20.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 77:1444–1452Google Scholar
  21. 21.
    Lobentanz IS, Asenbaum S, Vass K, Sauter C, Klosch G, Kollegger H, Kristoferitsch W, Zeitlhofer J (2004) Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand 110:6–13CrossRefPubMedGoogle Scholar
  22. 22.
    Mathiowetz V, Weber K, Kashman N, Volland G (1985) Adult norms for the Nine Hole Peg Test of finger dexterity. Occup Ther J Res 5:24–28Google Scholar
  23. 23.
    Mohr DC, Goodkin DE, Likosky W, Beutler L, Gatto N, Langan MK (1997) Identification of Beck Depression Inventory items related to multiple sclerosis. J Behav Med 20:407–414CrossRefPubMedGoogle Scholar
  24. 24.
    No authors listed (1998) Burden of illness of multiple sclerosis: Part II: Quality of life. The Canadian Burden of Illness Study Group. Can J Neurol Sci 25:31–38Google Scholar
  25. 25.
    Nortvedt MW, Riise T, Myhr KM, Nyland HI (1999) Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology 53:1098–1103PubMedGoogle Scholar
  26. 26.
    Oberg T, Karsznia A, Oberg K (1993) Basic gait parameters: reference data for normal subjects, 10–29 years of age. J Rehabil Res Dev 30:210–223PubMedGoogle Scholar
  27. 27.
    Patten SB, Beck CA, Williams JVA, Barbui C, Metz LM (2003) Major depression in multiple sclerosis: a population-based perspective. Neurology 61:1524–1527PubMedGoogle Scholar
  28. 28.
    Poser C, Paty D, Scheinberg L, McDonald W, Davis F, Ebers G (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231CrossRefPubMedGoogle Scholar
  29. 29.
    Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 41:685–691PubMedGoogle Scholar
  30. 30.
    Rodriguez M, Siva A, Ward J, Stolp- Smith K, O’Brien P, Kurland L (1994) Impairment, disability, and handicap in multiple sclerosis: a population-based study in Olmsted County, Minnesota. Neurology 44:28–33PubMedGoogle Scholar
  31. 31.
    Rudick RA, Goodkin DE, Jacobs LD, Cookfair DL, Herndon RM, Richert JR, Salazar AM, Fischer JS, Granger CV, Simon JH, Alam JJ, Simonian NA, Campion MK, Bartoszak DM, Bourdette DN, Braiman J, Brownscheidle CM, Coats ME, Cohan SL, Dougherty DS, Kinkel RP, Mass MK, Munschauer FE, Priore RL, Pullicino PM, Scherokman BJ, Weistock-Guttman B, Whitham RH, Multiple Sclerosis Collaborative Research Group (2001) Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis. 1997. Neurology 57:S25–30PubMedGoogle Scholar
  32. 32.
    Smith A (1982) Symbol Digit Modalities Test (SDMT). In: Lezak M (ed) Neuropsychological assessment. 3rd ed. Oxford University Press, New York, pp 379–381Google Scholar
  33. 33.
    Swingler RJ, Compston DA (1992) The morbidity of multiple sclerosis. Q J Med 83:325–337PubMedGoogle Scholar
  34. 34.
    Swirsky-Sacchetti T, Field HL, Mitchell DR, Seward J, Lublin FD, Knobler RL, Gonzales CF (1992) The sensitivity of the Mini-Mental State Exam in the white matter dementia of multiple sclerosis. J Clin Psychol 48:779–786CrossRefPubMedGoogle Scholar
  35. 35.
    The National Collaborating Centre for Chronic Conditions at the Royal College of Physicians (2004) Multiple Sclerosis. Available at: http://www.rcplondon. Accessed April 27, 2006Google Scholar
  36. 36.
    The Swedish MS Association (2005) Sundström P, Vrethem M, Wallentin F, Myr Å (Editorial Committee). Metodboken. Accessed April 27, 2006Google Scholar
  37. 37.
    The Swedish MS Registry http:// Accessed April 27, 2006Google Scholar
  38. 38.
    Turnbull JC, Kersten P, Habib M, McLellan L, Mullee MA, George S (2000) Validation of the Frenchay Activities Index in a general population aged 16 years and older. Arch Phys Med Rehabil 81:1034–1038CrossRefPubMedGoogle Scholar
  39. 39.
    Wade DT, Legh-Smith J, Langton Hewer R (1985) Social activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med 7:176–181PubMedGoogle Scholar
  40. 40.
    WHO. World Health Organization (2001) International classification of functioning, disability and health Accessed March 13, 2006Google Scholar

Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Sverker Johansson
    • 1
    • 4
  • Charlotte Ytterberg
    • 1
    • 4
  • Ingrid M. Claesson
    • 2
  • Jenny Lindberg
    • 2
  • Jan Hillert
    • 1
  • Magnus Andersson
    • 3
  • Lotta Widén Holmqvist
    • 1
    • 4
  • Lena von Koch
    • 1
  1. 1.Division of Neurology, Dept. of Clinical NeuroscienceKarolinska Institutet, Karolinska University Hospital HuddingeStockholmSweden
  2. 2.Dept. of Physical TherapyKarolinska University Hospital HuddingeStockholmSweden
  3. 3.Division of Neurology, Dept. of Clinical NeuroscienceKarolinska Institutet, Karolinska University Hospital SolnaStockholmSweden
  4. 4.Division of Physiotherapy 23100, Dept. of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden

Personalised recommendations