Pain contributed the most to multiple sclerosis (MS) outpatients’ perception of health, followed by gait dysfunction and fatigue, according to a recent study. These findings suggest that “invisible disability” may be more important to patients’ sense of well-being than physical disability, and challenge the notion that physical disability should be the primary outcome measure in MS. Patients in 2 MS centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by MS. Researchers found:

• Among 1,865 MS outpatients (68% women, 78% with relapsing–remitting MS, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 (moderate to good).
• Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r=0.68) as did each of the symptoMScreen domain subscores.
• In regression analysis, pain (t=7.00), ambulation (t=6.91), and fatigue (t=5.85) contributed the highest amount of variance in self-rated health.