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Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis

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Abstract

Introduction

Few studies have evaluated the contribution of individual symptoms and impairments to the burden of multiple sclerosis (MS). This article reviews the contribution of walking impairment, fatigue, spasticity, depression, and pain, to quality of life (QOL) of the patient and economic burden of MS.

Methods

Studies for inclusion were chosen from the literature that reported on QOL and costs in patients with MS, identified through PubMed searches (main search terms: “multiple sclerosis” combined with “quality of life,” “costs,” or “burden”). Articles were selected based on whether the analyses included evaluation of symptoms and impairments as contributory factors to QOL or costs.

Results

Impaired mobility was ranked to be of high concern, and was suggested to be an important contributory factor to QOL, having a greater impact on physical components than mental components. Fatigue was associated with QOL, with effects on both physical and mental components of QOL, independent of disability level. Depression was inversely associated with QOL. Spasticity may affect physical components of QOL, and daily activities may be impacted in as many as 44% of patients with MS. Pain, occurring in up to 86% of patients with MS, impacts daily function and QOL across the range of physical and mental domains. The contribution of these impairments and symptoms to the economic burden has been less well characterized, although the importance of mobility to employment and productivity has been suggested by several studies.

Conclusions

Evidence suggests that impaired mobility and symptoms such as fatigue, pain, depression, and spasticity are important contributory factors to the observed reduction in QOL, and in some cases, increased costs, associated with MS. There is a need for greater recognition of the presence and effects of these disabilities, and effective targeted treatment options for specific impairments, potentially resulting in improved QOL and reduced indirect costs.

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References

  1. National Multiple Sclerosis Society web site. About MS. Available at: http://www.nationalmssociety.org/about-multiple-sclerosis/index.aspx. Accessed April 3, 2009.

  2. Prescott JD, Factor S, Pill M, Levi GW. Descriptive analysis of the direct medical costs of multiple sclerosis in 2004 using administrative claims in a large nationwide database. J Manag Care Pharm. 2007;13:44–52.

    PubMed  Google Scholar 

  3. Minden S, Hoaglin D, Jureidini S, et al. Disease-modifying agents in the Sonya Slifka Longitudinal Multiple Sclerosis Study. Mult Scler. 2008;14:640–655.

    Article  CAS  PubMed  Google Scholar 

  4. Richards RG, Sampson FC, Beard SM, Tappenden P. A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models. Health Technol Assess. 2002;6:1–73.

    Article  CAS  PubMed  Google Scholar 

  5. Schwendimann RN. Treatment of symptoms in multiple sclerosis. Neurol Res. 2006;28:306–315.

    Article  PubMed  Google Scholar 

  6. Henze T, Rieckmann P, Toyka KV; Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur Neurol. 2006;56:78–105.

    Article  CAS  PubMed  Google Scholar 

  7. Boissy AR, Cohen JA. Multiple sclerosis symptom management. Expert Rev Neurother. 2007;7:1213–1222.

    Article  PubMed  Google Scholar 

  8. Cohen BA. Identification, causation, alleviation, and prevention of complications (ICAP): an approach to symptom and disability management in multiple sclerosis. Neurology. 2008;71(suppl. 3):S14–S20.

    Google Scholar 

  9. Rothwell PM, McDowell Z, Wong CK, Dorman PJ. Doctors and patients don’t agree: cross sectional study of patients’ and doctors’ perceptions and assessments of disability in multiple sclerosis. BMJ. 1997;314:1580–1583.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Hemmett L, Holmes J, Barnes M, Russell N. What drives quality of life in multiple sclerosis? QJM. 2004;97:671–676.

    Article  CAS  PubMed  Google Scholar 

  11. Nortvedt MW, Riise T, Myhr KM, Nyland HI. Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology. 1999;53:1098–1103.

    Article  CAS  PubMed  Google Scholar 

  12. Solari A, Radice D. Health status of people with multiple sclerosis: a community mail survey. Neurol Sci. 2001;22:307–315.

    Article  CAS  PubMed  Google Scholar 

  13. Wu N, Minden SL, Hoaglin DC, Hadden L, Frankel D. Quality of life in people with multiple sclerosis: data from the Sonya Slifka Longitudinal Multiple Sclerosis Study. J Health Hum Serv Adm. 2007;30:233–267.

    PubMed  Google Scholar 

  14. Gottberg K, Einarsson U, Ytterberg C, et al. Health-related quality of life in a population-based sample of people with multiple sclerosis in Stockholm County. Mult Scler. 2006;12:605–612.

    Article  CAS  PubMed  Google Scholar 

  15. Kobelt G, Berg J, Atherly D, Hadjimichael O. Costs and quality of life in multiple sclerosis: a cross-sectional study in the United States. Neurology. 2006;66:1696–1702.

    Article  PubMed  Google Scholar 

  16. Orme M, Kerrigan J, Tyas D, Russell N, Nixon R. The effect of disease, functional status, and relapses on the utility of people with multiple sclerosis in the UK. Value Health. 2007;10:54–60.

    Article  PubMed  Google Scholar 

  17. Jones CA, Pohar SL, Warren S, Turpin KVL, Warren KG. The burden of multiple sclerosis: a community health survey. Health Qual Life Outcomes. 2008;6:1.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–1452.

    Article  CAS  PubMed  Google Scholar 

  19. Martin CL, Phillips BA, Kilpatrick TJ, et al. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler. 2006;12:620–628.

    Article  CAS  PubMed  Google Scholar 

  20. Goldman M, Marrie RA, Cohen JA. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler. 2008;14:383–390.

    Article  PubMed  Google Scholar 

  21. Johansson S, Ytterberg C, Claesson IM, et al. High concurrent presence of disability in multiple sclerosis. Associations with perceived health. J Neurol. 2007;254:767–773.

    Article  PubMed  Google Scholar 

  22. Kurtzke JF, Wallin MT. Epidemiology. In: Burks JS, Johnson KP, eds. Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation. New York: Demos Medical Publishing, Inc; 2000:49–71.

    Google Scholar 

  23. Whetten-Goldstein K, Sloan FA, Goldstein LB, Kulas ED. A comprehensive assessment of the cost of multiple sclerosis in the United States. Mult Scler. 1998;4:419–425.

    Article  CAS  PubMed  Google Scholar 

  24. Kobelt G, Berg J, Lindgren P, Fredrikson S, Jönsson B. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry. 2006;77:918–926.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Kobelt G, Berg J, Lindgren P, Kerrigan J, Russell N, Nixon R. Costs and quality of life of multiple sclerosis in the United Kingdom. Eur J Health Econ. 2006;7(suppl. 2):S96–S104.

    Article  PubMed  Google Scholar 

  26. McCrone P, Heslin M, Knapp M, Bull P, Thompson A. Multiple sclerosis in the UK: service use, costs, quality of life and disability. Pharmacoeconomics. 2008;26:847–860.

    Article  PubMed  Google Scholar 

  27. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

    Article  PubMed  Google Scholar 

  28. Ware JE, Kosinski M, Keller SD. A 12-item short form health survey (SF-12): construction of scales and preliminary tests of reliability and validity. Med Care. 1996;32:220–233.

    Article  Google Scholar 

  29. Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res. 1995;4:187–206.

    Article  CAS  PubMed  Google Scholar 

  30. Feeny D, Furlong W, Boyle M, Torrance GW. Multiattribute health status classification systems. Health Utilities Index. Pharmacoeconomics. 1995;7:490–502.

    Article  CAS  PubMed  Google Scholar 

  31. The EuroQuol Group. EuroQol-a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.

    Article  Google Scholar 

  32. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–558.

    Article  Google Scholar 

  33. Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A. The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain. 2001;124:962–973.

    Article  CAS  PubMed  Google Scholar 

  34. Swingler RJ, Compston DA. The morbidity of multiple sclerosis. Q J Med. 1992;83:325–337.

    CAS  PubMed  Google Scholar 

  35. World Health Organization (WHO). International Classification of Functioning, Disability and Health (ICF). Available at: http://www.who.int/classifications/icfbrowser/. Accessed April 3, 2009.

  36. Myhr KM, Riise T, Vedeler C, et al. Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension. Mult Scler. 2001;7:59–65.

    Article  CAS  PubMed  Google Scholar 

  37. Paltamaa J, Sarasoja T, Leskinen E, Wikström J, Mälkiä E. Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis. Arch Phys Med Rehabil. 2007;88:1649–1657.

    Article  PubMed  Google Scholar 

  38. Datamonitor Healthcare Reports. Treatment algorithms 1999: segmenting the multiple sclerosis patient population. London, UK: Datamonitor Healthcare Reports; 1999.

  39. Heesen C, Bohm J, Reich C, Kasper J, Goebel M, Gold SM. Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler. 2008;14:988–991.

    Article  CAS  PubMed  Google Scholar 

  40. Forbes A, While A, Mathes L, Griffiths P. Health problems and health-related quality of life in people with multiple sclerosis. Clin Rehabil. 2006;20:67–78.

    Article  PubMed  Google Scholar 

  41. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ. The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci. 1994;21:9–14.

    Article  CAS  PubMed  Google Scholar 

  42. Wynia K, Middel B, van Dijk JP, De Keyser JH, Reijneveld SA. The impact of disabilities on quality of life in people with multiple sclerosis. Mult Scler. 2008;14:972–980.

    Article  CAS  PubMed  Google Scholar 

  43. Hadjimichael O, Vollmer T, Oleen-Burkey M; North American Research Committee on Multiple Sclerosis. Fatigue characteristics in multiple sclerosis: the North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes. 2008;6:100.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Kos D, Kerckhofs E, Nagels G, D’hooghe MB, Ilsbroukx S. Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil Neural Repair. 2008;22:91–100.

    Article  CAS  PubMed  Google Scholar 

  45. The Canadian Burden of Illness Study Group. Burden of illness of multiple sclerosis: Part II: Quality of life. Can J Neurol Sci. 1998;25:31–38.

    Article  Google Scholar 

  46. Pfennings L, Cohen L, Miller D, et al. Using the Short Form-36 with multiple sclerosis patients in five countries: a cross-cultural comparison. Psychol Rep. 1999;85:19–31.

    Article  CAS  PubMed  Google Scholar 

  47. Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler. 2001;7:340–344.

    Article  CAS  PubMed  Google Scholar 

  48. Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci. 2002;205:51–58.

    Article  PubMed  Google Scholar 

  49. Merkelbach S, Sittinger H, Koenig J. Is there a differential impact of fatigue and physical disability on quality of life in multiple sclerosis? J Nerv Ment Dis. 2002;190:388–393.

    Article  PubMed  Google Scholar 

  50. Benedict RH, Wahlig E, Bakshi R, et al. Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci. 2005;231:29–34.

    Article  PubMed  Google Scholar 

  51. Pittion-Vouyovitch S, Debouverie M, Guillemin F, Vandenberghe N, Anxionnat R, Vespignani H. Fatigue in multiple sclerosis is related to disability, depression and quality of life. J Neurol Sci. 2006;243:39–45.

    Article  CAS  PubMed  Google Scholar 

  52. Fruehwald S, Loeffler-Stastka H, Eher R, Saletu B, Baumhackl U. Depression and quality of life in multiple sclerosis. Acta Neurol Scand. 2001;104:257–261.

    Article  CAS  PubMed  Google Scholar 

  53. Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler. 2004;10:589–595.

    Article  CAS  PubMed  Google Scholar 

  54. O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2008;137:96–111.

    Article  PubMed  Google Scholar 

  55. Grasso MG, Clemenzi A, Tonini A, et al. Pain in multiple sclerosis: a clinical and instrumental approach. Mult Scler. 2008;14:506–513.

    Article  CAS  PubMed  Google Scholar 

  56. Svendsen KB, Jensen TS, Hansen HJ, Bach FW. Sensory function and quality of life in patients with multiple sclerosis and pain. Pain. 2005;114:473–481.

    Article  PubMed  Google Scholar 

  57. Khan F, Pallant J. Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain. 2007;8:614–623.

    Article  PubMed  Google Scholar 

  58. Hadjimichael O, Kerns RD, Rizzo MA, Cutter G, Vollmer T. Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain. 2007;127:35–41.

    Article  PubMed  Google Scholar 

  59. Beiske AG, Pedersen ED, Czujko B, Myhr KM. Pain and sensory complaints in multiple sclerosis. Eur J Neurol. 2004;11:479–482.

    Article  CAS  PubMed  Google Scholar 

  60. Svendsen KB, Jensen TS, Overvad K, Hansen HJ, Koch-Henriksen N, Bach FW. Pain in patients with multiple sclerosis: a population-based study. Arch Neurol. 2003;60:1089–1094.

    Article  PubMed  Google Scholar 

  61. Ehde DM, Gibbons LE, Chwastiak L, Bombardier CH, Sullivan MD, Kraft GH. Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler. 2003;9:605–611.

    Article  PubMed  Google Scholar 

  62. Kalia LV, O’Connor PW. Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult Scler. 2005;11:322–327.

    Article  PubMed  Google Scholar 

  63. Rao SM, Leo GJ, Ellington L, Nauertz T, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology. 1991;41:692–696.

    Article  CAS  PubMed  Google Scholar 

  64. Nortvedt MW, Riise T, Myhr KM, Landtblom AM, Bakke A, Nyland HI. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler. 2001;7:231–235.

    Article  CAS  PubMed  Google Scholar 

  65. Nortvedt MW, Riise T, Frugård J, et al. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler. 2007;13:106–112.

    Article  CAS  PubMed  Google Scholar 

  66. Patwardhan MB, Matchar DB, Samsa GP, McCrory DC, Williams RG, Li TT. Cost of multiple sclerosis by level of disability: a review of literature. Mult Scler. 2005;11:232–239.

    Article  CAS  PubMed  Google Scholar 

  67. Scheinberg L, Holland N, Larocca NG, Laitin P, Bennett A, Hall H. Multiple sclerosis. Earning a living. N Y State J Med. 1980;80:1395–1400.

    CAS  PubMed  Google Scholar 

  68. Edgley K, Sullivan M, Dehoux E. A survey of multiple sclerosis: II. Determinants of employment status. Can J Rehabil. 1991;4:127–132.

    Google Scholar 

  69. Kornblith AB, LaRocca NG, Baum HM. Employment in individuals with multiple sclerosis. Int J Rehabil Res. 1986;9:155–165.

    Article  CAS  PubMed  Google Scholar 

  70. Julian LJ, Vella L, Vollmer T, Hadjimichael O, Mohr DC. Employment in multiple sclerosis: exiting and re-entering the work force. J Neurol. 2008;255:1354–1360.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Piwko C, Desjardins OB, Bereza BG, et al. Pain due to multiple sclerosis: analysis of the prevalence and economic burden in Canada. Pain Res Manag. 2007;12:259–265.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Casado V, Romero L, Gubieras L, et al. An approach to estimating the intangible costs of multiple sclerosis according to disability in Catalonia, Spain. Mult Scler. 2007;13:800–804.

    Article  CAS  PubMed  Google Scholar 

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  1. The Multiple Sclerosis Center at Doctors Hospital, 6862 Granada Boulevard, Coral Gables, Florida, 33146, USA

    Howard L. Zwibel

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Zwibel, H.L. Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis. Adv Therapy 26, 1043–1057 (2009). https://doi.org/10.1007/s12325-009-0082-x

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