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Pittock et al¹ conclude in a provocative title that quality of life (QOL) is favorable for most patients with multiple sclerosis (MS). This conclusion is in striking contrast to population-based studies reporting that 45% of MS patients were unemployed due to their disease and 37% experienced a decline in their standards of living.^2-3 The conclusion is based on the finding that patients’ Short Form-36 scores were comparable to that of the US population on 3 of 4 mental health scales, even though they reported lower scores on 4 of 8 Short Form-36 scales.

The absence of a decrease in mental health scores in patients who face increasing functional limitations is a rather common finding in questionnaire studies and explained by a phenomenon called response shift.⁴ Response shift occurs due to changes in definitions and reference standards for the QOL domains. For example, the impact of disease on social interactions (Short . . . [Full Text of this Article]

AUTHOR INFORMATION

A. Cecile J. W. Janssens, PhD; Rogier Q. Hintzen, MD, PhD