title: Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis.
abstract: BACKGROUND
  Few studies have evaluated the contribution of individual symptoms and impairments to the burden of multiple sclerosis (MS). This article reviews the contribution of walking impairment, fatigue, spasticity, depression, and pain, to quality of life (QOL) of the patient and economic burden of MS.
  
  
  METHODS
  Studies for inclusion were chosen from the literature that reported on QOL and costs in patients with MS, identified through PubMed searches (main search terms: "multiple sclerosis" combined with "quality of life," "costs," or "burden"). Articles were selected based on whether the analyses included evaluation of symptoms and impairments as contributory factors to QOL or costs.
  
  
  RESULTS
  Impaired mobility was ranked to be of high concern, and was suggested to be an important contributory factor to QOL, having a greater impact on physical components than mental components. Fatigue was associated with QOL, with effects on both physical and mental components of QOL, independent of disability level. Depression was inversely associated with QOL. Spasticity may affect physical components of QOL, and daily activities may be impacted in as many as 44% of patients with MS. Pain, occurring in up to 86% of patients with MS, impacts daily function and QOL across the range of physical and mental domains. The contribution of these impairments and symptoms to the economic burden has been less well characterized, although the importance of mobility to employment and productivity has been suggested by several studies.
  
  
  CONCLUSIONS
  Evidence suggests that impaired mobility and symptoms such as fatigue, pain, depression, and spasticity are important contributory factors to the observed reduction in QOL, and in some cases, increased costs, associated with MS. There is a need for greater recognition of the presence and effects of these disabilities, and effective targeted treatment options for specific impairments, potentially resulting in improved QOL and reduced indirect costs.
authors.affiliation: The Multiple Sclerosis Center at Doctors Hospital, 6862 Granada Boulevard, Coral Gables, Florida 33146, USA. zwibelmdms@aol.com
authors.forename: Howard L
authors.initials: HL
authors.lastname: Zwibel
mesh_terms: D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D018450:Disease Progression; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D009128:Muscle Spasticity / Q000503:physiopathology; D010146:Pain / Q000209:etiology / Q000523:psychology; D011788:Quality of Life; D016138:Walking