Avaliação transversal da qualidade de vida em portadores de esclerose múltipla por meio de um instrumento genérico (SF-36)

Abstract

Multiple sclerosis (MS) is a chronic disease which may exert signifícant effects on the lives of patients. The Kurtzke Expanded Disability Status Scale (EDSS) remains the most widely used outcome measure in MS, despite its limitations. The use of health-related quality of life (HRQoL) as outcome measure has been increasing in the last years, with development and utilization of several instruments. One of most utilized is the Medicai Outcome Study 36-Item Short-Form Health Survey (SF-36), a generic measure utilized for general population and for many diseases, including MS. The goals of this study are to assess psychometric properties of SF-36 (Brazilian version) in MS patients, and measure HRQoL in MS patients in the city of Uberlândia, State of Minas Gerais, Brazil. HRQoL was measured in 23 MS patients and in 40 subjects of general population (blood donors) in Uberlândia, using the Brazilian version of the SF-36. EDSS score was assigned by neurologic examination at the time of interview. Reliability and validity of SF-36 were assessed. Mean scores of SF-36 domains in general and MS patient groups, general and MS patient subgroup with EDSS < 3.5, and MS patients with EDSS <3.5 e > 4.0 were compared. Correlations among clinicai aspects of disease and SF-36 scores were assessed. The Brazilian version of SF-36 is reliable and valid for use in MS patients. MS patients show lower scores in all SF-36 scales than do the general population, principally in physical function domains (p<0.05). Patients with EDSS scores < 3.5 also show lower scores in all SF-36 scales than control group. The patients with EDSS scores <3.5 have higher mean scores in physical functioning, bodily pain, general health and energy/vitality domains than do the patients with EDSS scores > 4.0 (p<0.05). There is no correlation among time of disease and time since diagnosis with SF-36 scores. Depressive symptoms and heat intolerance show correlation with SF-36 domains and components. In conclusion, the Brasilian version of SF-36 is valid to measure HRQoL in MS patients. MS patients have a signifícant negative impact on all HRQoL domains measured by SF-36, including mental and social domains, compared with general population, even in the stages with less disability. Physical SF-36 scales, but not mental and social scales, decrease with EDSS progression.