Health‐related quality of life in patients with multiple system atrophy using the EQ‐5D‐5L

Abstract

Background Multiple system atrophy (MSA) is an incurable neurodegenerative disease. We aimed to investigate the health‐related quality of life (HRQoL) and the determinants of HRQoL in patients with MSA. Methods The five‐level EuroQol five‐dimensional questionnaire (EQ‐5D‐5L) was used to evaluate patients’ HRQoL. The results of HRQoL were indicated by the EQ‐5D‐5L index values and visual analog scale (EQ VAS) scores. Specific scales were used to measure disease severity, cognition, frontal lobe function, anxiety, depression, fatigue, and sleep disorders. The beta mixture model and the linear regression model were used to explore the determinants of HRQoL in patients with MSA. Results A total of 205 patients with cerebellar variants (MSA‐C; 53.9%) and 175 patients with parkinsonian variants (MSA‐P; 46.1%) were included in this cross‐sectional study. The mean values of the EQ‐5D‐5L index values and EQ VAS scores were .558 and 59.5, respectively. Problem with mobility was the problem reported by the highest proportion of patients (92.1%), followed by problems with usual activities (88.7%), self‐care (81.3%), anxiety/depression (72.1%), and pain/discomfort (53.9%). The determinants of the lower EQ‐5D‐5L index values in patients with MSA were greater disease severity, fatigue, Parkinson's disease‐related sleep problems (PD‐SP), depressive mood, and anxious mood. Greater disease severity, fatigue, and depressive mood were associated with lower EQ VAS scores. Conclusion The problem reported most frequently by Chinese individuals with MSA was mobility. In addition to the greater disease severity of MSA, fatigue, PD‐SP, depression, and anxiety were determinants of poor HRQoL.

Pain in Multiple System Atrophy a Systematic Review and Meta‐Analysis

“…The corresponding authors of all included studies were contacted to retrieve data on the prevalence of pain in male and female individuals with MSA separately. Three authors kindly provided this additional information 18,21,24 . Pooling data of n = 480 individuals with MSA (210 females, 270 males), we found no difference in the prevalence of pain between male (52% [95% CI = 42%–61%]) and female (66% [95% CI = 49%–81%]) individuals with MSA ( P = 0.143) (Fig.…”

“…Four studies reported a higher prevalence of pain in individuals with MSA‐P compared to MSA‐C, 18,23,24,26 whereas two others did not detect any statistically significant difference between the MSA‐P and MSA‐C subtypes 19,25 . Across studies, the pooled prevalence of pain was significantly higher in individuals with MSA‐P than MSA‐C (76% [95% CI = 63%–87%] vs. 45% [95% CI = 33%–57%], P = 0.001).…”

“…Six papers provided information on the MSA phenotype (cumulative n = 748), with 51% (n = 379) of the individuals presenting predominantly with MSA-P and 49% (n = 369) with MSA-C. MSA was diagnosed according to the 2008 consensus criteria 17 in 10 papers, 8,[18][19][20][21][22][23][24][25][26] whereas three papers did not provide information on the applied diagnostic criteria. [27][28][29] Assessing the prevalence of pain in a cohort of individuals with MSA was the primary objective in six of the 13 studies included in the quantitative synthesis, 8,19,20,[22][23][24] whereas in the remaining studies (n = 7) 18,21,[25][26][27][28][29] the prevalence of pain was reported as a secondary outcome. The key information about the analyzed studies is summarized in Table 1.…”

“…General health status and quality of life questionnaires were also applied, including the pain item of the European Quality of Life 5 Dimensions questionnaire (EQ-5D, used in six studies), 18,[25][26][27][28][29] the "bodily discomfort" item of the Parkinson's Disease Questionnaire-8 items (PDQ8), 27 and the 36-Item Short Form Survey (SF-36). 26 Other studies used the item 27 of the Parkinson's Disease Non-Motor Symptom Scale (NMSS), 23 the item 1.9 of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) 24 or the pain item of the Palliative Care Outcomes Scale (PCOS).…”

Cerebellar, Not Nigrostriatal Degeneration Impairs Dexterity in Multiple System Atrophy

“…Autonomic deficits are observed early in the course of both subtypes, sometimes already as initial clinical manifestation 5 . With disease progression, these deficits lead to impairment in almost all areas of daily activity with a substantial reduction in quality of life 6 . Impaired dexterity is often present in both MSA subtypes and contributes to the loss of independency in activities of daily living, such as cutting food or dressing 7 .…”