Journal of Neurology

, Volume 243, Issue 4, pp 337–344 | Cite as

Impairment, disability and handicap in multiple sclerosis A cross-sectional study in an incident cohort in Møre and Romsdal County, Norway

  • Rune Midgard
  • Trond Rüse
  • Harald Nyland
Original Communication


We conducted a cross-sectional, geographically based study of functional status in an incident cohort of 124 multiple sclerosis (MS) patients with onset of disease from 1 January 1976 to 31 December 1986 in Møre and Romsdal County, Norway. The cohort comprised 58 men (46.8%) and 66 women (53.2%). One hundred and thirteen patients (91.1 %) had a primary remitting course of disease and 11 (8.9%) had primary progressive MS. The mean age of onset was 33.3 years (range 14–64), and the mean duration of disease 7.8 years (range 1–23). The Minimal Record of Disability (MRD) of multiple sclerosis was applied to measure the degree of impairment, disability and handicap. The mean Kurtzke Expanded Disability Status Scale (EDSS) score was 3.76 (0–10), and the frequency distribution of the EDSS scores in the cohort was bimodal. Twenty-eight (22.6%) patients in the cohort had marked paraparesis, paraplegia or quadriplegia. Nineteen patients (15.3%) had frequent urinary incontinence, need for almost constant catheterization, or need for constant use of measures to evacuate stools. Five patients (4%) had a severe decrease in mentation or dementia. Forty-eight patients (38.7%) reported frequent problems with fatigue or fatigability preventing sustained physical function. Less than half of the cohort (42.7%) was working fulltime, and 49.2% of the patients reported that they received external support to maintain their usual financial standard. Lack of ability to work full-time and accordingly the dependence upon external financial support were significantly associated with the primary progressive course of disease. Fatigue was statistically significantly related to lack of working ability. The estimated cost of MS in the county in 1991 was 48.2 million NOK (≈ 7.531.250 US $) based on the cost-of-illness methodology.

