THE "INVISIBLE" BURDEN: WORKPLACE DIFFICULTIES IN EARLY-STAGE RELAPSING-REMITTING MULTIPLE SCLEROSIS WITH LOW PHYSICAL DISABILITY
Author(s)
Elena Garcia-Arcelay, N/A1, Angel Perez-Sempere, Dr2, Jacobo Caruncho, Dr3, Antonio Candeliere-Merlicco, Dr4, Aida Orviz, Dr5, Jesus Martin-Martinez, Dr6, Raquel Piñar-Morales, Dr7, Elena Alvarez-Rodriguez, Dr8, Eva Pacheco, Dr9, Laura Borrega, Dr10, Ignacio Casanova, Dr11, Ana Caminero, Dr12, Jose Luis Sánchez Menoyo, Dr13, Montserrat Gomez-Gutierrez, Dr14, Olga Carmona, Dr15, Carmen Calles, Dr16, Miguel Angel Hernandez, Dr17, Pablo Lopez-Muñoz, Dr18, Ines Gonzalez-Suarez, Dr19, Jorge Maurino, Dr20.
1SNC Medical Expert, Roche Farma SA, Madrid, Spain, 2Hospital General Universitario de Alicante, Alicante, Spain, 3AVEMPO (Asociación Viguesa de Esclerosis Múltiple), Vigo, Spain, 4Hospital General Universitario Rafael Méndez, Lorca, Spain, 5Hospital Universitario Fundación Jiménez Díaz,, Madrid, Spain, 6Hospital Universitario Miguel Servet,, Zaragoza, Spain, 7Hospital Clínico San Cecilio, Granada, Granada, Spain, 8Department of Neurology, Hospital Álvaro Cunqueiro,, Vigo, Spain, 9Hospital Juan Ramón Jiménez,, Department of Neurology, Spain, 10Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain, 11, Hospital de Torrejón, Department of Neurology, Spain, 12Complejo Asistencial de Ávila, Ávila,, Department of Neurology, Spain, 13Hospital de Galdakao-Usansolo,, Department of Neurology, Spain, 14Hospital San Pedro de Alcántara, Cáceres, Spain, 15Department of Neurology, Hospital de Figueres, Figueres, Spain, 16Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain, 17Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria,, Santa Cruz de Tenerife, Spain, 18Department of Neurology, Hospital Arnau de Vilanova, Valencia, Spain, 19Department of Neurology, Hospital Álvaro Cunqueiro, Vigo, Spain, 20Roche Farma SA, Madrid, Spain.
1SNC Medical Expert, Roche Farma SA, Madrid, Spain, 2Hospital General Universitario de Alicante, Alicante, Spain, 3AVEMPO (Asociación Viguesa de Esclerosis Múltiple), Vigo, Spain, 4Hospital General Universitario Rafael Méndez, Lorca, Spain, 5Hospital Universitario Fundación Jiménez Díaz,, Madrid, Spain, 6Hospital Universitario Miguel Servet,, Zaragoza, Spain, 7Hospital Clínico San Cecilio, Granada, Granada, Spain, 8Department of Neurology, Hospital Álvaro Cunqueiro,, Vigo, Spain, 9Hospital Juan Ramón Jiménez,, Department of Neurology, Spain, 10Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain, 11, Hospital de Torrejón, Department of Neurology, Spain, 12Complejo Asistencial de Ávila, Ávila,, Department of Neurology, Spain, 13Hospital de Galdakao-Usansolo,, Department of Neurology, Spain, 14Hospital San Pedro de Alcántara, Cáceres, Spain, 15Department of Neurology, Hospital de Figueres, Figueres, Spain, 16Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain, 17Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria,, Santa Cruz de Tenerife, Spain, 18Department of Neurology, Hospital Arnau de Vilanova, Valencia, Spain, 19Department of Neurology, Hospital Álvaro Cunqueiro, Vigo, Spain, 20Roche Farma SA, Madrid, Spain.
