The pure effects of occurrence relapse on fatigue and quality of life in patients with multiple sclerosis: A post hoc analysis with high statistical control

Authors
GHASEM salehpoor
Javad Molazade
Shiraz University
Abstract
Introduction: Relapses are the most obvious clinical feature of multiple sclerosis (MS) that can have different effects on patients fatigue and quality of life. Therefore, the aim of present study was to evaluate pure effects of occurrence relapse on fatigue and quality of life in patients with MS.

Materials and Methods: In a cross-sectional study, 162 patients with MS (in three groups: non-relapse, 1-2 times of relapses, and ≥ 3 times of relapses) were selected by consecutive sampling and using the clinical and demographic variables inventory, the Health Survey questionnaire (SF-36) and Fatigue Severity Scale (FSS) along with identical analog-spring balance were examined. The data were analyzed byChi-square test, one-way analysis of variance (ANOVA), multivariate analysis of variance (MANOVA), multivariate analysis of covariance (MANCOVA), and post hoc tests of Fisher least significant difference (LSD) and Scheffe.

Results: The adjusted analyses showed that effects of occurrence relapse was significant in physical functioning, vitality, social functioning, mental health, and physical and mental components (P < 0.05). The following of difference between means in relapse groups showed that patients with ≥3 times of relapses in all identified significant variables have lower mean scores (P < 0.05). In the meantime, significant differences were not observed between different groups of relapse in terms of fatigue level (P > 0.05).

Conclusion: MS relapses leading to reduced quality of life in patients and its effects in patients with high relapse rate is highlight.


