An article published in Multiple Sclerosis and Related Disorders found that health-related quality of life (HRQoL) was lower in patients with relapsing-remitting multiple sclerosis (RRMS) than non-patient controls and that the fear of relapse (FoR) was the best predictor of their physical quality of life.

The study investigated several factors for their impact on HRQoL including FoR, health anxiety (HA), number of relapses, the duration of the disease, type of disease-modifying therapy (DMT) being used, the perceived level of side effects, and the treating neurologist’s estimation of disease severity.

The linear regression model initially showed that the neurologist’s estimated disease severity was strongly associated with HRQoL, however, this relationship decreased and no longer became significant when the model was adjusted to reflect FoR. After adjustment, FoR was found to be the only statistically significant covariate for HRQoL.

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The author’s postulated that FoR’s better prediction than neurologist’s estimation of disease severity was likely due to the fact that quality of life is subjective while the neurologist’s assessment is based on objective measures from medical records. This indicates that it is necessary for physicians to take patient perception into account when estimating quality of life as previous studies suggested that lower quality of life can lead to reduced adherence to DMTs.

High levels of HA were found to be associated with lower physical quality of life in both RRMS and disease-free patients. HA was also found to accurately predict FoR in RRMS patients.

The study did not differentiate FoR into fear of the impact of relapse on their current state of life (such as hospitalizations) and the fear of disease progression leading to further disability but suggested this separation for future work.

The study recruited 140 participants, 70 with RRMS and 70 healthy controls without neurological or psychiatric disorders, to participate through online surveys. Both sets of participants filled out the Short Form 36 (SF36) questionnaire to evaluate their health-related quality of life and the Health-Anxiety Inventory (HAI-18) while the RRMS patients also completed the Fear of Relapse scale, as well as provided a list of DMTs they were taking and the contact information for their neurologist.

Multivariable linear regression analysis was used to estimate the factors impacting the physical component of quality of life and also, separately, for the mental component, although no factors were found to be significant predictors of mental quality of life.

“This study’s findings have important implications for the management of MS in RRMS patients and point to the critical roles of FoR and HA as drivers of HRQoL in RRMS,” the study authors wrote.


Khatibi A, Weiland TJ, Dehghani M. Fear of relapse in patients suffering from RRMS influence their quality of life. Mult Scler Relat Disord. 2021;54(103137):103137. doi:10.1016/j.msard.2021.103137