Joly H, Brissart H, Fabre R, Cambiaggio S, Zerlini M, Honan C, Lebrun-Frenay C
Centre Hospitalier Universitaire de Nice, Service de Neurologie, CRC SEP, Nice, France; Université Nice Côte d'Azur, UR2CA-URRIS, Nice, France; Université de Lorraine, CNRS, 54000 Nancy, France.
Université de Lorraine, CNRS, 54000 Nancy, France; Service de Neurologie, CHRU de Nancy, Nancy, France.
Rev Neurol (Paris). 2025 Apr;181(4):349-362. doi: 10.1016/j.neurol.2025.02.005. Epub 2025 Mar 10.
Work difficulties are a primary issue of multiple sclerosis (MS). This is because disease onset usually occurs during a time when establishing a career and employment is of paramount importance. The MSWDQ-23 (Multiple Sclerosis Work Difficulties Questionnaire) was developed to assess work difficulties in MS. The WORKSEP project aimed to adapt and validate the French MSWDQ-23 and develop cutoff scores through a multicentric study in 14 centers across France. Two hundred and six persons with MS were recruited: 149 with relapsing-remitting MS and 57 with progressive forms of MS. They completed the MSWDQ-23 in French, the DEX to assess the subjective cognitive executive complaint, and the SF-36 evaluating mental (MC) and physical (PC) health-related quality of life. The results indicated that the French version of MSWDQ-23 has high internal consistency (Cronbach's α: 0.93) and test-retest reliability (ICC=0.83). A confirmatory factor analysis demonstrated a scale structure identical to the original English version comprising physical barriers (PB), psychological and cognitive barriers (PCB), and external barriers (EB). The construct and convergent validity were strong. A higher level of work difficulties at PB score was related to a higher level of disability at the EDSS and lower PC quality of life, and a higher level of PCB was related to higher cognitive executive complaints and lower MC quality of life. ROC curves based on the difference between employed and unemployed patients allowed for determining cutoff values of 32 for the total score, 37 for PB, and 27 for PCB. This study allowed the validation of the MSWDQ-23 in the French language and is the first to propose a cutoff. Determining the cutoff value enables identifying patients needing intervention and targets the limitations that MS patients may encounter in the workplace. This easy-to-use instrument provides the opportunity to propose an adapted rehabilitation program or work adjustments to improve the quality of life in patients with MS.
工作困难是多发性硬化症（MS）的一个主要问题。这是因为疾病通常在建立职业生涯和就业至关重要的时期发病。MSWDQ - 23（多发性硬化症工作困难问卷）旨在评估MS患者的工作困难。WORKSEP项目旨在对法国版的MSWDQ - 23进行改编和验证，并通过法国14个中心的多中心研究确定临界值。招募了206名MS患者：149名复发缓解型MS患者和57名进展型MS患者。他们用法语完成了MSWDQ - 23、用于评估主观认知执行功能障碍的DEX以及评估心理（MC）和身体（PC）健康相关生活质量的SF - 36。结果表明，法语版的MSWDQ - 23具有较高的内部一致性（克朗巴赫α系数：0.93）和重测信度（ICC = 0.83）。验证性因素分析表明，其量表结构与原始英文版相同，包括身体障碍（PB）、心理和认知障碍（PCB）以及外部障碍（EB）。结构效度和收敛效度很强。PB得分较高的工作困难水平与EDSS残疾水平较高以及PC生活质量较低相关，而PCB得分较高与较高的认知执行功能障碍以及较低的MC生活质量相关。基于在职和失业患者差异的ROC曲线确定了总分的临界值为32、PB为37、PCB为27。这项研究验证了法语版的MSWDQ - 23，并且首次提出了临界值。确定临界值能够识别需要干预的患者，并针对MS患者在工作场所可能遇到的限制。这种易于使用的工具为提出适应性康复计划或工作调整以改善MS患者的生活质量提供了机会。
