title: Social and economic burden of walking and mobility problems in multiple sclerosis.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a chronic progressive neurological disease and the majority of patients will experience some degree of impaired mobility. We evaluated the prevalence, severity and burden of walking and mobility problems (WMPs) in 5 European countries.
  
  
  METHODS
  This was a cross-sectional, patient record-based study involving 340 neurologists who completed detailed patient record forms (PRF) for patients (>18 years) attending their clinic with MS. Patients were also invited to complete a questionnaire (PSC). Information collected included demographics, disease characteristics, work productivity, quality of life (QoL; EuroQol-5D and Hamburg Quality of Life Questionnaire Multiple Sclerosis [HAQUAMS]) and mobility (subjective patient-reported and objectively measured using the timed 25 foot walk test [T25FW]). Relationships between WMPs and disease and other characteristics were examined using Chi square tests. Analysis of variance was used to examine relationships between mobility measures and work productivity.
  
  
  RESULTS
  Records were available for 3572 patients of whom 2171 also completed a PSC. WMPs were regarded as the most bothersome symptom by almost half of patients who responded (43%; 291/683). There was a clear, independent and strong directional relationship between severity of WMPs (subjective and objective) and healthcare resource utilisation. Patients with longer T25FW times (indicating greater walking impairment) were significantly more likely to require additional caregiver support (p < 0.0001), visit a variety of healthcare professionals including their primary care physicians (p = 0.0044) and require more long-term non-disease modifying drugs (p = 0.0001). A similar pattern was observed when subjective reporting of the severity of WMPs was considered. Work productivity was also markedly impacted by the presence of WMPs with fewer patients working full time and a reduction in weekly working hours as T25FW times and the subjective severity of WMPs increased.
  
  
  CONCLUSIONS
  In Europe, WMPs in MS represent a considerable personal and social burden both financially and in terms of quality of life. Interventions to improve mobility could have significant benefits for patients and society as a whole.
authors.affiliation: Adelphi Real World, Macclesfield, UK. james.pike@adelphigroup.com
authors.forename: James
authors.initials: J
authors.lastname: Pike
authors.forename: Edward
authors.initials: E
authors.lastname: Jones
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.forename: James
authors.initials: J
authors.lastname: Piercy
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
mesh_terms: D000328:Adult; D015897:Comorbidity; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000191:economics* / Q000453:epidemiology*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012922:Social Change