Quality of life is a measure of a person’s level of comfort, health and happiness. For people with multiple sclerosis (MS), a new study has found that there are specific factors that can influence a person’s physical and mental quality of life. The study is published in the August 10, 2022 online issue of Neurology®the medical journal of the American Academy of Neurology.
Multiple sclerosis is a disease of the central nervous system that consists of the brain, spinal cord and optic nerves. It is chronic and can be unpredictable and disabling. Symptoms may include fatigue, numbness and tingling, loss of balance, weakness, and vision problems. While there is currently no cure for MS, there are medications to alter the course of the disease and slow its progress and treat the symptoms.
People with multiple sclerosis report a lower quality of life compared to people without the disease, and even people with other chronic conditions. There are several factors that can play a role. Our research sought to identify such factors so that they can be addressed early in the course of the disease.”
Julia O’Mahony, PhD, study author, Health Sciences Center Winnipeg in Winnipeg, Canada
The study involved 4,888 people enrolled in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, 81% women, with an average age of 42 years when they were diagnosed with MS. All were diagnosed within three years of the start of the study.
Each person was assessed for health-related quality of life at least three times and completed an average of 12 quality of life questionnaires for up to 27 years.
For physical quality of life, researchers divided the participants into five groups. The first group, 26% of the participants, had a consistently low and stable quality of life. The second group, 29%, had a moderately low and stable quality of life. The third group, 13%, had a moderate to low quality of life in the first years after diagnosis, followed by a normal quality of life thereafter. The fourth group, 17%, had an early decline and then an increase to moderate to normal quality of life. The fifth group, 14%, had a normal quality of life for 20 years and then a decline.
Researchers found that people who were older when diagnosed with MS and those with more severe physical disabilities or worse fatigue had an increased risk of being in the group with the worst physical quality of life. The people in the lowest group had a mean age of 46 years at diagnosis, compared with a mean age of 38 years for the group with the highest quality of life. The people in the worst group had moderate disabilities, such as problems with gait and mobility, or started using a cane to walk, while those in the best group had normal functioning or mild disabilities.
For mental quality of life, researchers divided the participants into four groups. The first group, 19% of the participants, had a chronically low quality of life. The second group, 33%, had a moderately low and stable quality of life. The third group, 22%, reported moderately low quality of life with the first 10 years after diagnosis, followed by normal mental health. The fourth group, 26%, reported a chronically normal quality of life.
Researchers found that people with an annual income of $50,000 or less or no post-secondary education had an increased risk of falling into the group with the worst mental quality of life. Overall, 62% of people in the lowest group had incomes of $50,000 or less, compared to 44% of those in the highest group. And 38% of those in the lowest group had no post-secondary education, compared to 22% of those in the highest group.
A person’s subtype of disease, namely relapsing remitting or primary progressive at onset, did not affect membership in any of the physical or mental quality of life groups.
“There are early risk factors for those who will end up in the worst health-related quality of life groups that can be easily identified by physicians and other health professionals,” O’Mahony said. “For example, socio-economic factors such as reduced education and income can be easily identified. This could provide an opportunity for early interventions that can help people with MS live better lives.”
A limitation of the study was that the participants were volunteers, so the results may not be the same for the general population.
The study was funded in part by the Consortium of Multiple Sclerosis Centers.
American Academy of Neurology
O’Mahony, J., et al. (2022) Physical and mental health-related quality of life trajectories in people with multiple sclerosis. Neurology. doi.org/10.1212/WNL.000000000000200931.