OBJECTIVES: Multiple sclerosis (MS) predominantly affects young adults during their peakproductive years, often leading to early labor force withdrawal. This studyassessed perceived workplace difficulties in patients with early-stage relapsing-remitting MS (RRMS) and identified the clinical predictors associated with thesechallenges.
METHODS: We conducted a non-interventional, cross-sectional study across 16 neuroimmunology units in Spain. Eligible participants included adults diagnosed with RRMS within the previous 3 years with Expanded Disability Status Scale(EDSS) scores ranging from 0.0 to 5.5. Workplace difficulties were measured using the 23-item MS Work Difficulties Questionnaire (MSWDQ-23), which assesses physical, psychological/cognitive, and external barriers. Significant workplace difficulty was defined as an MSWDQ-23 total score ≥32. Independent predictors were identified using multivariable logistic regression analysis.
RESULTS: A total of 128 patients were studied (mean age: 37.2 years [SD 10.2], 68% female). Despite minimal physical disability (median EDSS score: 1.5 [IQR 0.0-2.0]), 40.6% (N=52) reported significant workplace difficulties. The highest perceived burden related to external barriers (mean score: 33.4), followed by psychological/cognitive (26.2), and physical (21.8) domains. Women reported significantly higher total difficulty scores than men (29.9 vs. 21.2, p=0.010), primarily due to psychological and external factors. Patients experiencing significant difficulties exhibited higher levels of fatigue, anxiety, depression, hopelessness, and illness-related uncertainty. Multivariable analysis identified anxiety (OR = 1.205; 95% CI: 1.054-1.378; p = 0.0063) and fatigue (OR = 1.372; 95% CI: 1.170-1.608; p < 0.0001) as independent predictors of workplace challenges
CONCLUSIONS: Workplace difficulties affect over 40% of patients with early-stage RRMS and are driven by "invisible" symptoms, specifically fatigue and anxiety, rather than other physical impairment. These findings emphasize the importance of early screening with patient-reported measures like the MSWDQ-23. Timely identification of these barriers is essential to implementing rehabilitation and workplace adjustments aimed at maintaining work participation.
METHODS: We conducted a non-interventional, cross-sectional study across 16 neuroimmunology units in Spain. Eligible participants included adults diagnosed with RRMS within the previous 3 years with Expanded Disability Status Scale(EDSS) scores ranging from 0.0 to 5.5. Workplace difficulties were measured using the 23-item MS Work Difficulties Questionnaire (MSWDQ-23), which assesses physical, psychological/cognitive, and external barriers. Significant workplace difficulty was defined as an MSWDQ-23 total score ≥32. Independent predictors were identified using multivariable logistic regression analysis.
RESULTS: A total of 128 patients were studied (mean age: 37.2 years [SD 10.2], 68% female). Despite minimal physical disability (median EDSS score: 1.5 [IQR 0.0-2.0]), 40.6% (N=52) reported significant workplace difficulties. The highest perceived burden related to external barriers (mean score: 33.4), followed by psychological/cognitive (26.2), and physical (21.8) domains. Women reported significantly higher total difficulty scores than men (29.9 vs. 21.2, p=0.010), primarily due to psychological and external factors. Patients experiencing significant difficulties exhibited higher levels of fatigue, anxiety, depression, hopelessness, and illness-related uncertainty. Multivariable analysis identified anxiety (OR = 1.205; 95% CI: 1.054-1.378; p = 0.0063) and fatigue (OR = 1.372; 95% CI: 1.170-1.608; p < 0.0001) as independent predictors of workplace challenges
CONCLUSIONS: Workplace difficulties affect over 40% of patients with early-stage RRMS and are driven by "invisible" symptoms, specifically fatigue and anxiety, rather than other physical impairment. These findings emphasize the importance of early screening with patient-reported measures like the MSWDQ-23. Timely identification of these barriers is essential to implementing rehabilitation and workplace adjustments aimed at maintaining work participation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR123
Topic
Clinical Outcomes, Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
Neurological Disorders