Evidence map›Paper›PMID 26962068›Full record

ArticleNeurology2016

Health-related quality of life in multiple sclerosis: Direct and indirect effects of comorbidity.

Lindsay I Berrigan, John D Fisk, Scott B Patten, Helen Tremlett, Christina Wolfson, Sharon Warren, Kirsten M Fiest, Kyla A McKay, Ruth Ann Marrie, CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS)

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06699095 ("Tele-riabilitazione in Sclerosi Multipla), which is not on this map. Cited by 104 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
104citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06699095 narecruitingnot on this mapstarted 2024, after this paper: background citation

"Tele-riabilitazione in Sclerosi Multipla: Continuità Terapeutica Domiciliare Dopo Trattamento Di Neuro-riabilitazione Intensiva, Studio Randomizzato Controllato Con Piattaforma Integrata Per La Riabilitazione Del Disequilibrio"

TypeinterventionalSponsorFondazione I.R.C.C.S. Istituto Neurologico Carlo BestaRan2024 to 2025Enrolled20ConditionsMultiple SclerosisArmsTelerehabilitation
3 · Its place in the literature

Who cites it

104 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Association of serum homocysteine, folate, and vitamin BMultiple sclerosis and related disorders · 2023
    Trial
  7. Trial
  8. Article
  9. Informal carers' perception on perspective taking when reporting as proxies about someone else's health.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026
    Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Comorbidity and modifiable risk factors in multiple sclerosis.Therapeutic advances in neurological disorders · 2026
    Review
  16. Article
  17. Article
  18. Quality of life and access to treatment for patients with multiple sclerosis during economic crisis: the Lebanese experience.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2025
    Article
  19. Article
  20. Article

44 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Lindsay I BerriganFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. lberriga@stfx.ca.
John D FiskFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Scott B PattenFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Helen TremlettFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Christina WolfsonFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Sharon WarrenFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Kirsten M FiestFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Kyla A McKayFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Ruth Ann MarrieFrom the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the direct and indirect influences of physical comorbidity, symptoms of depression and anxiety, fatigue, and disability on health-related quality of life (HRQoL) in persons with multiple sclerosis (MS).

methodsA large (n = 949) sample of adults with MS was recruited from 4 Canadian MS clinics. HRQoL was assessed using the patient-reported Health Utilities Index Mark 3. Expanded Disability Status Scale scores, physical comorbidity, depression, anxiety, and fatigue were evaluated as predictors of HRQoL in a cross-sectional path analysis.

resultsAll predictors were significantly associated with HRQoL and together accounted for a large proportion of variance (63%). Overall, disability status most strongly affected HRQoL (β = -0.52) but it was closely followed by depressive symptoms (β = -0.50). The direct associations of physical comorbidity and anxiety with HRQoL were small (β = -0.08 and -0.10, respectively), but these associations were stronger when indirect effects through other variables (depression, fatigue) were also considered (physical comorbidity: β = -0.20; anxiety: β = -0.34).

conclusionsIncreased disability, depression and anxiety symptoms, fatigue, and physical comorbidity are associated with decreased HRQoL in MS. Disability most strongly diminishes HRQoL and, thus, interventions that reduce disability are expected to yield the most substantial improvement in HRQoL. Yet, interventions targeting other factors amenable to change, particularly depression but also anxiety, fatigue, and physical comorbidities, may all result in meaningful improvements in HRQoL, as well. Our findings point to the importance of further research confirming the efficacy of such interventions.

Identifiers

PMID26962068
PMCPMC4831037

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.