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The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

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Will Rogers phenomenon in multiple sclerosis.

Maria Pia Sormani¹, Mar Tintorè, Marco Rovaris

¹Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Italy.

Annals of Neurology

|August 9, 2008

Summary

This summary is machine-generated.

Diagnostic criteria for multiple sclerosis (MS) impact prognosis staging, not the overall disease course. This "Will Rogers phenomenon" necessitates caution when using historical controls in MS treatment trials.

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Area of Science:

Neurology
Clinical Epidemiology

Background:

The
Will Rogers phenomenon
describes how changes in classification criteria can alter stage-specific prognoses without affecting the overall disease trajectory.
This phenomenon poses challenges for using historical controls in clinical trials.
Its impact on multiple sclerosis (MS) prognosis under varying diagnostic criteria is not well-established.

Purpose of the Study:

To evaluate whether the
Will Rogers phenomenon
influences the prognosis of patients with clinically isolated syndrome (CIS) suggestive of MS when different diagnostic criteria are applied.
To assess the implications for using historical controls in MS research.

Main Methods:

A cohort of 309 patients with CIS suggestive of MS was followed for a median of 84 months.
Patients were classified as CIS or having evolved to MS after 1 year using both Poser and McDonald criteria.
Prognosis was determined by the time to reach an Expanded Disability Status Scale (EDSS) score of ≥3.0.

Main Results:

After 1 year, 16% of patients met MS criteria (Poser) versus 44% (McDonald).
At median follow-up, the probability of reaching EDSS ≥3.0 was lower in McDonald-classified MS patients (27%) compared to Poser-classified (46%).
Patients with discordant diagnoses showed intermediate prognoses, worse than CIS but better than MS by both criteria.

Conclusions:

The choice of diagnostic criteria significantly alters the apparent medium-term prognosis of MS.
This effect, the
Will Rogers phenomenon
, can create spurious improvements in prognosis.
Extreme caution is advised when employing historical controls in MS clinical trials due to potential criterion-induced biases.