Impact of the COVID-19 Pandemic on Personal Networks and Neurological Outcomes of People with Multiple Sclerosis: A Case-Control Cross-sectional and Longitudinal Analysis

Abstract

Background: The COVID–19 pandemic has negatively impacted the social fabric of people with multiple sclerosis (pwMS). Objective: To evaluate the associations between personal social network environment and neurological function in pwMS and controls during the COVID–19 pandemic and compare with the pre–pandemic baseline. Methods: We first analyzed data collected from 8 cohorts of pwMS and control participants during the COVID–19 pandemic (March–December 2020). We then leveraged data collected between 2017–2019 in 3 of the 8 cohorts for longitudinal comparison. Participants completed a questionnaire that quantified the structure and composition of their personal social network, including the health behaviors of network members. We assessed neurological disability using three interrelated patient–reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale–Revised (MSRS–R), and Patient Reported Outcomes Measurement Information System (PROMIS)–Physical Function. We identified the network features associated with neurologic disability using paired t–tests and covariate–adjusted regressions. Results: In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 control participants, higher percent of network members with a perceived negative health influence was associated with greater neurological symptom burden in pwMS (MSRS-R: Beta[95% CI]=2.181[1.082, 3.279], p<.001) and worse physical function in controls (PROMIS-Physical Function: Beta[95% CI]=-5.707[-7.405, -4.010], p<.001). In the longitudinal analysis of 230 pwMS and 136 control participants, the percent of people contacted "weekly or less" (p<.001) decreased during the COVID-19 pandemic for both pwMS (30.34% to 18.78%) and controls (23.48% to 14.89%) when compared to the pre-pandemic period. PwMS further experienced a greater reduction in network size (p<.001), increase in constraint (a measure of close ties of the network, p<.001) and decrease in maximum degree (highest number of ties of a network member, p<.001) than controls during the COVID–19 pandemic. These changes in network features were not associated with worsening neurological disability during the pandemic. Conclusions: Our findings suggest that negative health influences in personal social networks are associated with worse disability in all participants, and the COVID–19 pandemic led to contraction of personal social networks to a greater extent for pwMS than controls.

Aging-dependent Change in Th17 and Cytokine Response in Multiple Sclerosis

“…This cross-sectional study included 368 participants (primary cohort) who enrolled in a clinicbased prospective cohort study (Prospective Investigation of Multiple Sclerosis in the Three Rivers Region, PROMOTE; Pittsburgh, PA) during 2017-2021 (Figure 1). [31][32][33][34][35][36][37][38][39][40][41][42] The cohort enrollment criteria included adults 18 years or older with a neurologist-confirmed diagnosis of MS according to the 2017 McDonald criteria. Given the clinical outcome of interest is relapse event indicative of inflammatory disease activity, we included pwMS of relapsing remitting (RRMS) and secondary progressive (SPMS) type and excluded primary progressive type (PPMS), which is not characterized by relapse events.…”