We are pleased that the Olmsted County cohort study was able to find that quality of life (QOL) was less adversely affected than studies have found in Canada,1 Norway,2 Spain,3 or the United Kingdom.4 However, there may be methodological reasons why this is the case. The study from Pittock et al5 not only excluded patients with substantial cognitive impairment (itself a major cause of poor QOL for both patients and caregivers),6 but also relied on medical notes for 9 subjects. Medical notes notoriously underreport neuropsychiatric and QOL variables.7 In addition, they used the Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54), which had been criticized owing to questionable validity.8 Strangely, the authors report that 77% of patients were mostly satisfied or delighted, but these are not continuous points on question 54 of the MSQOL, and further, they do not report comparison data from the general population.
Mitchell AJ, Benito-León J, Rivera-Navarro J, Morales-González JM. Quality of Life Is Not Favorable for Most Patients With Multiple Sclerosis. Arch Neurol. 2004;61(11):1807–1808. doi:10.1001/archneur.61.11.1807-b
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