Keywords
multiple sclerosis
Relapse
Quality of Life
Fatigue
1. Halper J. The psychosocial effect of multiple sclerosis: the impact of relapses. J Neurol Sci 2007;256 suppl 1:S34-8.
2. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302.
3. Galea I, Ward-Abel N, Heesen Ch. Relapse in multiple sclerosis. BMJ 2015;350:h1765.
4. Nickerson M, Cofield SS, Tyry T, Salter AR, Cutter GR, Marrie RA. Impact of multiple sclerosis relapse: The NARCOMS participant perspective. Mult Scler Relat Disord 2015;4(3):234-40.
5. Mäurer M, Comi G, Freedman MS, Kappos L, Olsson TP, Wolinsky JS, et al. Multiple sclerosis relapses are associated with increased fatigue and reduced health-related quality of life - A post hoc analysis of the TEMSO and TOWER studies. Mult Scler Relat Disord 2016;7:33-40.
6. Healy BC, Degano IR, Schreck A, Rintell D, Weiner H, Chitnis T, et al. The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis. Qual Life Res 2012;21(10):1677-84.
7. Scalfari A, Neuhaus A, Degenhardt A, Rice GP, Muraro PA, Daumer M, et al. The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain 2010;133(7):1914-29.
8. Trojano M, Liguori M, Bosco Zimatore G, Bugarini R, Avolio C, Paolicelli D, et al. Age-related disability in multiple sclerosis. Ann Neurol 2002;51(4):475-80.
9. Alroughani RA, Akhtar S, Ahmed SF, Al-Hashel JY. Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort. Int J Neurosci 2015;125(11):831-7.
10. Abbasi M, Nabavi SM, Fereshtehnejad SM, Ansari I, Zerafatjou N, Shayegannejad V, et al. Risk factors of Multiple sclerosis and their Relation with Disease Severity: A Cross-sectional Study from Iran. Arch Iran Med 2016;19(12):852-60.
11. Bergamaschi R. Prognostic factors in multiple sclerosis. Int Rev Neurobiol 2007;79:423-47.
12. D'hooghe MB, Haentjens P, Van Remoortel A, De Keyser J, Nagels G. Self-reported levels of education and disability progression in multiple sclerosis. Acta Neurol Scand 2016;134(6):414-9.
13. Baghizadeh S, Sahraian MA, Beladimoghadam N. Clinical and demographic factors affecting disease severity in patients with multiple sclerosis. Iran J Neurol 2013;12(1):1-8.
14. Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. Lancet Neurol 2015;14(2):183-93.
15. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50(1):121-7.
16. Krupp LB, LaRocca N, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46(10):1121-3.
17. Salehpoor Gh, Rezaei S, Hosseininezhad M. Psychometric properties of fatigue severity scale in patients with multiple sclerosis. J Kerman Uni Med Scie 2013;20(3):263-78. [Persian]
18. Ware JE JR, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30(6):473-83.
19. Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC. Psychological correlates of functional status in chronic fatigue syndrome. J Psychosom Res 2002;53(6):1097-106.
20. Salehpoor Gh, Kafi SM, Salehi I, Rezaei S. Psychometric characteristics of the health survey questionnaire (SF-36) for evaluation of multiple sclerosis: psychometric evaluation in Iranian patients. Jundishapur Sci Med J 2015;14(4):367-84. [Persian]
21. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-63.
22. Pittock SJ, Mayr WT, McClelland RL, Jorgensen NW, Weigand SD, Noseworthy JH, et al. Quality of life is favorable for most patients with multiple sclerosis: a population-based cohort study. Arch Neurol 2004;61(5):679-86.
23. Leary SM, Porter B, Thompson AJ. Multiple sclerosis: diagnosis and the management of acute relapses. Postgrad Med J 2005;81(955):302-8.
1. Halper J. The psychosocial effect of multiple sclerosis: the impact of relapses. J Neurol Sci 2007;256 suppl 1:S34-8.
2. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302.
3. Galea I, Ward-Abel N, Heesen Ch. Relapse in multiple sclerosis. BMJ 2015;350:h1765.
4. Nickerson M, Cofield SS, Tyry T, Salter AR, Cutter GR, Marrie RA. Impact of multiple sclerosis relapse: The NARCOMS participant perspective. Mult Scler Relat Disord 2015;4(3):234-40.
5. Mäurer M, Comi G, Freedman MS, Kappos L, Olsson TP, Wolinsky JS, et al. Multiple sclerosis relapses are associated with increased fatigue and reduced health-related quality of life - A post hoc analysis of the TEMSO and TOWER studies. Mult Scler Relat Disord 2016;7:33-40.
6. Healy BC, Degano IR, Schreck A, Rintell D, Weiner H, Chitnis T, et al. The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis. Qual Life Res 2012;21(10):1677-84.
7. Scalfari A, Neuhaus A, Degenhardt A, Rice GP, Muraro PA, Daumer M, et al. The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain 2010;133(7):1914-29.
8. Trojano M, Liguori M, Bosco Zimatore G, Bugarini R, Avolio C, Paolicelli D, et al. Age-related disability in multiple sclerosis. Ann Neurol 2002;51(4):475-80.
9. Alroughani RA, Akhtar S, Ahmed SF, Al-Hashel JY. Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort. Int J Neurosci 2015;125(11):831-7.
10. Abbasi M, Nabavi SM, Fereshtehnejad SM, Ansari I, Zerafatjou N, Shayegannejad V, et al. Risk factors of Multiple sclerosis and their Relation with Disease Severity: A Cross-sectional Study from Iran. Arch Iran Med 2016;19(12):852-60.
11. Bergamaschi R. Prognostic factors in multiple sclerosis. Int Rev Neurobiol 2007;79:423-47.
