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Concordance between severity of disease, disability and health-related quality of life in Myasthenia gravis
Neurological Sciences, 10/20/09

Raggi A et al. – Results confirm a significant relationship between MG severity groups, HRQoL and disability profiles. In this opinion, HRQoL and disability instruments should be employed in clinical trials to match efficacy of treatments, measured on symptoms’ reductions only, with their effects on patients’ disability and HRQoL.

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Alberto Raggi, 11/09/09

In this study, we highlighted a clear relationship between severity of disease, disability profiles and HRQoL, both for mental and physical aspects; as expected, patients with severe MG are more likely to experience high levels of disability and a substantial decrement in HRQoL. Moreover, we detected an intermediate area of disability and HRQoL decrement which is not well described by MG severity classification only: this pattern is observed in more than 25% of our MG sample. We speculate that this lack of concordance could be explained on the basis of the underlying constructs: on one side, a measure of HRQoL, which is a subjective appraisal of health states; on the other side, a measure of disability, which describes the interaction between a health condition and the contextual factors in which patients live. These construct are not equal and should not be taken as transposable. In our opinion, a measure of disability like the WHO-DAS II, easy to use and consistent with ICF’s model, should be employed to measure disability in MG patients. The reason for this is that the effect of MG on patients’ daily activities are necessarily mediated by the disease itself, but also by the effectiveness of contextual factors, such as medical intervention, social intervention in the field of labor policies or the assistance provided by family members and other relevant persons.

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