The impact of the COVID-19 pandemic and lockdowns on the health-related quality of life of people living with multiple sclerosis in Australia

Objectives: People living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia experienced a 112-day, COVID-19 related lockdown in mid-2020. This lockdown severely limited civilian movement and access to services. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions. The resulting natural experiment was exploited by this study, which assessed the associations between lockdowns, COVID-19 related adversity, and health-related quality of life (HRQoL).

Methods: : Data (quantitative and qualitative) were extracted from Australian MS Longitudinal Study surveys, which included the AQoL-8D multiattribute utility instrument and a specialised COVID-19 questionnaire. This COVID-19 questionnaire required participants to indicate levels of COVID-19 related adversity across several health dimensions. Ordered probits were used to identify variables contributing to higher adversity rankings. Multiple regression was applied to determine the impact of adversity on HRQoL, defined using AQoL-8D health state utilities (HSUs). Qualitative data were examined thematically.

Results: : n=1666 PwMS (average age 58.5y; 79.8% female; typical of MS-related studies) entered the study, with n=369 (22.0%) exposed to the 112-day lockdown. The lockdown was strongly associated with higher adversity rankings, as was disability severity, relapse-onset phenotypes, and lower age (p,0.01 for all variables). Higher adversity rankings were associated with reduced HSUs. Participants reporting major adversity, across measured health dimensions, had HSUs 0.163 (p,0.01) lower than participants reporting no adversity and were more likely (OR:2.36, p,0.01) to report a clinically significant HSU reduction, before versus during the COVID-19 pandemic. A clinically significant decrease in HSU was defined as D.0.08, based on the literature. Additionally, COVID-19 adversity pertaining to emotional wellbeing was predominant in its association with reduced HSUs (b=-0.065, p,0.01). Themes in qualitative data supported quantitative findings.

Conclusions: : This study demonstrated that COVID-19 related adversity can substantially reduce the HRQoL of PwMS. Directing resources to ameliorate instances of this effect should be a public health priority, with psychological interventions being paramount.