Quality of Life in Multiple Sclerosis: A Meta-analytic Review

Abstract

Background: Multiple Sclerosis (MS) is a disabling disease that can have a substantial impact on quality of life (QoL). However, use of various assessment instruments to assess QoL, in addition to demographic and MS characteristics, may produce different results. Aim: To examine QoL differences between adults with MS and healthy controls as well as the potential moderating role of demographic and disease characteristics (i.e. age, years since diagnosis, disability severity). Methods: Thirty-five eligible studies (3,493 MS, 187,296 controls) were identified from a search of the CINAHL, Embase, PsycINFO, PubMed, and Scopus databases. Methodological rigour of the included studies was evaluated using the National Institute of Health Quality Assessment Tool. Group mean differences in QoL were standardised by calculating Hedges’ g. In addition, 95% confidence intervals, p values, failsafe Ns, and heterogeneity statistics (Cochran’s Q, I-squared, and tau) were computed, using a random effects model. Sources of between-study variability were examined with a multivariate meta-regression. Results: Mean QoL ratings were significantly lower for adults with MS compared to healthy peers (gw = -0.907, CI -1.168 to -0.654, p <.01), although effect sizes varied markedly across QoL domains (gw range = -.31 to – 1.15). Older age, years since diagnosis, and disability impairment explained 38% of the variance seen. Conclusion: The findings suggest that QoL should be routinely measured in clinical research and practice as a study outcome. Multidisciplinary interventions provided on an ongoing basis can ensure that care needs are met with disease progression.