More MS news articles for Nov 2001

Study Examines Relationship Between Mobility And Use Of Preventive Health Services By Women With MS

November 02, 2001


A study by investigators at UCLA involving women who have MS suggests that the less able a woman is to walk, the less likely she is to receive female preventive health services such as Pap smears, mammograms and breast exams. Further research is under way to determine the reasons for this disparity and ways to ensure that individuals with MS receive the best possible health care.


Researchers report that women with MS who are not ambulatory, or able to walk, may be less likely to obtain female preventive health services, such as Pap smears, mammograms and breast exams. Drs. Eric Cheng, Barbara Vickrey and colleagues at the University of California, Los Angeles reported their findings in the October 27, 2001 issue of the British Medical Journal. The study was supported in part by the Health Care Delivery and Policy Research Program of the National Multiple Sclerosis Society.


Men and women who have MS are susceptible to other diseases, such as cancer, heart disease and stroke, and should receive standard preventive health services such as routine monitoring of blood pressure and cholesterol. In addition, women should have regular Pap smears, breast examinations, and – beginning in midlife – mammograms.

A recent study by Lisa Iezzoni, MD (Harvard Medical School, Boston) and colleagues of women with any of several different medical conditions indicated that those who were not ambulatory did not receive female preventive services as frequently as fully ambulatory women. In the current study, Dr. Cheng and colleagues focused on a population of women with MS to determine whether this finding held true in this specific population. These women were younger (average age was 47) and more educated (40% were college graduates) than those in the prior study. In addition, they all had health insurance, which means that financial factors probably would not have interfered with their access to preventive health services.


In 1996, while undertaking a study for different purposes, the investigators mailed questionnaires to 1,164 men and women with MS who had received outpatient care in 1993 or 1994 from three health care systems in the United States. To address the current question, they analyzed data from the 713 women who completed and returned the survey. The authors collected information on Pap smears, mammography and breast exams (if 50 or over), blood pressure checks, cholesterol screening and physician assessment of health habits (eating habits, exercise, and use of alcohol and drugs). The researchers compared the rates of use of these services (or the percentage of women who had received specific tests within standard periods of time) to the participants’ mobility levels (fully ambulatory, ambulatory with assistance, or not ambulatory), and to nationally accepted standards for preventive health care.

For the group as a whole, overall rates for Pap smears (within the past 3 years), breast exams (within the past year) and mammograms (within the past 2 years) equaled or surpassed the national standards. However, the use of such tests for women who were non-ambulatory were significantly lower than those of women who were fully ambulatory.  Using the results for Pap smears as an example, the national standard for Pap smears within the past 3 years is 85%. Pap smear rates in this study were 68% for women who were not ambulatory and 93% for those who were fully ambulatory – a statistically significant difference. By contrast, rates for general preventive services (such as blood pressure checks) did not differ by mobility.


The authors suggest several possible explanations for the lower rates of preventive services for women who were not ambulatory: People may be reluctant to undergo screening services that might be uncomfortable or embarrassing, or the medical systems and equipment may not accommodate people with impaired mobility. “Women with impaired mobility should be considered a vulnerable population for receipt of breast exams, mammography and Pap smears,” they write. “Studies are needed to identify factors causing this and to evaluate interventions to close the gap in rates of women’s preventive services across mobility levels.”

A related study is currently being supported by the National MS Society. William D. Frey, PhD (Westat, Rockville, MD) is evaluating the results of a telephone survey among men and women with MS to determine the nature and extent of their use of health-promoting and preventive measures, how this use relates to the type of health care providers they use, what the barriers to these services might be, and how use of these services compares to that of the general population. Dr. Frey’s study will amplify upon the UCLA group’s findings and should help pinpoint the reasons for any differences in the use of preventive services.

Data from these types of studies can help ensure that individuals with MS obtain the best possible specialized and general medical care. In particular, these data are likely to suggest to what extent future National MS Society efforts should be directed toward education of health care providers, ensuring physical accessibility of health care facilities, or education of persons with MS concerning health-promoting measures.

-- Research Programs

© 2001 The National Multiple Sclerosis Society