Results from a recent study demonstrate that coronavirus disease 2019 (COVID-19) negatively impacts physical activity levels (P =.014) and psychological state by elevating fear of COVID-19 (P =.006) in individuals with multiple sclerosis (MS) who are COVID-positive.

Interestingly, quality of life as measured by 2 different sections of the EuroQoL Instrument assessment tool (P =.021 and P =.014, respectively) was significantly higher in the COVID-positive group than in the COVID-negative group. In addition, COVID-19 did not impact anxiety, sleep quality, or fatigue in individuals with MS.

Investigators observed moderate correlations between fear of COVID-19 and disability status (r=-0.362); physical activity level and MS relapse duration, disability status, and fatigue (r1=-0.471, r2=-0.389, r3=-0.388, respectively); and quality of life and fatigue (r=-0.404), disability status (r=-0.393), and sleep quality (r=-0.357).

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Patients With IPF Are at High Risk of Poor Outcomes From COVID-19

The authors suggested that the reduction in physical activity resulted from the COVID-19 quarantine, as well as from the cardiopulmonary impact from having the virus. They related the fear of COVID-19 to young individuals with MS with high academic backgrounds; however, they mentioned that the fear did not reach the level of anxiety due to their medical care being handled via telemedicine.

The researchers attributed the improved quality of life in the COVID-positive group to more careful behaviors surrounding nutrition and daily care because they had the virus. They also suggested that the young ages of the COVID-positive group resulted in the virus having a milder impact that did not affect quality of life. Patients also had to quarantine for 14 days, which reduced occupational and mental stressors and allowed them to rest and recover.

The authors remarked, “It is unique to reveal how patients’ clinical conditions are affected by their symptoms and possible lifestyle changes. [This study] will provide the current information on COVID-19 disease in people with MS.”

Study Methods

The researchers enrolled 104 individuals with MS in this study, with 46 of them having a positive history of COVID-19. The investigators evaluated the patients using the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), EuroQoL Instrument (EQ-5D-3L), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Pittsburgh Sleep Quality Index (PSQI). The researchers then compared the COVID-19-positive patients with the COVID-19-negative patients within the cohort. They also examined the correlations between the individual assessment tools.


One study limitation was the lack of standardization in demonstrating the severity of COVID-19. The researchers mentioned that a numerical or categorical variable reflecting COVID severity evaluated by regression analysis could make a more significant contribution to clinical practice. This variable could also create a regression model between existing parameters related to COVID-19 and other parameters found to have a causal relationship.

Another limitation included the small sample size of 46 COVID-19-positive patients with MS. The authors also recommended longer follow-up periods with 2 separate evaluation times.


Özkeskin M, Özden F, Karaman B, Ekmekçi Ö, Yüceyar N. The comparison of fatigue, sleep quality, physical activity, quality of life, and psychological status in multiple sclerosis patients with or without COVID-19. Mult Scler Relat Disord. 2021;55:103180. doi:10.1016/j.msard.2021.103180