Health-related quality of life and depression in an Italian sample of multiple sclerosis patients.
Patti F, Cacopardo M, Palermo F, Ciancio MR, Lopes R, Restivo D and Reggio A;
Commented by , 22 Aug 2003
Background
Clinical trials in MS has focused on physical disability as an outcome measure, and most studies use the expanded disability status scale (EDSS) as a reference. Since there are considerable drawbacks in the properties of this scale, alternatives have been explored.
In this regard, The Multiple Sclerosis Functional Composite Measure seems to be a more robust tool, describing impairment in clinical research. Less attention has been directed towards self-reported measurements, such as physical, psychological and social function, which has a high impact on the daily life of the MS patients. Health–related Quality of Life (HRQoL) scales has successfully incorporated these measurements.
Aim
To describe self-assessed burden of MS using the HRQoL SF-36 survey, and compare the results with physical disability, depression and disease duration.
Methods
308 consecutive Italian patients were examined. Patients with no knowledge of their disease, concomitant disease, cognitive dysfunction and disease exacerbation were excluded (128 patients).
Neurological impairment were assessed using Kurtzke’s EDSS and depression was measured by Beck Depression Inventory (BDI). HRQoL were evaluated using the SF-36 health survey, which is one of the most widely used QL measurements. Data from a large Italian normal population were used for comparison.
HRQoL scores were compared with the normal material using Z-test. ANOVA was used for testing differences in three EDSS groups (<3, 3-6, and > 6) and subgroups of EDSS, BDI and time since diagnosis. Pearson’s correlation test was used to estimate the association between measurements.
Results
MS patients scored significantly lower in all SF-36 health dimensions compared with the controls. The subgroup analysis showed that patients with the highest EDSS scores (> 6) had the lowest HRQoL scores and patients with low BDI scores had corresponding low scores.
The patients with high BDI and low EDSS had significantly better HRQoL scores compared to the rest of the patients. HRQoL scores tended to decrease, while BDI scores tended to increase with disease duration. There were significant correlation between HRQoL scores and EDSS as well as disease duration, but the strongest correlation were found between HRQoL and BDI measurements.
Discussion
Few papers have been published on HRQoL and MS and it is encouraging to see new data on this issue. The study confirms that HRQoL is affected in MS and associated to the severity of the disease.
The strongest correlation was found between HRQoL and depression scores, underlining the importance of detecting and treating these symptoms. The association between HRQoL and EDSS was weaker, reflecting that the EDSS does not describe the general impact of the disease.
A statistical comment should be made, since results were not corrected for multiple comparisons, which generally reduces the impact of the study.
Including HRQoL measurements in clinical MS research is important, in order to explore the potential of these tests more thoroughly. A longitudinal multicenter study with MS patients is currently conducted, assessing the global impact of the disease. The SF-36 could be a future common standard for describing HRQoL in MS patients.