Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Neurology, Flevoziekenhuis, Almere, The Netherlands.
Mult Scler Relat Disord. 2019 Jun;31:32-37. doi: 10.1016/j.msard.2019.03.011. Epub 2019 Mar 16.
Multiple sclerosis (MS) is associated with high rates of disability pension and work absence. Little is known about work absence in early MS. The objectives of this study were (1) to assess the prevalence of work absence shortly after MS diagnosis, (2) to explore health-related quality of life (HRQoL) and disease impact in relation to work absence and (3) to investigate demographic and clinical factors that may be associated with high work absence.
Patients with relapsing remitting (RRMS) or primary progressive MS (PPMS) were included shortly after MS diagnosis. We collected data on work absence due to MS in the year prior to inclusion, disability (Expanded Disability Status Scale), relapse rate, fatigue (Neurological Fatigue Index), health-related quality of life (HRQoL, 36-Item Short Form Survey) and disease impact (Multiple Sclerosis Impact Scale). For analysis, patients were divided in 2 groups: low work absence (<1 month) and high work absence (≥1 month). Data was analyzed using backward logistic regression techniques.
In total, 90 MS patients participated (80 RRMS, 10 PPMS, mean age = 39.3 years, median disease duration since diagnosis = 0.5 year). Work absence in the year prior to inclusion was reported by 66 patients (73.3%). High work absence of ≥ 1 month was reported by 41 patients (45.6%). Disability, gender, age, disease duration and education did not differ between groups. Patients with high work absence reported a lower HRQoL and higher disease impact compared to patients with low work absence. Backward regression analysis showed that high work absence is associated with being single/not married, fatigue and relapses. The strongest association was found for fatigue (highest fatigue vs. lowest fatigue level: OR total group = 7.8, RRMS = 15.8). In RRMS patients the second-strongest association was relapse rate (≥2 relapses in the past year vs. no relapses: OR 11.1).
Prevalence of work absence is high in early MS. Patients with high work absence report a lower HRQoL and a higher disease impact. High work absence is associated with being single/not married, fatigue and relapses. Interventions aimed at fatigue and prevention of relapses may help maintain employment in early MS.
多发性硬化症（MS）与高残疾抚恤金和旷工率相关。关于早期 MS 的旷工情况知之甚少。本研究的目的是：(1) 评估 MS 确诊后不久旷工的发生率；(2) 探讨与旷工相关的健康相关生活质量（HRQoL）和疾病影响；(3) 调查可能与高旷工率相关的人口统计学和临床因素。
研究纳入了复发缓解型 MS（RRMS）或原发性进展型 MS（PPMS）患者，这些患者在确诊后不久入组。我们收集了入组前 1 年内因 MS 导致的旷工情况、残疾情况（扩展残疾状态量表）、复发率、疲劳（神经疲劳指数）、HRQoL（36 项简短健康调查）和疾病影响（多发性硬化影响量表）等数据。采用向后逻辑回归技术分析患者分为低旷工组（<1 个月）和高旷工组（≥1 个月）。
共纳入 90 例 MS 患者（80 例 RRMS，10 例 PPMS；平均年龄 39.3 岁，中位确诊后病程 0.5 年）。66 例（73.3%）患者报告入组前 1 年内有旷工情况。41 例（45.6%）患者报告高旷工（≥1 个月）。高旷工组和低旷工组在残疾程度、性别、年龄、病程和教育程度方面无差异。与低旷工组相比，高旷工组报告的 HRQoL 更低，疾病影响更高。向后回归分析显示，高旷工与单身/未婚、疲劳和复发有关。与最低疲劳水平相比，最高疲劳水平时，相关性最强（总人群：OR=7.8，RRMS：OR=15.8）。RRMS 患者中，第二强的相关性是复发率（过去 1 年中有≥2 次复发：OR=11.1）。
早期 MS 旷工发生率较高。高旷工组报告的 HRQoL 更低，疾病影响更高。高旷工与单身/未婚、疲劳和复发有关。针对疲劳和预防复发的干预措施可能有助于维持早期 MS 患者的就业。
