Wednesday, 26 December 2012

Health status changes

#MSBlog: Would treating early and hard have made a difference? What do you think?

EpubGiordano et al; The POSMOS study. Self-assessed health status changes in a community cohort of people with multiple sclerosis: 11 years of follow-up. Eur J Neurol. 2012 Dec 6. doi: 10.1111/ene.12028.

BACKGROUND AND PURPOSE: Few data are available on the health status of MSers in the community. These investigators assessed changes in self-perceived health status and health related quality of life of a community-based cohort of MSers over a decade, and identified predictors of such changes.

METHODS: In 1999 they started the POSMOS study (Postal Survey of Self-Assessed Health of MS Adults and their Significant Others) on a random sample of 251 adults MSers from the Milan area (mean age 42 years, range 18-71 years), and prospectively assessed changes in self-perceived health status over 11 years. Participants completed the Multiple Sclerosis Quality-of-Life-54 (MSQOL-54) and a general/clinical questionnaire. We re-assessed the cohort in 2004 and 2010, sending the same questionnaires plus the Chicago Multiscale Depression Inventory.

RESULTS: There were 205 (86%) respondents in 2004, 171 (74%) in 2010; 28 (11%) died during the study. Severely impaired [self-determined Expanded Disability Status Scale (EDSS) > 6.5] increased from 19% to 32%. One-fifth remained fully ambulatory (EDSS < 4.0): 25% women (median age 44 years [interquartile range, IQR 39-53], median years from diagnosis 16 [IQR 12-19]); and 17% men (median age 40 years [IQR 38-45], median years from diagnosis 14 [IQR 12-17]). Changes in MSQOL-54 composite scores were negligible; but among individual scales, change in health, cognitive function and general health worsened, and social function and emotional wellbeing improved significantly. Depressive symptoms were high and stable.

CONCLUSIONS: Multiple sclerosis had a pervasive but inhomogeneous impact on the lives of these Italian MSers. Notwithstanding overall clinical deterioration and aging, hospital admissions and medical consultations decreased, suggesting reduced use of health care resources. By contrast, housing adaptations and home care increased, psychological burden was high and self-perceived cognitive functioning worsened.

"The results of this survey speak for themselves and demonstrate the impact MS has on a population, this is despite the era of DMTs. Hopefully, the new era of more aggressive therapy  with adoption of the treatment philosophy of treat early and hard things will change!"


  1. What constitutes hard and early? Starting DMT's within weeks months of a diagnosis?


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