title: Health problems and health-related quality of life in people with multiple sclerosis.
abstract: OBJECTIVE
  To explore the interrelationship between a number of common multiple sclerosis-related problems and health-related quality of life independent of the effect of physical disease impact.
  
  
  METHODS
  A cross-sectional postal survey.
  
  
  METHODS
  The study was conducted in seven treatment centres within England.
  
  
  METHODS
  Nine hundred and twenty-nine people with multiple sclerosis.
  
  
  METHODS
  The severity of the multiple sclerosis problems (fatigue, pain, urinary incontinence, bowel, depression, pressure ulcers, sexual and employment problems) was assessed using 5-point self-report ordinal scales. Disease impact was measured using the Multiple Sclerosis Impact Scale-29. Health-related quality of life was measured using the 36-Item Short Form Health Survey, version 2 (SF-36). The relationship between the problems, disease impact and health-related quality of life was determined using multivariate analysis of covariance.
  
  
  RESULTS
  Seventy four per cent of the sample experienced four or more of the selected problems. The extent and severity of problems increased with the level of disease impact (P< 0.001). Fatigue, pain, employment, depression and relationship problems were all found to have negative effect on the SF-36 scales independent to the effect of disease impact. SF-36 scores were most compromised in patients experiencing multiple problems. The data suggest an interdependent relationship between depression, fatigue and pain.
  
  
  CONCLUSIONS
  The data suggest that many multiple sclerosis complications negatively affect health-related quality of life, independent of the effect of overall disease impact.
authors.affiliation: King's College London, The Florence Nightingale School of Nursing & Midwifery, Research in Primary and Intermediate Care Section, London, UK. angus.forbes@kcl.ac.uk
authors.forename: Angus
authors.initials: A
authors.lastname: Forbes
authors.forename: Alison
authors.initials: A
authors.lastname: While
authors.forename: Lucia
authors.initials: L
authors.lastname: Mathes
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology; D011788:Quality of Life; D012720:Severity of Illness Index