DOCTORS AND PATIENTS DONT AGREE - CROSS-SECTIONAL STUDY OF PATIENTS AND DOCTORS PERCEPTIONS AND ASSESSMENTS OF DISABILITY IN MULTIPLE-SCLEROSIS

Objectives: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most importan t to patients with multiple sclerosis with the opinions of patients th emselves; to compare assessment of physical disability in multiple scl erosis by a clinician using Kurtzke's expanded disability status scale and a non-clinically qualified assistant using the Office of Populati on Census and Surveys' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by pat ients using tile SF-36 and the EuroQol questionnaire; and to compare t he scores of patients for each domain of the SF-36 with control data m atched for age and sex. Design: Cross sectional study. Setting: Clinic al department of neurology, Edinburgh. Subjects: 42 consecutive patien ts with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status sc ale; the OPCS disability scale. Results: Patients and clinicians disag reed on which domains of health status were most important (chi(2) = 2 1, df = 7, P = 0.003). Patients' assessment of their physical disabili ty using the physical functioning domain of the SF-36 was highly corre lated with the clinicians' assessment (r = -0.87, P < 0.001) and the n on-clinical assessment (r = -0.90, P < 0.001). However, none of tile m easures of physical disability correlated with overall health related quality of life measured with EuroQol. Quality of life correlated with vitality, general health, and mental health in the SF-36, each of whi ch patients rated as more important than clinicians and for each of wh ich patients scored lower than tile controls. Conclusions: Patients wi th multiple sclerosis, and possibly those with other chronic diseases, are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess th e effect of treatment on the other elements of health status that pati ents consider important, which are also affected by the disease proces s, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment.