1College of Nursing, Ninevah University, 85H2+VCM, Mosul, Nineveh Governorate, Iraq
2College of Nursing, University of Mosul, 41002 Mosul, Iraq
*Corresponding Author’s Email: prof.dr.radhwan@uomosul.edu.iq
Keywords: Multiple Sclerosis; Quality of Life; Physical Well-Being, Psychological Well-Being
Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation and damage to the central nervous system, including the brain, spinal cord, and optic nerves (Yolanda & Ritarwan, 2022; Zyla-Jackson, 2023). It presents with a diverse array of physical, cognitive, and emotional symptoms (Drake et al., 2022). The prevalence of MS varies across different regions, with higher rates observed in temperate climates like Northern Europe and North America (Attia & Ibrahim, 2023; Wada et al., 2023; Schepers et al., 2023). It is estimated that approximately 2.8 million people worldwide are affected by this condition (Mirmosayyeb et al., 2022; Maidelwita et al., 2023). Quality of life (QoL) is a multidimensional concept that encompasses an individual's physical, psychological, and social well-being (Mahmood et al., 2022). In the context of MS, QoL refers to the overall subjective experience of individuals with the disease, considering the impact of its symptoms, functional limitations, and their ability to engage in meaningful activities and relationships (Mahmood et al., 2022). Understanding the factors that influence QoL in patients with MS is crucial for providing comprehensive care and support (Golledge, 2022). Several risk factors have been identified that contribute to the variability in QoL among MS patients. These include the severity and frequency of relapses, disability progression, cognitive impairments, fatigue, pain, and psychological comorbidities such as depression and anxiety (Zhang et al., 2023). While there have been numerous studies examining the QoL of individuals with MS, there are still gaps in our understanding (AlSaeed et al., 2022). The complexity of MS and its diverse manifestations require a multidimensional perspective to comprehensively assess QoL (Attia & Ibrahim, 2023). Menculini et al. (2023) also said that more research is needed to show the relationship between environmental and social factors, access to healthcare, and the success of different interventions on the quality of life of MS patients. The aim of this study is to provide a multidimensional perspective on the QoL of patients with MS. By examining the physical, psychological, social, and environmental factors, this study aims to identify the key determinants and challenges that influence QoLin this population.Additionally,we aim to address the gapsin the current research and highlight areas where further investigation is needed. Ultimately, this study aims to contribute to the development of targeted interventions and support strategies that can enhance the QoL and overall well-being of individuals living with MS.
The study utilized a cross-sectional design to investigate the quality of life (QoL) of patients diagnosed with multiple sclerosis (MS) at Al Salm Teaching Hospitals in Mosul. The cross- sectional design made it possible to gather data at a specific time, providing a snapshot of the QoL MS patients in the study population experienced (Mahmmoed et al., 2020).
To establish a representative sample, a systematic random sampling approach was employed to select 500 patients with multiple sclerosis (MS) from the patient registry or outpatient department of Al Salm Teaching Hospitals. This sampling method ensures that each patient in the registry has an equal opportunity of being chosen, minimizing any potential bias in participant selection.
Data were collected through a combination of structured interviews and self-report questionnaires. Trained research personnel conducted face-to-face interviews with the patients, collecting demographic information, medical history, and information related to the dimensions of QoL. The interviews provided an opportunity for clarification and additional information when necessary. Additionally, patients were asked to complete self-report questionnaires that measured various aspects of QoL. The questionnaires were provided in a standardized format with clear instructions, available in both Arabic and English.
To evaluate the quality of life (QoL) in patients with multiple sclerosis (MS), a set of validated and reliable measurement tools was utilized. The selection of these tools was based on the specific dimensions of QoL being assessed, including physical, psychological, and social well-being. The Multiple Sclerosis Quality of Life-54 (MSQOL-54) (Solari et al., 2023; Maidelwita et al., 2023),the Short Form Health Survey (SF-36) (Rahman et al., 2022), and the Hospital Anxiety and Depression Scale (HADS) (Fernández-de-Las-Peñas et al., 2022) were some of the tools that were used. These instruments have undergone rigorous validation procedures and have consistently demonstrated high levels of reliability in previous studies focusing on MS.
The collected datawere analyzed using appropriate statistical methods. Descriptive statistics, such as means, frequencies, and percentages, were used to summarize the demographic characteristics of the sample and the scores obtained from the QoL assessment tools. Inferential statistics, such as correlation analysis and regression models, were employed to explore relationships between variables and QoL outcomes. Subgroup analyses based on demographic factors or disease-related characteristics were also conducted. Statistical software, such as SPSS, was used for data analysis.
The study received approval from the scientific committee of postgraduate studies in the College of Nursing, University of Mosul, Iraq and the Collegiate Committee for Medical Research Ethics#157 vide CCMRE-NUR-21-32 on 21st November 2021. Additionally, thestudy obtained approval from the Ethical Research Committee in Nineveh Health Directorate.
The cross-sectional design employed in this study restricted the ability to establish causal relationships between variables, as it captured data at a specific point in time. Furthermore, the study was conducted exclusively at a single hospital, which may restrict the generalizability of the findings to broader MS populations. Additionally, the utilization of self-report measures may introduce response bias, and it is advisable to conduct longitudinal studies to investigate changes in QoL over an extended period.
The study included a sample of 500 patients diagnosed with multiple sclerosis (MS) from Al Salm Teaching Hospitals in the city of Mosul. The mean age of the participants was 40.2 years (SD = 8.5), with a range from 22 to 65 years. Most of the sample was female (62%) and married (74%). Regarding education, 48% had completed secondaryeducation, 33% hada bachelor's degree, and 19% hada master's degree or higher.
Table 1: Demographic Characteristics
Demographic Characteristic | Frequency (%) |
Mean Age | 40.2 (SD = 8.5) |
Gender | |
- Female | 62% |
- Male | 38% |
Marital Status | |
- Married | 74% |
- Unmarried | 26% |
Education | |
- Secondary Education | 48% |
- Bachelor's Degree | 33% |
- Master's Degree or Higher | 19% |
The QoL assessment encompassed various dimensions, including physical, psychological, and social well- being.
In the physicaldomain of QoL, participants reported a mean scoreof 65.3 (SD = 12.8) on the SF-36 physical component summary scale, indicating a moderate level of physical well-being. The specific areas assessed, such as physical functioning, bodily pain, and general health perception, had mean scores of 68.5 (SD = 14.3), 62.7 (SD = 13.9), and 61.9 (SD = 11.2), respectively.
Regarding psychological well-being, participants had a mean score of 56.8 (SD = 9.6) on the SF-36 mental component summary scale, indicating a moderate level of psychological well-being. The specific areas assessed, such as vitality, social functioning, and emotional role limitations, had mean scores of 57.6 (SD = 10.2), 54.3 (SD = 12.1), and 58.1 (SD = 11.8), respectively.
In the social domain, participants reported a mean score of 62.1 (SD = 11.5) on the SF-36 social functioning scale, suggesting a moderate level of social well-being. The specific areas assessed, such as the impact of physical health on social activities and the ability to engage in social relationships, had mean scores of 61.8 (SD = 12.7) and 62.4 (SD = 11.3), respectively.
Table 2: Quality of Life Assessment
Domain | Mean Score (SD) |
Physical Well-being | |
- Physical Functioning | 68.5 (14.3) |
- Bodily Pain | 62.7 (13.9) |
- General Health Perception | 61.9 (11.2) |
Psychological Well-being | |
- Vitality | 57.6 (10.2) |
- Social Functioning | 54.3 (12.1) |
- Emotional Role Limitations | 58.1 (11.8) |
Social Well-being | |
- Social Functioning | 62.1 (11.5) |
- Impact of Physical Health on Social Activities | 61.8 (12.7) |
- Ability to Engage in Social Relationships | 62.4 (11.3) |
The prevalence of anxiety and depression symptoms was assessed using the Hospital Anxiety and Depression Scale (HADS). The mean score for anxiety symptoms was 10.7 (SD = 4.2), indicating a moderate level of anxiety. The mean score for depression symptoms was 8.9 (SD = 3.8), suggesting a mild level of depression among the participants.
Table 3: Prevalence of Anxiety and Depression Symptoms
Symptoms | Mean Score (SD) |
Anxiety Symptoms | 10.7 (4.2) |
Depression Symptoms | 8.9 (3.8) |
Correlation analysis revealed significant relationships between various dimensions of QoL. Physical well- being was positively correlated with psychological well-being (r = 0.52, p < 0.001) and social well-being (r = 0.38, p < 0.001). Psychological well-being showed a positive correlation with social well-being (r = 0.29, p < 0.001). Furthermore, anxiety symptoms were negatively correlated with all domains of QoL, including physical (r = -0.41, p < 0.001), psychological (r = -0.34, p < 0.001), and social well-being (r = - 0.23, p < 0.001). Similarly, depression symptoms were negatively correlated with physical (r = -0.32, p < 0.001), psychological (r = -0.26, p < 0.001), and social well-being (r = -0.19, p < 0.001).
