Social and economic burden of walking and mobility problems in multiple sclerosis

Abstract

BackgroundMultiple sclerosis (MS) is a chronic progressive neurological disease and the majority of patients will experience some degree of impaired mobility. We evaluated the prevalence, severity and burden of walking and mobility problems (WMPs) in 5 European countries.MethodsThis was a cross-sectional, patient record-based study involving 340 neurologists who completed detailed patient record forms (PRF) for patients (>18 years) attending their clinic with MS. Patients were also invited to complete a questionnaire (PSC). Information collected included demographics, disease characteristics, work productivity, quality of life (QoL; EuroQol-5D and Hamburg Quality of Life Questionnaire Multiple Sclerosis [HAQUAMS]) and mobility (subjective patient-reported and objectively measured using the timed 25 foot walk test [T25FW]). Relationships between WMPs and disease and other characteristics were examined using Chi square tests. Analysis of variance was used to examine relationships between mobility measures and work productivity.ResultsRecords were available for 3572 patients of whom 2171 also completed a PSC. WMPs were regarded as the most bothersome symptom by almost half of patients who responded (43%; 291/683). There was a clear, independent and strong directional relationship between severity of WMPs (subjective and objective) and healthcare resource utilisation. Patients with longer T25FW times (indicating greater walking impairment) were significantly more likely to require additional caregiver support (p < 0.0001), visit a variety of healthcare professionals including their primary care physicians (p = 0.0044) and require more long-term non-disease modifying drugs (p = 0.0001). A similar pattern was observed when subjective reporting of the severity of WMPs was considered. Work productivity was also markedly impacted by the presence of WMPs with fewer patients working full time and a reduction in weekly working hours as T25FW times and the subjective severity of WMPs increased.ConclusionsIn Europe, WMPs in MS represent a considerable personal and social burden both financially and in terms of quality of life. Interventions to improve mobility could have significant benefits for patients and society as a whole.

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

“…and is associated with reduced quality of life and increased financial burden [1,2]. Weakness [3], sensory loss [4], ataxia [5] and spasticity [6] may impair walking ability in people with MS, while reduced speed [7] and increased energy cost [8] can reduce the capacity to walk long distances.…”

Assessment of Upper Extremity Function in Multiple Sclerosis: Review and Opinion

“…[1][2][3] Walking impairment is a hallmark symptom of MS that has been reported in up to 90% of people with MS, and it engenders increased financial costs and patient burdens. 4,5 Although dysfunction of the upper limbs is also common, its importance is under-recognized relative to walking impairment. Therefore, the purpose of this article is to create greater recognition of this impairment in individuals with MS by reviewing its magnitude and highlighting barriers to its assessment.…”

The impact of employment on cognition and cognitive reserve: implications across diseases and aging

“…There are several studies that show that, as people develop a disease or chronic condition, they either: 1) develop cognitive impairments and reduce the hours they work or 2) they have to reduce work due to treatment and then report cognitive impairments; but it is unclear whether the cognitive impairments are due to the loss of employment or treatment of their disease, or perhaps a combination of both. 49,66,67 Carefully planned longitudinal studies are needed to show what happens to the cognition of those with certain diseases as they leave and reintegrate back into employment.…”