Characteristics of included articles
| Authors, publication year | Study design | Quality of life measurement | Sample size (N) Age (mean) Sex (female%) | Main results | |
| Risk factors | Protective factors | ||||
| Clinical variables | |||||
| Gupta et al (2014)25 | Cross- sectional | Short Form Health Survey 12 (SF-12) | N=74 451 47.9 years 51.3% | EDSS (PCS) | |
| Gross et al (2017)36 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=810 RRMS 48.9 years SPMS 55.7 years RRMS 71.6% SPMS 56.2% | Progressive MS type (PCS) | |
| Zhang et al (2019)38 | Cross-sectional | EuroQol 5-Dimensions (EQ-5D) | N=1958 55.3 years 78.1% | Progressive MS type onset | |
| Rezapour et al (2017)26 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=171 35.7 years 76.6% | Relapses in the last 3 months | Mild EDSS RRMS type |
| Marck et al (2017)56 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=2296 45.5 years 82.2% | Pain | |
| Milinis et al (2016)57 | Cross- sectional | Leeds MS Quality of Life Scale (MSQoL) | N=701 48.8 years 72% | Spasticity | |
| Zettl et al (2014)58 | Cross- sectional | EuroQol 5-Dimensions (EQ-5D) Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=414 48.6 years 64.3% | Spasticity | |
| Leonavicius et al (2016)42 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=137 44.7 years 72.3% | Fatigue (MCS) | |
| Garg et al (2016)43 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=89 54.26 years 66% | Fatigue | |
| Fernández-Muñoz et al (2015)44 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=108 44 years 55% | Fatigue | |
| Weiland et al (2015)45 | Cross-sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=2738 45.5 years 82.3% | Fatigue | |
| Aygünoğlu et al (2015)46 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=120 34.24 years 70% | Fatigue | |
| Vister et al (2015)47 | Cross- sectional | WHO Disability Assessment Schedule (WHODAS) 2.0 | N=210 50.8 years 72.4% | Fatigue | |
| Tabrizi et al (2015)48 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=217 36.2 years 79% | Fatigue Poor sleep quality Low MCS (PCS) | |
| White et al (2019)64 | Cross- sectional | EuroQol 5-Dimensions (EQ-5D) | N=531 51.60 years 70.1% | Sleep disorder | |
| Barin et al (2018)49 | Cross- sectional | EuroQol 5-Dimensions (EQ-5D) EuroQol Visual Analogue Scale (EQ-VAS) | N=855 48 years 72.7% | Fatigue Balance Spasticity Paralysis Walking difficulties | |
| Kratz et al (2016)50 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=180 50.5 years 78% | Fatigue (MCS) Pain (MCS) Memory loss (MCS) | |
| Colbeck et al (2018)53 | Cross- sectional | RAND-36 Health Item Survey (RAND-36) | N=30 – 73.33% | Cognitive fatigue Low sensory sensitivity Sensation avoiding | |
| Grech et al (2015)65 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=107 48.8 years 77.6% | Cognitive inflexibility | |
| Sgaramella et al (2014)68 | Cross- sectional | Quality of life questionnaire (QoL) | N=39 42.2 years 71.8% | Executive function | |
| Khalaf et al (2016)59 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=1048 47.8 years 81% | Lower urinary tract symptoms | |
| Vitkova et al (2014)60 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=223 38.4 years 67.3% | Bladder dysfunction (PCS) Sexual dysfunction (MCS) | |
| Qaderi et al (2014)61 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=132 36.9 years 100% | Sexual problems (PCS and MCS) | |
| Schairer et al (2014)62 | Cross- sectional | Short Form Health Survey 12 (SF-12) | N=6138 50.6 years 74.7% | Sexual dysfunction | |
| Ma et al (2017)63 | Cross- sectional | Multiple Sclerosis Impact Scale (MSIS-29) | N=231 40.2 years 58.4% | Sleep disorders | |
| Psychosocial variables | |||||
| Hernández-Ledesma et al (2018)71 | Cross- sectional | WHO Quality of Life Questionnaire (WHOQoL-BREF) | N=26 39.2 years 57.5% | Problem avoidance Social withdrawal Wishful thinking Self-criticism Anxiety Depression | Problem resolution Cognitive restructuring Emotional social and instrumental support Emotional expression |
| Grech et al (2018)80 | Cross- sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=107 48.8 years 77.57% | Behavioural disengagement Suppression and self-control Emotional venting | Acceptance Growth Restrain |
