Impact of the COVID-19 Pandemic on Personal Networks and Neurological Outcomes of People with Multiple Sclerosis
Shruthi Venkatesh1, Claire Riley2, Amar Dhand3, Nandini Doshi1, Katelyn Kavak4, Elle Levit5, Christopher Perrone6, Bianca Weinstock-Guttman4, Erin Longbrake5, Philip De Jager2, Zongqi Xia1
1University of Pittsburgh, 2Columbia University Irving Medical Center, 3Brigham and Women's Hospital, 4Jacobs MS Treatment and Research Center, 5Yale University, 6University of Pennsylvania
Objective:
To evaluate the associations between personal social networks and neurological function in pwMS and controls during the COVID-19 pandemic and compare with the pre-pandemic baseline.
Background:
The COVID-19 pandemic has negatively impacted the social fabric of people with multiple sclerosis (pwMS).
Design/Methods:
We first analyzed data collected by MSReCOV at 8 study sites during the COVID-19 pandemic (March-December 2020). We then leveraged data collected between 2017-2019 in 3 of the 8 cohorts for longitudinal comparison. Participants completed a questionnaire quantifying the structure and composition of their personal social network, including the health behaviors of network members. We assessed neurological disability using three interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale – Revised (MSRS-R), and Patient Reported Outcomes Measurement Information System (PROMIS)-Physical Function. We identified the network features associated with neurologic disability using paired t-tests and covariate-adjusted regressions.
Results:
In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 controls, higher percent of network members with a perceived negative health influence was associated with greater neurological symptom burden in pwMS (MSRS-R: Beta[95% CI]=2.181[1.082, 3.279], p<.001) and worse physical function in controls (PROMIS-Physical Function: Beta[95% CI]=-5.707[-7.405, -4.010], p<.001). In the longitudinal analysis of 230 pwMS and 136 controls, the percent of people contacted “weekly or less” (p<.001) decreased during the COVID-19 pandemic for both pwMS (30.34% to 18.78%) and controls (23.48% to 14.89%) when compared to the pre-pandemic period. PwMS experienced a greater contraction in network features (increased constraint, decreased size and decreased maximum degree) during the pandemic (p<.001), however, this was not associated with worsening neurological disability.
Conclusions:
Our findings suggest that perceived negative health influences in personal social networks are associated with worse disability in all participants, and the COVID-19 pandemic led to contraction of personal social networks to a greater extent for pwMS than controls.