Key words

Multiple sclerosis Impairment Disability Handicap 


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  1. 1.
    Ammann W, Plohmann A, Roelcke U, Leenders KL, Lechner-Scott J, Huber S, Kappos L (1995) Assessment of fatigue in multiple sclerosis (MS), correlation with neurological and neuropsychological findings. J Neurol 242 [Suppl 2]: S119Google Scholar
  2. 2.
    Bauer HJ (1980) IMAB Enquete concerning the diagnosis criteria for MS. In: Bauer HJ, Poser S, Ritter G (eds) Progress in multiple sclerosis research. Springer, Berlin Heidelberg New York, pp 555–563Google Scholar
  3. 3.
    Bergamaschi R, Romani A, Zilioli A, Raiola E, Versino M, Cosi V (1995) Fatigue and motor impairment in 100 multiple sclerosis patients. J Neurol 242 [Suppl 2]: S112Google Scholar
  4. 4.
    Grønning M, Hannisdal E, Mellgren SI (1990) Multivariate analyses of factors associated with unemployment in people with multiple sclerosis. J Neurol Neurosurg Psychiatry 53:388–390Google Scholar
  5. 5.
    Hodgson TA, Meiners MR (1982) Cost-of-illness methodology: a guide to current practices and procedures. Milbank Memorial Fund Quarterly/Health and Society 60 (3):429–462Google Scholar
  6. 6.
    Hohol MJ, Orav EJ, Weiner HL (1995) Disease Steps in multiple sclerosis: a simple approach to evaluate disease progression. Neurology 45:251–255Google Scholar
  7. 7.
    Hutchinson J, Hutchinson M (1995) The Functional Limitations Profile may be a valid, reliable and sensitive measure of disability in multiple sclerosis. J Neurol 242:650–657Google Scholar
  8. 8.
    Jönsson B (1995) The economic cost of multiple sclerosis in Sweden. EFI Research Paper no. 6551Google Scholar
  9. 9.
    Kornblith AB, LaRocca NG, Baum HM (1986) Employment in individuals with multiple sclerosis. Int J Rehabil Res 9:155–165Google Scholar
  10. 10.
    Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437Google Scholar
  11. 11.
    Kurtzke JF (1955) A new scale for evaluating disability in multiple sclerosis. Neurology 5:580–583Google Scholar
  12. 12.
    Kurtzke JF (1989) The Disability Status Scale for multiple sclerosis: apologia pro DSS sua. Neurology 39:291–302Google Scholar
  13. 13.
    LaRocca J, Kalb R, Scheinberg L, Kendall P (1985) Factors associated with unemployment of patients with multiple sclerosis. J Chronic Dis 38:203–210Google Scholar
  14. 14.
    LaRocca NG, Scheinberg LC, Slater RJ, et al (1984) Field testing of a minimal record of disability in multiple sclerosis: the United States and Canada. Acta Neurol Scand [Suppl] 101:126–138Google Scholar
  15. 15.
    MacLean AR, Berkson J (1951) Mortality and disability in multiple sclerosis. A statistical estimate of prognosis. JAMA 15:1367–1369Google Scholar
  16. 16.
    Martyn CN (1991) The epidemiology of multiple sclerosis. In: Matthews WB, Compston A, Allen IV, Martyn CN (eds) McAlpine's multiple sclerosis. Churchill Livingstone, Edinburgh, pp 9–10Google Scholar
  17. 17.
    Matthews WB (1985) Clinical aspects. Course and prognosis. In: Matthews WB, Acheson ED, Batchelor JR, Weller RO (eds) McAlpine's multiple sclerosis. Churchill Livingstone, Edinburgh, pp 49–72Google Scholar
  18. 18.
    Midgard R, Riise T, Nyland H (1991) Epidemiologic trends in multiple sclerosis in Møre and Romsdal, Norway: a prevalence/incidence study in a stable population. Neurology 41:887–892Google Scholar
  19. 19.
    Midgard R, Riise T, Kvåle G, Nyland H (in press) Disability and mortality in multiple sclerosis in Western Norway. Acta Neurol ScandGoogle Scholar
  20. 20.
    Midgard R, Albrektsen G, Riise T, Kvåle G, Nyland H (1995) Prognostic factors for survival in multiple sclerosis: a longitudinal, population based study in Møre and Romsdal, Norway. J Neurol Neurosurg Psychiatry 58:417–421Google Scholar
  21. 21.
    Minimal Record of Disability for Multiple Sclerosis (1985) U.S. National Multiple Sclerosis Society, New YorkGoogle Scholar
  22. 22.
    Mitchell JN (1981) Multiple sclerosis and the prospects for employment. J Soc Occup Med 31:134–138Google Scholar
  23. 23.
    Norušis MJ (1993) SPSS for Windows. Advanced Statistics Release 6.0. SPSS Inc., ChicagoGoogle Scholar
  24. 24.
    Phillips VL (1995) Community care for severely disabled people on low incomes. BMJ 311:1121–1123Google Scholar
  25. 25.
    Riise T, Grønning M, Aarli JA, Nyland H, Larsen JP, Edland A (1988) Prognostic factors for life expectancy in multiple sclerosis analysed by Cox-models. J Clin Epidemiol 41:1031–1036Google Scholar
  26. 26.
    Riise T, Grønning M, Fernández O, Lauer K, Midgard R, Minderhoud JM, Nyland H, Pálffy G, Poser S, Aarli JA (1992) Early prognostic factors for disability in multiple sclerosis, a European multicenter study. Acta Neurol Scand 85:212–218Google Scholar
  27. 27.
    Rodriguez M, Siva A, Ward J, Stolp-Smith K, O'Brien P, Kurland LT (1994) Impairment, disability, and handicap in multiple sclerosis: a population-based study in Olmsted County, Minnesota. Neurology 44:28–33Google Scholar
  28. 28.
    Runmarker B, Andersen O (1993) Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up. Brain 116:117–134Google Scholar
  29. 29.
    Slater RJ, LaRocca NG, Scheinberg LC (1984) Development and testing of a minimal record of disability in multiple sclerosis. Ann NY Acad Sci 436:453–468Google Scholar
  30. 30.
    Stein REK, Gortmaker SL, Perrin EC, et al (1987) Severity of illness: concepts and measurements. Lancet II:1506–1509Google Scholar
  31. 31.
    Swingler RJ, Compston DAS (1992) The morbidity of multiple sclerosis. Q J Med 83:325–337Google Scholar
  32. 32.
    Weinshenker BG, Bass B, Rice GPA, Noseworthy J, Carriere W, Baskerville J, Ebers GC (1989) The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain 112:133–146Google Scholar
  33. 33.
    Willoughby EW, Paty DW (1988) Scales for rating impairment in multiple sclerosis: a critique. Neurology 38:1793–1798Google Scholar
  34. 34.
    Wood C (1994) The cost of multiple sclerosis — a pharmacoeconomic model. Mineo, University of OxfordGoogle Scholar
  35. 35.
    Zeldow PB, Pavlou M (1988) Physical and psychosocial functioning in multiple sclerosis: descriptions, correlations, and a tentative typology. Br J Med Psychol 61:185–195Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Rune Midgard
    • 1
  • Trond Rüse
    • 2
  • Harald Nyland
    • 3
  1. 1.Department of NeurologyMolde County HospitalMoldeNorway
  2. 2.Department of Occupational MedicineUniversity of BergenBergenNorway
  3. 3.Department of NeurologyUniversity of BergenBergenNorway

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