Life issues in multiple sclerosis.

A diagnosis of multiple sclerosis (MS), an incurable condition, introduces great uncertainty into virtually all aspects of a person's life. From early in the disease course, people with MS are vulnerable to disempowerment, poor psychological health, and social exclusion including high unemployment. Current health-care research for people with MS is reviewed here within the context of three philosophies of disability and health-care service provision: the biomedical, biopsychosocial and sociopolitical models. Some of the uncertainties concerning the patient's life that result from MS have been reduced by improved diagnostic tools, advances in immunotherapy, multidisciplinary rehabilitation, community programs, and provision of information specifically designed to facilitate shared decision-making and empowerment. Such progress is modest, however, and substantial improvements to the psychological health, empowerment, and quality of life of people with MS requires more sociopolitically oriented research.