title: High concurrent presence of disability in multiple sclerosis. Associations with perceived health.
abstract: OBJECTIVE
  (1) To explore functioning and concurrent presence of disabilities - concerning cognition, manual dexterity, walking, energy, mood, activities of daily living (ADL), and social/lifestyle activities - in persons with multiple sclerosis (PwMS) cared for at an outpatient MS clinic. 2) To describe the PwMS' perceived physical and psychological impact and associations with the same disabilities.
  
  
  METHODS
  A descriptive cross-sectional study was carried out in 219 PwMS at the MS Centre, Karolinska University Hospital. Logistic regression employing proportional odds models was used to identify the associations of the disabilities with the perceived physical and psychological impact.
  
  
  RESULTS
  In this sample the distribution with regard to disease severity as per Expanded Disability Status Scale was; mild 59.5%, moderate 17% and severe 23.5%. Despite the high proportion with mild disease severity disability regarding cognition was found in 49%, manual dexterity 76%, walking 43%, energy 67%, mood 29%, ADL 44% and social/lifestyle activities in 48%. Two or more disabilities were found in 80%, 24 % had six or seven disabilities. Disability regarding energy, mood, walking, manual dexterity and ADL was significantly associated with increase in the perceived physical impact, whereas disability in energy and mood was significantly associated with increase in the perceived psychological impact.
  
  
  CONCLUSIONS
  The presence of several concurrent disabilities, some significantly associated with high perceived physical and psychological impact, in the majority of PwMS in outpatient clinics highlights the importance to identify disabilities, in particular fatigue and depressed mood, in order to supply health care interventions aiming to improve the life situation of PwMS.
authors.affiliation: Division of Neurology, Dept. of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. sverker.johansson@ki.se
authors.forename: Sverker
authors.initials: S
authors.lastname: Johansson
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Claesson
authors.forename: Jenny
authors.initials: J
authors.lastname: Lindberg
authors.forename: Jan
authors.initials: J
authors.lastname: Hillert
authors.forename: Magnus
authors.initials: M
authors.lastname: Andersson
authors.forename: Lotta
authors.initials: L
authors.lastname: Widén Holmqvist
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D004185:Disability Evaluation; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D009048:Motor Skills; D009069:Movement Disorders / Q000453:epidemiology*; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012919:Social Behavior; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology