Self-Assessment of Neurologic Impairment in Multiple Sclerosis (original) (raw)
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A comparison of two neurologic scoring instruments for multiple sclerosis
Journal of Neurology, 1996
We examined the degree of association between two neurologic impairment scales, the Extended Disability Status Scale (EDSS) and the Scripps Neurologic Rating Scale (SNRS), with data from a randomized, double-blind, placebocontrolled clinical trial assessing the safety and efficacy of cladribine as treatment for chronic progressive multiple sclerosis (MS). We found that the EDSS and SNRS were not strongly correlated within individual patients, contrary to expectation; moreover, in 9 of the 48 evaluable patients, the directions of their changes from baseline values were not mutually consistent. The scales were differentially sensitive to clinical changes over time, with the EDSS indicating a more abrupt, and the SNRS a more gradual, change in the clinical course of disease. The validity of different impairment scales, and their sensitivity to detect clinical changes, should be formally assessed in future clinical trials using these scales as outcome measures.
Multiple Sclerosis Journal, 2000
Kurtzke's EDSS remains the most widely-used measure for clinical evaluation of MS patients. However, several studies have demonstrated the limited reliability of this tool. We introduce a computerized instrument, MS-CANE (Multiple Sclerosis Computer-Aided Neurological Examination), for clinical evaluation and follow up of patients with multiple sclerosis (MS) and to compare its reliability to that of conventional Expanded Disability Status Scale (EDSS) assessment. We developed a computerized interactive instrument, based on the following principles: structured gathering of neurological findings, reduction of compound notions to their basic components, use of precise definitions, priority setting and automated calculations of EDSS and functional systems scores. An expert panel examined the consistency of MS-CANE with Kurtzke's specifications. To determine the effect of MS-CANE on the reliability of EDSS assessment, 56 MS patients underwent paired conventional EDSS and MS-CANE...
2011
The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for multiple sclerosis (MS) is an application of the ICF to describe the typical spectrum of functioning in people with MS. The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physicians. Using a three-round Delphi technique, physicians experienced in the MS treatment were requested to name patients’ problems, resources, and aspects of environment. The statements of the first Delphi round were linked to ICF categories based on established linking rules. These categories as well as the results of the second round were reported back to the participants. Eighty-four physicians participated in the study. Totally, 89 categories (64.5%) of the Comprehensive ICF Core Set for MS were confirmed by the participants. Eight ICF categories, which are currently not included in the ICF Core Set, were identified. The validity of the Comprehensive ...
A multidimensional assessment of multiple sclerosis: relationships between disability domains
Acta Neurologica Scandinavica, 2009
Objective - i) To test the feasibility of a multidimensional assessment based on both task-related and self-evaluation questionnaire scores in patients with multiple sclerosis (MS); ii) to correlate the results from selective measures with the severity of illness in terms of the Expanded Disability Status Scale (EDSS) score; iii) to assess the relationships between different domains of MS-related disability and handicap. Patients and methods - Eighty-three MS patients (M/F 31/52; age 43.26±10.9 years, range 21–72) underwent a standard clinical evaluation of motor abilities (by means of the Rivermead Mobility index, Timed Walking Test, Nine Hole Peg test and Hauser Ambulation Index) and cognitive performances (using Digit Symbol, Buschke-Fuld selective remind test, “FAS” Word Fluency, Wisconsin Card Sorting test and Block design test). The Beck Depression inventory, MS Specific Fatigue Scale, Functional Assessment of MS and London Handicap Scale were applied to evaluate mood, fatigue, quality of life and handicap, respectively. Minimal Record of Disability measures - MRD (i.e. EDSS, Inability Status Scale and Environmental Status Scale) were also applied to test the criterion validity of the selected disability and handicap scales. The Kruskal-Wallis H-test for independent samples tested differences between subgroups with an increasing EDSS score (<3.5, 3.5–6.0, >6.0). The covariance and redundancy of measures included in the multidimensional assessment were evaluated through Factor Analysis. The Multiple Regression Analysis was used to detect the relative impact of either motor or cognitive disabilities and depression on handicap and quality of life. Results - The multimodal assessment took 70 min on average to be performed, being well accepted by patients. Motor abilities worsened as the EDSS score rose, unlike cognitive performances which proved to be similarly impaired at different severity levels. Measures of fatigue and depression were not related to EDSS values. The chosen measures were assigned by Factor Analysis to 4 domains corresponding to motor performance, executive performance, cognitive abilities and quality of life, respectively. Regression analysis showed how handicap and depression independently affect quality of life. While the handicap score is mostly influenced by motor ability, as measured by the Rivermead Mobility Index, the depression score grows independently of any physical or cognitive disability and seems to be related to fatigue self-assessment scores. Conclusions - A multidimensional approach to MS patient assessment allows a more detailed and sensitive evaluation of their disability profile and perceived difficulties, leading to a care programme tailored to the patient's needs.
The development and validation of the Impact of Multiple Sclerosis Scale and the Symptoms of Multiple Sclerosis Scale. Objective: To develop and validate the Impact of Multiple Sclerosis Scale (IMSS) and the Symptoms of Multiple Sclerosis Scale (SMSS) using the Extended Disability Status Scale (EDSS) for construct validity. Design: Panel design involving test-retest over 4 months. Setting: A mailed survey. Participants: Volunteers with a diagnosis of multiple sclerosis (MS) recruited from an MS support service in Australia: 193 people (mean age, 39y) and 150 people participated at time 1 and time 2, respectively. Main Outcome Measures: Principal components analyses, the Cronbach alphas and descriptive statistics for the 2 scales; correlations for construct validity with the EDSS and retest; and confirmatory factor analysis to test the stability of IMSS and SMSS components over time. Results: The IMSS yielded 5 independent and reliable components; the SMSS yielded 3 components; both component structures were stable over time. These scales showed convergent validity with the EDSS. Conclusions: The IMSS and SMSS are psychometrically sound scales suitable for clinical and research purposes to assess the symptoms and impact of MS.
Multiple Sclerosis Impact Scale (MSIS-29): reliability and validity in hospital based samples
Journal of Neurology, Neurosurgery & Psychiatry, 2002
Background and aim: The psychometric properties of rating scales are sample dependent and need evaluations in different samples. The Multiple Sclerosis Impact Scale (MSIS-29), a new patient based rating scale for multiple sclerosis (MS) was predominantly developed from a community based sample derived from the MS Society. A number of important patient characteristics of this sample remain unknown. The aim of the study was to evaluate five psychometric properties of the MSIS-29 in three hospital based samples: people admitted for rehabilitation, people admitted for intravenous corticosteroid treatment for MS relapses, and people with primary progressive MS. Methods: People with MS were recruited from the three clinical settings. They completed several health measures. MSIS-29 data were evaluated for data quality, scaling assumptions, acceptability, reliability and validity, and compared with those from a previously reported community based study. Results: A total of 233 people (rehabilitation =53; corticosteroids =76; primary progressive =104) completed questionnaires. In all samples, missing data were low (<2.2%), scaling assumptions were satisfied, and reliability was high (>0.91). Correlations between the MSIS-29 and other scales were consistent with a priori hypotheses. Findings were consistent with those from the community samples. Conclusions: The psychometric properties of the MSIS-29 are consistent across three hospital based samples, and similar to those in the community samples. These findings further support its use as an outcome measure in different clinical settings.
Outcome measures for multiple sclerosis
Physical Therapy Reviews, 2014
Background: This review determined the most commonly used, and reliable, measures for assessing clinical outcomes for Multiple Sclerosis (MS). Objectives: It was anticipated that this would facilitate the development of a common set of metrics, and aid reaching a consensus regarding the outcome measures that are typically used in the field of MS clinical research. Major Findings: A thorough literature review of clinical outcome measures for MS produced 166 measures that have been used in this context. This list was then refined by discussion with a panel of consultant neurologists, which reduced the list to 23 commonly employed tools. This shortlist was then further refined through surveying 41 centres for MS treatment, which reduced the shortlist to 16 measures. The properties of these scales, in terms of their symptom/function domains, their specificity for MS, their administration characteristics, and their reliability and validity for MS, are all discussed. Conclusions: Conclusions regarding the development of potential sets of assessment measures for MS, that encompasses broad symptom/function domains, and which are sensitive to the practical requirements of administration within clinical contexts, are explored.