Lorefice Lorena, Fenu Giuseppe, Frau Jessica, Coghe Giancarlo, Marrosu Maria Giovanna, Cocco Eleonora
Department of Medical Sciences and Public Health, Multiple Sclerosis Centre, University of Cagliari, Sardinia, Italy.
Work. 2018;60(2):263-270. doi: 10.3233/WOR-182682.
Frequently diagnosed in young adulthood, multiple sclerosis (MS) and several MS-related factors can influence patients' unemployment status and negatively affect work productivity and daily functioning.
We examined MS patients' employment status and evaluated clinical features influencing it. Furthermore, we investigated patients' burdens due to visible and invisible MS symptoms through their worsening daily functioning.
The study included outpatients affected by MS according to the 2010 McDonald criteria. The co-occurrence of invisible symptoms (fatigue, depression and apathy) was stated using validated, self-administered tools: Fatigue Severity Scale (FSS); Beck Depression Inventory-Second Edition (BDI-II); Apathy Evaluation Scale (AES). Impairment in daily functioning due to MS was assessed using the Work and Social Adjustment Scale (WSAS). Descriptive statistics, hierarchical regression analyses, Pearson's correlation, and the t-test were conducted.
Of the 123 participants, 52 (42.3%) were unemployed. Results showed employment to be positively associated with higher education levels (p 0.01); female gender (p 0.03) and higher disability (p 0.02) showed negative associations with employment. No associations were found between employment and fatigue or clinically relevant depressive and apathetic symptoms. High correlations were found between WSAS score and Expanded Disability Status Scale score (r = 565, p < 0.001), BDI-II score (r = 588, p < 0.001), and FSS score (r = 545, p < 0.001).
Our study revealed physical disability's significance in determining MS patients' unemployment. Alternatively, invisible MS symptoms negatively affected principally patients' social lives. Therefore, programs should be designed to improve MS patients' work integration and daily activities.
多发性硬化症（MS）常于青年期被诊断出来，多种与MS相关的因素会影响患者的就业状况，并对工作效率和日常功能产生负面影响。
我们研究了MS患者的就业状况，并评估了影响其就业的临床特征。此外，我们通过患者日常功能的恶化情况，调查了可见和不可见MS症状给患者带来的负担。
该研究纳入了根据2010年麦克唐纳标准确诊为MS的门诊患者。使用经过验证的自我管理工具来确定不可见症状（疲劳、抑郁和冷漠）的共现情况：疲劳严重程度量表（FSS）；贝克抑郁量表第二版（BDI-II）；冷漠评估量表（AES）。使用工作和社会适应量表（WSAS）评估MS导致的日常功能损害。进行了描述性统计、分层回归分析、皮尔逊相关性分析和t检验。
123名参与者中，52人（42.3%）失业。结果显示就业与较高的教育水平呈正相关（p<0.01）；女性（p<0.03）和较高的残疾程度（p<0.02）与就业呈负相关。就业与疲劳或临床相关的抑郁和冷漠症状之间未发现关联。WSAS评分与扩展残疾状态量表评分（r = 0.565，p<0.001）、BDI-II评分（r = 0.588，p<0.001）和FSS评分（r = 0.545，p<0.001）之间存在高度相关性。
我们的研究揭示了身体残疾在决定MS患者失业方面的重要性。另外，不可见的MS症状主要对患者的社交生活产生负面影响。因此，应设计相关项目来改善MS患者的工作融入和日常活动。
