Factors predicting quality of life in a group of Polish subjects with multiple sclerosis: Accounting for functional state, socio-demographic and clinical factors
Introduction
Since 1948, when the World Health Organization defined health as being not only the absence of disease and infirmity but also the presence of physical, mental and social well-being, quality of life has become steadily more important both in health care practice and in research [1]. Presently, quality of life (QoL) has firmly established position as an important endpoint in medical care. This is of particular significance in chronic disorders such as multiple sclerosis (MS). QoL measures provide information that traditional outcome measures used in MS studies fail to deliver and extend the physicians’ knowledge of the impact of the disease on the patients’ state. It has been revealed that functional disability only partially explains impaired QoL of MS patients [2], [3], [4], [5], [6]. This supports the hypothesis that factors other than physical state may influence QoL of MS patients.
Many of these factors influencing QoL have been previously assessed, with ambiguous results. Most studies confirmed the role of functional disability, depression and fatigue on QoL [7], [8], but data on the association between QoL and sociodemographic and other disease-related factors are still inconsistent. Therefore, it is recommended to assess both depression and cognitive functions together with QoL measurement, as they constitute an important context for interpretation of QoL tests [9], but it is likely that other factors may also influence QoL of MS patients. Little is known for example on the influence of religious life on QoL, though this relationship became a subject of recent interest in MS [10]. Levine and Targ found significant correlations of spirituality and religiosity with functional well-being in patients with cancer [11]. Other recent studies on patients with different disorders confirmed that religious involvement and spirituality are associated with better recovery from illness, increased coping skills and also better health related QoL, less anxiety and depression [12], [13], [14]. Knowledge of the influence of different factors on QoL of MS patients is important to diminish the burden of the disease, as many of these factors are modifiable.
QoL of MS patients in many European countries has already been assessed [3], [8], [15], [16], [17], [18], [19], [20], unfortunately studies on QoL of Polish MS patients are lacking. For that reason we designed a multidimensional assessment study of Polish group of MS patients.
Health related quality of life should include at least three core domains: physical, psychological and social [21]. Consequently, we decided to use a generic measure, World Health Organization Quality of Life Instrument (WHOQOL-100) for QoL assessment.
The main goal of our study were to assess QoL of Polish subjects with MS and to elicit the most relevant factors influencing QoL of this population. Socio-demographic measures (age, sex, place of living, marital status and employment status), clinical factors (disease duration, course of the disease, disease activity measured by annual relapse rate, level of depression and fatigue) and disability level (Expanded Disability Status Scale and Ambulation Index) were analyzed.
Section snippets
Patients
The study cohort consisted of 173 MS patients consecutively admitted to the Department of Neurology of Medical University of Lublin, Poland and 86 healthy controls. All MS patients satisfied the following inclusion criteria: a diagnosis of MS [22], knowledge of the diagnosis and written informed consent. MS patients included into the study were not on any of disease modifying therapies at the moment of QoL assessment. All study participants were assessed by 1 investigator; the recruitment
Results
Out of the 193 MS patients who were deemed eligible for the study, 173 underwent final assessment. The remaining 20 patients were excluded for the following reasons: 3 patients refused to participate in the study, 7 had severe cognitive impairment, which could impede their self-assessment, and 10 had concomitant diseases which could severely influence QoL assessment. The control group consisted of 86 subjects recruited from the general population, matched in age, sex and educational level (p >
Discussion
Over the last decade there has been a growing interest to elicit such measures of clinical assessment of MS patients, which would be suitable for selecting the most beneficial therapeutic approach for certain subgroup of MS patients. As there is a consensus about the need to assess disease related dysfunctions according to the WHO classification of impairment, disability and handicap, we decided to use a generic measure WHOQOL-100, which incorporates different aspects of health according to the
Conclusions
- 1.
MS as a chronic disease strongly impairs global QoL as well as different aspects of life such as physical and psychological functioning, social relations, level of independence and satisfaction with the environment in which the patients live.
- 2.
MS patients with relapsing–remitting course of disease have better QoL compared to patients with a progressive course.
- 3.
The strongest predictors of QoL in Polish MS patients are depression, disability level and fatigue.
Acknowledgements
The authors thank all MS patients who agreed to participate in the study.
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