| Zengin et al (2017)79 | Cross- sectional | WHO Quality of Life Questionnaire (WHOQoL-BREF) | N=214 36–46 years 53.2% | Self-distraction Denial Substance use | Planning Active coping Acceptance Positive reinterpretation Social support |
| Farran et al (2016)81 | Cross- sectional | Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL) | N=34 36 years 56% | Self-criticism Escape avoidance Distancing Self-controlling | Emotional social support Instrumental social support Planful problem solving Positive reappraisal |
| Mikula et al (2014)82 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=113 40.8 years 77% | Problem focused coping Stopping unpleasant emotion Getting support | |
| Van Damme et al (2016)85 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=117 41 years 70.2% | Acceptance (PCS and MCS) tenacious goal pursuit (PCS) flexible goal adjustment (MCS) | |
| Wilski et al (2016)88 | Cross- sectional | Multiple Sclerosis Impact Scale (MSIS-29) | N=257 47.9 years 69.93% | Self-efficacy Self-esteem Illness identity | |
| Nery-Hurwit et al (2018)86 | Cross- sectional | Function Neutral Health-Related Quality of Life Short Form (FuNHRQoL-SF) | N=259 48.6 years 84.23% | Resilience Self-compassion | |
| Calandri et al (2018)89 | Cross- sectional | Short Form Health Survey 12 (SF-12) | N=90 37 years 61.1% | Sense of coherence | |
| Fernández-Muñoz et al (2018)75 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=108 44 years 55% | Depression | |
| Pham et al (2018)76 | Cross- sectional | Short Form Health Survey 12 (SF-12) | N=310 49 years 73.6% | Anxiety | |
| Prisnie et al (2018)72 | Longitudinal (T1=basal level/T2=2 weeks later) | Short Form Health Survey 12 (SF-12) | N=139 40 years 70.5% | Anxiety Depression | |
| Alsaadi et al (2018)73 | Cross- sectional | WHO Quality of Life Questionnaire (WHOQoL-BREF) | N=80 35.1 years 65% | Anxiety Depression | |
| Labiano-Fontcuberta et al (2015)74 | Cross- sectional | Functional Assessment of Multiple Sclerosis (FAMS) | N=157 41.7 years 66.9% | Depression Anxiety Anger expression-in | |
| Paziuc et al (2018)69 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=60 46 years 85% | Trait anxiety State anxiety Depression | Extraversion Emotional Stability |
| Phillips et al (2014)70 | Cross-seccional | WHO Quality of Life Questionnaire (WHOQoL-BREF) | N=32 44.0 years 75% | Emotional problems | |
| Salhofer-Polanyi et al (2018)77 | Cross-sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=139 40.0 years 70.5% | Depressive temperament Cyclothymic temperament | Hyperthymic temperament |
| Demirci et al (2017)78 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=74 35.3 years 65.51% | Type D personality | |
| Mikula et al (2015)93 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=116 40.4 years 72.4% | Social participation (MCS y PCS) | |
| Costa et al (2017)92 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=150 41.7 years 70.7% | Social support | |
| Nakazawa et al (2018)27 | Cross-sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=63 41.7 years 66.67% | EDSS level | Resilience |
| Ciampi et al (2018)28 | Cross-sectional | Multiple Sclerosis Impact Scale (MSIS-29) | N=43 57.2 years 65.1% | EDSS level Fatigue Depression | |
| Fernández-Jiménez et al (2015)32 | Cross-sectional | Functional Assessment of Multiple Sclerosis (FAMS) | N=97 47.3 years 82.5% | EDSS level Depression | |
| Klevan et al (2014)29 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=93 41.8 years 69% | EDSS (PCS) Fatigue Depression Apathy | |
| Williams et al (2014)55 | Cross-sectional | Short Form Health Survey 36 (SF-36) Short Form Health Survey 12 (SF-12) | N=447 49.3 years 70.02% | Pain (PCS) Muscle spasms (PCS) Stiffness (PCS) Depression (MCS) | |
| Hyncicova et al (2018)40 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=67 32.3 years 53.7% | Number and severity of symptoms Fatigue Stress Depression Anxiety | |
| Shahrbanian et al (2015)39 | Cross- sectional | Person Generated Index (PGI) | N=188 43 years 74% | Pain Fatigue Irritability Anxiety Depression Sleep disorder Cognitive deficit | |
