title: Patient-reported quality of life in multiple sclerosis differs between cultures and countries: a cross-sectional Austrian-German-Polish study.
abstract: BACKGROUND
  Patient-reported quality of life (QOL) is an outcome measure in clinical trials in multiple sclerosis (MS), but translated QOL instruments may affect the actual comparability of data.
  
  
  OBJECTIVE
  We aimed to investigate possible differences in QOL in MS between cultures and countries. We employed the Functional Assessment of Multiple Sclerosis (FAMS) Version 4 questionnaire, which is a state-of-the-art QOL instrument.
  
  
  METHODS
  Some 484 MS patients from Austria (145), Germany (144), and Poland (195) aged 20-60 years, and stratified for sex and disease severity as measured by the Expanded Disability Status Scale (EDSS) score completed the respective FAMS translation and a socio-demographic questionnaire.
  
  
  RESULTS
  Analysis of variance and post-hoc Scheffé-test showed that 64% of the FAMS items were answered significantly differently (p < 0.001) between the three countries. A multivariate regression analysis including all the available disease-related and socio-demographic variables revealed the factors age, EDSS score, employment, social contacts, MS course, and country to be significant predictors of both the total FAMS score and the score for items answered differently between the three countries.
  
  
  CONCLUSIONS
  Differences exist in the QOL of MS patients from Austria, Germany, and Poland which seem to lie beyond the impact of disease severity. They appear to be related to culture or other country-specific factors, as country was an independent predictor of differently answered items of the FAMS and thus also of the whole FAMS. QOL instruments should consider this aspect to faithfully reflect subjective information such as patient-reported benefit of treatment in multinational clinical trials.
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria. aga.pluta@medunigraz.at
authors.forename: A
authors.initials: A
authors.lastname: Pluta-Fuerst
authors.forename: K
authors.initials: K
authors.lastname: Petrovic
authors.forename: T
authors.initials: T
authors.lastname: Berger
authors.forename: W
authors.initials: W
authors.lastname: Fryze
authors.forename: S
authors.initials: S
authors.lastname: Fuchs
authors.forename: R
authors.initials: R
authors.lastname: Gold
authors.forename: W
authors.initials: W
authors.lastname: Kozubski
authors.forename: G
authors.initials: G
authors.lastname: Ladurner
authors.forename: H
authors.initials: H
authors.lastname: Petereit
authors.forename: A
authors.initials: A
authors.lastname: Potemkowski
authors.forename: P
authors.initials: P
authors.lastname: Rieckmann
authors.forename: M
authors.initials: M
authors.lastname: Sailer
authors.forename: A
authors.initials: A
authors.lastname: Szczudlik
authors.forename: K
authors.initials: K
authors.lastname: Vass
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: B
authors.initials: B
authors.lastname: Zakrzewska-Pniewska
authors.forename: F
authors.initials: F
authors.lastname: Fazekas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001317:Austria; D016009:Chi-Square Distribution; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011044:Poland; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires