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Global, regional and national quality of life in patients with multiple sclerosis: a global systematic review and meta-analysis
  1. Fatemeh Pashazadeh Kan1,
  2. Zahra Hoseinipalangi1,
  3. Niloofar Ahmadi1,
  4. Hossein Hosseinifard2,
  5. Afsaneh Dehnad3,4,
  6. Batool Sadat Hoseini1,
  7. Mahsa Tohidi Asl1 and
  8. Ahmad Ghashghaee5,6
  1. 1 Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
  2. 2 Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  3. 3 School of Health Management and Information Sciences, University of Medical Sciences, Tehran, Iran
  4. 4 Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  5. 5 Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  6. 6 Health Management and Economics Research Center, Tehran, Iran
  1. Correspondence to Ahmad Ghashghaee, Iran University of Medical Sciences, Tehran 1449614535, Iran (the Islamic Republic of); ahmad.ghashghaee1996{at}


Background and aim The purpose of this study was to evaluate the health-related quality of life (HRQOL) of patients with multiple sclerosis (MS) globally to provide precise information for policy makers to take necessary steps to improve the quality of life of these patients. This systematic review and meta-analysis is the first global study in the last decade.

Materials and methods Data from January 2000 to April 2020 were collected from Scopus, PubMed, Embase, Web of Science and Google Scholar databases on the basis of inclusion and exclusion criteria. Data obtained were analysed by R software, and 54 articles were finally included in the study.

Results From the 2126 articles collected, a total of 54 articles were included in the study. Based on the results of random-effects analysis (DerSimonian and Laird), the mental HRQOL score was 55.18 (95% CI 52.71 to 57.65) and the physical HRQOL score was 48.72 (95% CI 45.93 to 51.52). In this study, age and duration of disease had a significant and direct relationship with mental HRQOL (p≤0.01). Moreover, mental HRQOL was higher in Europe than in other continents, while physical HRQOL was higher in Asia than in other continents. HRQOL was also evaluated on the basis of three valid questionnaires: Short Form 36, Multiple Sclerosis Quality of Life-54 and Multiple Sclerosis International Quality of Life.

Conclusion According to the results of this study, the total score for HRQOL indicates moderate quality of life. Factors such as depression, age and duration of disease have the greatest impact on HRQOL, whereas factors such as fatigue and the Expanded Disability Status Scale score have less effects on HRQOL, so that patients with MS continue their daily activities as long as they are physically able to, and this happens despite disease progression.

  • quality of life
  • supportive care
  • social care

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  • Contributors Conception and design of study: ZH, AG, FPK. Acquisition of data: ZH, AG, FPK. Analysis and/or interpretation of data: HH, ZH, NA, BSH. Drafting the manuscript: ZH, AG, MTA. Revising the manuscript critically for important intellectual content: ZH, AD, AG, FPK. Approval of the version of the manuscript to be published: ZH, AG, FPK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.