title: Feeling severely affected by multiple sclerosis: what does this mean?
abstract: BACKGROUND
  The situation for people feeling severely affected by Multiple Sclerosis (MS) remains largely unexamined and the term 'severe MS' is not clearly defined.
  
  
  OBJECTIVE
  Our study describes this sub-group of patients utilizing exclusively a subjective inclusion criterion to analyse their reasons for feeling severely affected and document their perceived unmet needs.
  
  
  METHODS
  A questionnaire with open- and closed-ended items addressing only patients feeling severely affected was sent out nationwide. Expanded Disability Status Score (EDSS) and subjectively severe affectedness were analysed for correlation. After dichotomizing both scores by a median split, the answers were allocated to these groups and tested for significant differences.
  
  
  METHODS
  1,110 questionnaires were analysed regarding the closed-ended questions while a subsample of 40% (n = 445) was analysed regarding the open-ended questions. Average age of participants was 51.87 years. Average time since diagnosis was 16.6 years. Main course of the disease was secondary progressive (35.5%).
  
  
  RESULTS
  The most frequently mentioned reasons for feeling severely affected were lack of mobility (56.4%) and fatigue (27.4%). Significant percentages for unmet needs were seen in the categories of funding services (31.0%), better social integration (24.7%) and medical support (25.2%). A significant correlation was observed between EDSS and subjectively felt affectedness (p ≤ 0.01). Motor disorders explained differences in patient needs behind a higher EDSS score; higher severe affectedness referred to other issues like dependency and immobility.
  
  
  CONCLUSIONS
  EDSS is insufficient for usage as the sole instrument for measuring severe affectedness as it does not take into account other potential reasons. Complex patient needs necessitate multi-professional care as offered by palliative medicine.
authors: Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany. julia.strupp@uk-koeln.de
authors: Julia
authors: J
authors: Strupp
authors: Alexander
authors: A
authors: Hartwig
authors: Heidrun
authors: H
authors: Golla
authors: Maren
authors: M
authors: Galushko
authors: Holger
authors: H
authors: Pfaff
authors: Raymond
authors: R
authors: Voltz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000523:psychology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000523:psychology*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult