Open Access Open Badges Research article

Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis

Hiromi Kikuchi1, Nobuhiro Mifune2, Masaaki Niino3*, Jun-ichi Kira4, Tatsuo Kohriyama5, Kohei Ota6, Masami Tanaka7, Hirofumi Ochi8, Shunya Nakane9 and Seiji Kikuchi10

Author affiliations

1 College of Nursing, Sapporo City University, Sapporo, Japan

2 Japan Society for the Promotion of Science, Kobe University, Kobe, Japan

3 Department of Clinical Research, Hokkaido Medical Center, Yamanote 5jo 7chome, Nishi-ku, Sapporo, 063-0005, Japan

4 Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

5 Department of Neurology, Hiroshima City Hospital, Hiroshima, Japan

6 Faculty of Science, Tokyo University of Science, Tokyo, Japan

7 MS Center, Utano National Hospital, Kyoto, Japan

8 Department of Geriatric Medicine & Neurology, Ehime University School of Medicine, Ehime, Japan

9 Department of Clinical Research, Nagasaki Kawatana Medical Center, Kawatana, Japan

10 Department of Neurology, Hokkaido Medical Center, Sapporo, Japan

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Citation and License

BMC Neurology 2013, 13:10  doi:10.1186/1471-2377-13-10

Published: 22 January 2013



To improve quality of life (QOL) in patients with multiple sclerosis (MS), it is important to decrease disability and prevent relapse. The aim of this study was to examine the causal and mutual relationships contributing to QOL in Japanese patients with MS, develop path diagrams, and explore interventions with the potential to improve patient QOL.


Data of 163 Japanese MS patients were obtained using the Functional Assessment of MS (FAMS) and Nottingham Adjustment Scale-Japanese version (NAS-J) tests, as well as four additional factors that affect QOL (employment status, change of income, availability of disease information, and communication with medical staff). Data were then used in structural equation modeling to develop path diagrams for factors contributing to QOL.


The Expanded Disability Status Scale (EDSS) score had a significant effect on the total FAMS score. Although EDSS negatively affected the FAMS symptom score, NAS-J subscale scores of anxiety/depression and acceptance were positively related to the FAMS symptom score. Changes in employment status after MS onset negatively affected all NAS-J scores. Knowledge of disease information improved the total NAS-J score, which in turn improved many FAMS subscale scores. Communication with doctors and nurses directly and positively affected some FAMS subscale scores.


Disability and change in employment status decrease patient QOL. However, the present findings suggest that other factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL.

Multiple sclerosis; Quality of life; Structural equation modeling; Severity; Treatment; and Intervention