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Medical Care:
doi: 10.1097/MLR.0000000000000117
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Defining Quality of Life Levels to Enhance Clinical Interpretation in Multiple Sclerosis: Application of a Novel Clustering Method.

Michel, Pierre PhD; Baumstarck, Karine MD, PhD; Boyer, Laurent MD, PhD; Fernandez, Oscar MD, PhD; Flachenecker, Peter MD, PhD; Pelletier, Jean MD, PhD; Loundou, Anderson PhD; Ghattas, Badih PhD; Auquier, Pascal MD, PhD; on behalf of the MusiQoL Study Group

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Abstract

Background: To enhance the use of quality of life (QoL) measures in clinical practice, it is pertinent to help clinicians interpret QoL scores.

Objective: The aim of this study was to define clusters of QoL levels from a specific questionnaire (MusiQoL) for multiple sclerosis (MS) patients using a new method of interpretable clustering based on unsupervised binary trees and to test the validity regarding clinical and functional outcomes.

Methods: In this international, multicenter, cross-sectional study, patients with MS were classified using a hierarchical top-down method of Clustering using Unsupervised Binary Trees. The clustering tree was built using the 9 dimension scores of the MusiQoL in 2 stages, growing and tree reduction (pruning and joining). A 3-group structure was considered, as follows: "high," "moderate," and "low" QoL levels. Clinical and QoL data were compared between the 3 clusters.

Results: A total of 1361 patients were analyzed: 87 were classified with "low," 1173 with "moderate," and 101 with "high" QoL levels. The clustering showed satisfactory properties, including repeatability (using bootstrap) and discriminancy (using factor analysis). The 3 clusters consistently differentiated patients based on sociodemographic and clinical characteristics, and the QoL scores were assessed using a generic questionnaire, ensuring the clinical validity of the clustering.

Conclusions: The study suggests that Clustering using Unsupervised Binary Trees is an original, innovative, and relevant classification method to define clusters of QoL levels in MS patients.

(C) 2014 by Lippincott Williams & Wilkins.

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