THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS

Bibliographic Details
Main Author:	MARRIE, RUTH ANN
Language:	English
Published:	Case Western Reserve University School of Graduate Studies / OhioLINK 2007
Subjects:	Multiple Sclerosis Comorbidity Disability Clinical characteristics Health behaviors
Online Access:	http://rave.ohiolink.edu/etdc/view?acc_num=case1182528613

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spelling	ndltd-OhioLink-oai-etd.ohiolink.edu-case11825286132021-08-03T05:32:18Z THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS MARRIE, RUTH ANN Multiple Sclerosis Comorbidity Disability Clinical characteristics Health behaviors The impact of comorbidity on multiple sclerosis (MS)-related outcomes is unknown. My aims were to validate self-reported MS diagnoses among participants in The North American Research Committee on Multiple Sclerosis (NARCOMS) registry; to establish the validity of Performance Scales as a disability measure for MS; and to determine the impact of comorbidities on clinical characteristics, disability at diagnosis, and disability progression associated with MS. NARCOMS participants self-report demographic and clinical information regarding their MS at enrollment and semi-annually thereafter; the MS diagnoses are unverified. Based on records review, physician survey, or phone interview I confirmed a diagnosis of MS in 98.7 +/- 1.3% of 52 randomly selected registry participants. NARCOMS participants report disability status using Performance Scales (PS), a self-report measure for multiple sclerosis (MS)-associated disability. The criterion and construct validity of the PS subscales were assessed in 44 outpatients; results supported the criterion and construct validity of PS overall, and its mobility, hand, vision, fatigue, and bladder subscales. In the Fall 2006 Update Questionnaire, NARCOMS participants were queried regarding physical and mental comorbidities. Of 18000 participants eligible for this survey, 16189 met inclusion criteria. Of these, 8983 (55.5%) responded. Comorbidity was common; 6907 (77.1%) participants had ≥1 physical comorbidity. Vascular, autoimmune, cancer, visual, and musculoskeletal comorbidities were associated with a later age of symptom onset and diagnosis. After adjustment, the delay between symptom onset and diagnosis increased if obesity, smoking, physical or mental comorbidities were present. After adjustment, the odds of moderate as compared to mild disability at diagnosis were increased in participants with vascular comorbidity (OR 1.51; 1.12-2.05) or obesity (OR 1.38; 1.02-1.87). The odds of severe as compared to mild disability were increased with musculoskeletal (OR 1.81; 1.25-2.63) or mental (OR 1.62; 1.23-2.14) comorbidity, or smoking (OR 1.60; 1.19-2.15). Vascular, musculoskeletal, gastrointestinal, visual, or mental comorbidity at diagnosis of MS increased the hazard of ambulatory disability. Comorbidity occurring later in the disease course also increased the hazard of ambulatory disability, with hazard ratios for needing unilateral walking assistance as high as 1.54 (1.44-1.65) for vascular comorbidity. Comorbidity is common in MS and adversely affects outcome. 2007-07-05 English text Case Western Reserve University School of Graduate Studies / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=case1182528613 http://rave.ohiolink.edu/etdc/view?acc_num=case1182528613 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.
collection	NDLTD
language	English
sources	NDLTD
topic	Multiple Sclerosis Comorbidity Disability Clinical characteristics Health behaviors
spellingShingle	Multiple Sclerosis Comorbidity Disability Clinical characteristics Health behaviors MARRIE, RUTH ANN THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
author	MARRIE, RUTH ANN
author_facet	MARRIE, RUTH ANN
author_sort	MARRIE, RUTH ANN
title	THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
title_short	THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
title_full	THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
title_fullStr	THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
title_full_unstemmed	THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS
title_sort	influence of comorbid diseases and health behaviors on clinical characteristics, disability at diagnosis, and disability progression in multiple sclerosis
publisher	Case Western Reserve University School of Graduate Studies / OhioLINK
publishDate	2007
url	http://rave.ohiolink.edu/etdc/view?acc_num=case1182528613
work_keys_str_mv	AT marrieruthann theinfluenceofcomorbiddiseasesandhealthbehaviorsonclinicalcharacteristicsdisabilityatdiagnosisanddisabilityprogressioninmultiplesclerosis AT marrieruthann influenceofcomorbiddiseasesandhealthbehaviorsonclinicalcharacteristicsdisabilityatdiagnosisanddisabilityprogressioninmultiplesclerosis
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THE INFLUENCE OF COMORBID DISEASES AND HEALTH BEHAVIORS ON CLINICAL CHARACTERISTICS, DISABILITY AT DIAGNOSIS, AND DISABILITY PROGRESSION IN MULTIPLE SCLEROSIS

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