Impaired Mobility in Multiple Sclerosis
Figure 4: Employment by Mobility Score in Men and Women with Multiple Sclerosis Using the NARCOMS Six-point Mobility Performance Subscale in the NARCOMS 2007 Registry Study
100 80 60 40 20 0
0123456 Employment by mobility score: women
Not working Working full-time 100 80 60 40 20 0
0123456 Employment by mobility score: men
Working part-time
n=8,180. Employment decreased significantly with increasing mobility scores in both men and women (p
both groups of individuals.20 Although QoL was comparatively worse
in the MS patients than in their carers, care-giving was associated with reduced mental health, vitality and general health and lower measures of QoL; these measures worsened with the condition of the patient. The authors concluded that better supportive strategies for MS care-givers are warranted.
A notable investigation of the socioeconomic effect of MS is the North American Research Consortium on Multiple Sclerosis (NARCOMS). This is a self-reported registry of persons with MS who are assessed twice yearly using both paper and web-based questionnaires.21
The study
assesses the effect of mobility performance, scored on a six-point scale (0 = no disability to 6 = total disability), on aspects of life. A recent analysis of 8,180 persons with MS in this registry showed that, in both men and women, employment decreased significantly with decreasing mobility performance (pFigure 4). Interestingly, this association was significant even at low mobility scores of 0, 1 and 2 (mild gait disability; p
The impact of MS on employment had already been demonstrated in an older study of 602 persons with MS (430 women and 172 men) conducted at neurological treatment centres across Canada.22 In total, 66% of the participants were unemployed and 78% of these believed their unemployment was related to MS symptoms. The most frequent patient-reported MS-related reasons for unemployment were walking difficulties (41%), fatigue (39%) and memory and vision problems (12%). A multivariate analysis of covariance showed that significant correlates of unemployment were mobility problems (p=0.001), age (p=0.001) and perceived
EUROPEAN NEUROLOGICAL REVIEW
cognitive problems (p=0.001). The study by Salter et al. described above therefore provided further evidence that walking is critical for employment among MS patients and maintaining walking ability is vital for preserving the patient’s normal life and independence at early stages of the disease.21
Overall, clinical trial and survey evidence from numerous research groups worldwide suggests that impaired mobility is a large contributory factor to diminished QoL. Although these studies have demonstrated the negative effect of reduced mobility, there remains a substantial need for greater recognition of the presence and effects of disabilities encompassing immobility, fatigue, pain, depression and spasticity and a need for targeted treatments for specific impairments.16
The Impact of Multiple Sclerosis on the Individual Patient – The Importance of Monitoring Mobility Loss
Assessments of the impact of MS or the effect of treatment on mobility impairment describe general population trends. Although providing valuable measures of overall mobility, these assessments fail to convey the devastating impact that losing the ability to walk has on the individual and the loss of freedom and increased dependency accompanying these changes. The scores from these tests also fail to convey the impact of measures that improve the circumstances of the individual coping with MS. A number of case reports have examined the effect of declining mobility on both individual MS patients and on their partners or care-givers.
In one report, the effects of MS on two separate married couples were considered and showed an increasing awareness of change in abilities over time.23
In one of the couples, a woman 53 years of age who had been diagnosed with SPMS 20 years earlier stated that during the course of the disease her “horizons had shrunk”. She needed a walker and was increasingly dependent on her husband for everyday functions. Prior to MS onset, she had enjoyed activities such as walking, rock climbing and swimming. When she had been
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Females (%)
Males (%)
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