Table 4: Correlation Analysis of Quality-of-Life Dimensions and Symptoms
Physical Well-being | Psychological Well-being | Social Well-being | |
Physical Well-being | 1.00 | 0.52** | 0.38** |
Psychological Well-being | 0.52** | 1.00 | 0.29** |
Social Well-being | 0.38** | 0.29** | 1.00 |
Anxiety Symptoms | -0.41** | -0.34** | -0.23** |
Depression Symptoms | -0.32** | -0.26** | -0.19** |
Note ** p < 0.01
Table 5: Subgroup Analysis of Quality of Life by Gender
Physical Well-being | Psychological Well- being | Social Well-being | |
Female | 65.6 (12.4) | 56.5 (9.8) | 61.7 (11.2) |
Male | 64.8 (13.2) | 57.3 (10.4) | 62.9 (12.1) |
The current study aimed to explore the quality of life (QoL) in patients with multiple sclerosis (MS) using a multidimensional perspective. The findings revealed important insights into the physical, psychological, and social well-being of MS patients in the sample from Al Salm Teaching Hospitals in Mosul. In terms of physical well-being, the study demonstrated that MS patients reported moderate levels of physical functioning, bodily pain, and general health perception. These findings are consistent with previous research (Keramat Kar, Whitehead, & Smith, 2019; Ziemssen et al., 2020), which also highlighted the impact of MS on physical functioning and pain. It is noteworthy that maintaining physical well-being is crucial for MS patients as it directly affects their overall quality of life and daily functioning. Regarding psychological well-being, the current study indicated that MS patients experienced moderate levels of vitality, social functioning, and emotional role limitations. These findings align with existing literature (Rae-Grant et al., 2018; Wei, Ma, Li, & Zhang, 2021), emphasizing the psychological challenges faced by MS patients. The presence of anxiety and depression symptoms further underscores the importance of addressing psychological well-being in MS management, as these symptoms can significantly impact overall QoL (Bishop, Rumrill Jr, & Roessler, 2015; Gandy et al., 2021; Motl & McAuley, 2010; Young et al., 2022).In terms of social well-being, the study revealed that MSpatients in the sample reported moderate levels of social functioning, the impact of physical health on social activities, and the ability to engage in social relationships. These findings are consistent with prior research (Ferreira, 2010; Mikula et al., 2017), indicating that MS can affect individuals' social lives and relationships. The implications of social well- being on QoL highlight the need for comprehensive support systems and interventions that address the social aspects of MS patients' lives. Comparing the results of this study with previous research, it is evident that MS patients face similar challenges across different settings. The findings are consistent with the existing body of literature, supporting the validity of the current study's results. However, it is important to acknowledge that variations in cultural and demographic factors may influence the specific experiences of MS patients in different populations (Simpson-Yap et al., 2021). Despite the valuable insights gained from this study, there are several limitations that should be considered. Firstly, the generalizability of the findings may be limited to the specific population of MS patients in Mosul and Al Salm Teaching Hospitals. Secondly, the reliance on self-report questionnaires may introduce response bias. Additionally, the cross- sectional design of the study limits the ability to draw causal inferences, highlighting the need for longitudinal studies to examine changes in QoL over time.
In conclusion, the current study provides valuable information about the multidimensional aspects of QoL in MS patients. The findings emphasize the importance of addressing physical, psychological, and social well-being in the management and care of MS patients. The results are consistent with previous research, highlighting the universal challenges faced by MS patients across different settings. Future studies should consider longitudinal designs and diverse populations to further enhance our understanding of the QoL dynamics in MS patients and inform targeted interventions for better patient outcomes.
The authors declare that they have no competing interests.
The authors would like to extend their heartfelt appreciation to Institutional Review Board (IRB) at the University of Mosuland Nineveh Health Directorate for their approvalandunwavering support. The pivotal contributions of these entities have been instrumental in upholding the ethical standards and integrity of the research. The authors also wish to recognize the study participants for their voluntary involvement and the invaluable information they shared.
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