Quality of life and assessment in multiple sclerosis: integrating physical and psychological components of wellbeing

Abstract

Health-related quality of life (HRQoL) has been more intensively studied in multiple sclerosis (MS) than in any otherneurological disorder. Traditional medical models of impairment and disability are an incomplete summary ofdisease burden. Quality of life can be thought of as the sum of all sources of satisfaction (including anticipatedsources) minus all threats (including anticipated threats). Many psychosocial factors including coping, mood, selfefficacy, and perceived support influence the quality of life of patients with MS more than biological variables such as weakness or extent of MRI lesions. Neuropsychiatric complications such as cognitive impairment and fatigue are also important predictors, even in those patients in the early stages of the disease. We review generic and specific HRQoL measures to help clinicians choose the most appropriate therapies. Subjective (self-report) HRQoL measures may serve to alert clinicians to areas that would otherwise be overlooked. Studies of new interventions should include an assessment of HRQoL not just impairment or disability alon.