| Strober et al (2018)51 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=69 40.4 years 89.5% | Pain Fatigue Behavioural disengagement Denial Depression Anxiety High neuroticism Low extroversion Low self-efficacy | Acceptance Growth Emotional social and instrumental support Planning Active coping Positive reinterpretation Humour |
| Dymecka et al (2018)52 | Cross-sectional | Multiple Sclerosis Impact Scale (MSIS-29) | N=137 46.5 years 53.3% | Fatigue Upper limb disability Lower limb disability Cognitive disorders Emotional problems | |
| Samartzis et al (2014)66 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=100 40.5 years 64% | Perceived planning/organisation dysfunction Perceived retrospective memory dysfunction Depression | |
| Brola et al (2016)31 | Cross-sectional | EuroQol 5-Dimensions (EQ-5D) EuroQol Visual Analogue Scale (EQ-VAS) Multiple Sclerosis Impact Scale (MSIS-29) | N=2385 37.8 years 69.7% | EDSS level MS duration Lack of DMD treatment Age | |
| Brola et al (2017)30 | Cross-sectional | EuroQol 5-Dimensions (EQ-5D) EuroQol Visual Analogue Scale (EQ-VAS) Multiple Sclerosis Impact Scale (MSIS-29) | N=765 44.9 years 67.7% | EDSS MS duration Be unemployed Age No immunomodulatory therapy | |
| Abdullah et al (2018)54 | Cross-sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=200 35.1 years 68% | Motor symptoms Low resistance Sensory symptoms Low income Be unemployed | |
| Nickel et al (2018)33 | Cross-sectional | Multiple Sclerosis International Quality of Life (MusiQoL) | N=1220 47.8 years 76% | EDSS Comorbidity | High educational level High employment status |
| Campbell et al (2017)67 | Cross-sectional | Functional assessment of multiple sclerosis (FAMS) EuroQol 5-Dimensions (EQ-5D) | N=62 49.4 years 69.35% | Cognitive deficit Be unemployed | |
| Chiu et al (2015)94 | Cross-sectional | Short Form Health Survey 12 (SF-12) | N=157 43.8 years 86% | Be unemployed | Disability adjusted employment |
| Boogar et al (2018)35 | Cross-sectional | Multiple Sclerosis Quality of Life-54 (MSQoL-54) | N=193 38.1 years 64.8% | High disability Depression Low socioeconomic status | Positive story treatment |
| Bishop et al (2015)41 | Cross-sectional | Quality of Life Scale (QoLS) | N=1839 54 years 78.1% | Number and severity of symptoms Perceived stress | High educational level High employment status Job satisfaction Job match |
| Cioncoloni et al (2014)34 | Cross-sectional | Short Form Health Survey 36 (SF-36) | N=57 41.7 years 68.42% | EDSS level Fatigue Pain Bladder dysfunction Bowel dysfunction Depressive manifestations Sleeping problems Introverted personality Be unemployed | |
| Cichy et al (2016)37 | Cross-sectional | Quality of Life Scale (QoLS) | N=703 63 years 76% | Progressive MS Progressive diagnosis Number and severity of symptoms Perceived stress Be male Not married/not living with significant other Unable to meet living expenses | |
| Mediational variables | Mediator variable | Mediated relation | |||
| Mikula et al (2018)84 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=156 40 years 75% | Coping strategies Problem focused Emotional focused Stopping | Personality type D and MCS |
| Mikula et al (2015)83 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=154 40.05 years 76% | Coping strategies | Fatigue and MCS and PCS |
| Mikula et al (2017)90 | Cross- sectional | Short Form Health Survey 36 (SF-36) | N=74 35.3 years 65.51% | Self-esteem | Social participation and MCS |
| Koelmel et al (2017)87 | Longitudinal (T1=basal level/T2=10 weeks later/T3=26 weeks later/T4=52 weeks later) | Short Form Health Survey 8 (SF-8) | N=163 52.2 years 87.1% | Resilience | Social support and MCS |
| Valvano et al (2016)91 | Cross- sectional | Leeds MS Quality of Life Scale (MSQoL) | N=128 45.5 years 85% | Cognitive fusion | Stigma and QoL |
DMD, disease modifying drug; EDSS, expanded disability status scale; MCS, Mental Composite Score; MS, multiple sclerosis; PCS, physical composite; QoL, quality of life; RRMS, remittent remitting; SPMS, secondary progressive.