12. D'hooghe MB, Haentjens P, Van Remoortel A, De Keyser J, Nagels G. Self-reported levels of education and disability progression in multiple sclerosis. Acta Neurol Scand 2016;134(6):414-9.
13. Baghizadeh S, Sahraian MA, Beladimoghadam N. Clinical and demographic factors affecting disease severity in patients with multiple sclerosis. Iran J Neurol 2013;12(1):1-8.
14. Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. Lancet Neurol 2015;14(2):183-93.
15. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50(1):121-7.
16. Krupp LB, LaRocca N, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46(10):1121-3.
17. Salehpoor Gh, Rezaei S, Hosseininezhad M. Psychometric properties of fatigue severity scale in patients with multiple sclerosis. J Kerman Uni Med Scie 2013;20(3):263-78. [Persian]
18. Ware JE JR, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30(6):473-83.
19. Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC. Psychological correlates of functional status in chronic fatigue syndrome. J Psychosom Res 2002;53(6):1097-106.
20. Salehpoor Gh, Kafi SM, Salehi I, Rezaei S. Psychometric characteristics of the health survey questionnaire (SF-36) for evaluation of multiple sclerosis: psychometric evaluation in Iranian patients. Jundishapur Sci Med J 2015;14(4):367-84. [Persian]
21. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-63.
22. Pittock SJ, Mayr WT, McClelland RL, Jorgensen NW, Weigand SD, Noseworthy JH, et al. Quality of life is favorable for most patients with multiple sclerosis: a population-based cohort study. Arch Neurol 2004;61(5):679-86.
23. Leary SM, Porter B, Thompson AJ. Multiple sclerosis: diagnosis and the management of acute relapses. Postgrad Med J 2005;81(955):302-8.
1. Halper J. The psychosocial effect of multiple sclerosis: the impact of relapses. J Neurol Sci 2007;256 suppl 1:S34-8.
2. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302.
3. Galea I, Ward-Abel N, Heesen Ch. Relapse in multiple sclerosis. BMJ 2015;350:h1765.
4. Nickerson M, Cofield SS, Tyry T, Salter AR, Cutter GR, Marrie RA. Impact of multiple sclerosis relapse: The NARCOMS participant perspective. Mult Scler Relat Disord 2015;4(3):234-40.
5. Mäurer M, Comi G, Freedman MS, Kappos L, Olsson TP, Wolinsky JS, et al. Multiple sclerosis relapses are associated with increased fatigue and reduced health-related quality of life - A post hoc analysis of the TEMSO and TOWER studies. Mult Scler Relat Disord 2016;7:33-40.
6. Healy BC, Degano IR, Schreck A, Rintell D, Weiner H, Chitnis T, et al. The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis. Qual Life Res 2012;21(10):1677-84.
7. Scalfari A, Neuhaus A, Degenhardt A, Rice GP, Muraro PA, Daumer M, et al. The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain 2010;133(7):1914-29.
8. Trojano M, Liguori M, Bosco Zimatore G, Bugarini R, Avolio C, Paolicelli D, et al. Age-related disability in multiple sclerosis. Ann Neurol 2002;51(4):475-80.
9. Alroughani RA, Akhtar S, Ahmed SF, Al-Hashel JY. Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort. Int J Neurosci 2015;125(11):831-7.
10. Abbasi M, Nabavi SM, Fereshtehnejad SM, Ansari I, Zerafatjou N, Shayegannejad V, et al. Risk factors of Multiple sclerosis and their Relation with Disease Severity: A Cross-sectional Study from Iran. Arch Iran Med 2016;19(12):852-60.
11. Bergamaschi R. Prognostic factors in multiple sclerosis. Int Rev Neurobiol 2007;79:423-47.
12. D'hooghe MB, Haentjens P, Van Remoortel A, De Keyser J, Nagels G. Self-reported levels of education and disability progression in multiple sclerosis. Acta Neurol Scand 2016;134(6):414-9.
13. Baghizadeh S, Sahraian MA, Beladimoghadam N. Clinical and demographic factors affecting disease severity in patients with multiple sclerosis. Iran J Neurol 2013;12(1):1-8.
14. Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. Lancet Neurol 2015;14(2):183-93.
15. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50(1):121-7.
16. Krupp LB, LaRocca N, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46(10):1121-3.
17. Salehpoor Gh, Rezaei S, Hosseininezhad M. Psychometric properties of fatigue severity scale in patients with multiple sclerosis. J Kerman Uni Med Scie 2013;20(3):263-78. [Persian]
18. Ware JE JR, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30(6):473-83.
19. Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC. Psychological correlates of functional status in chronic fatigue syndrome. J Psychosom Res 2002;53(6):1097-106.
20. Salehpoor Gh, Kafi SM, Salehi I, Rezaei S. Psychometric characteristics of the health survey questionnaire (SF-36) for evaluation of multiple sclerosis: psychometric evaluation in Iranian patients. Jundishapur Sci Med J 2015;14(4):367-84. [Persian]
21. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-63.
22. Pittock SJ, Mayr WT, McClelland RL, Jorgensen NW, Weigand SD, Noseworthy JH, et al. Quality of life is favorable for most patients with multiple sclerosis: a population-based cohort study. Arch Neurol 2004;61(5):679-86.
23. Leary SM, Porter B, Thompson AJ. Multiple sclerosis: diagnosis and the management of acute relapses. Postgrad Med J 2005;81(955):302-8.