Related Experiment Videos
Disease steps in multiple sclerosis: a simple approach to evaluate disease progression
M J Hohol1, E J Orav, H L Weiner
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract:
Current clinical scales in multiple sclerosis (MS) are often complicated to administer, suffer from interrater variability and lack of uniform representation across grades, and are insensitive to progression at certain stages. Furthermore, they are not easily applied by neurologists and do not clearly differentiate among functional stages of MS. For these reasons, we developed Disease Steps to assess disability in MS. A total of 1,323 patients were classified using both Disease Steps and the Expanded Disability Status Scale (EDSS) for a total of 2,755 assessments. The Disease Steps scale consists of 0 = Normal; 1 = Mild disability, mild symptoms or signs; 2 = Moderate disability, visible abnormality of gait; 3 = Early cane, intermittent use of cane; 4 = Late cane, cane-dependent; 5 = Bilateral support; 6 = Confined to wheelchair; and U = Unclassifiable. Results demonstrate that raters could simply and quickly categorize patients using Disease Steps. Patients were uniformly distributed with Disease Steps, whereas a bimodal distribution occurred with the EDSS. On the EDSS, 40.3% of patients scored between 1.0 and 3.5 and 36.0% scored from 6.0 to 6.5, with only 6.9% of patients scoring between 4.0 and 5.5. For 60 patients seen by two neurologists, concordance between raters was excellent for Disease Steps (kappa = 0.8) but only moderate for the EDSS (kappa = 0.54). As a simple and reproducible measure of different functional steps of MS, Disease Steps can be used as a guide in therapeutic decision-making, following response to therapy, and in assessing disease progression.
Insights
The new Disease Steps scale offers a simpler, more reproducible method for assessing multiple sclerosis (MS) disability compared to the Expanded Disability Status Scale (EDSS). It aids in clinical decisions and tracking disease progression.
Area of Science:
- Neurology
- Clinical Assessment
- Disability Measurement
Background:
- Current clinical scales for multiple sclerosis (MS) present challenges in administration, interrater reliability, and sensitivity to disease progression.
- Existing scales often lack uniformity and clear differentiation across functional MS stages, complicating clinical application for neurologists.
Purpose of the Study:
- To introduce and evaluate the Disease Steps scale as a novel, simplified tool for assessing disability in patients with multiple sclerosis.
- To compare the performance of the Disease Steps scale against the established Expanded Disability Status Scale (EDSS).
Main Methods:
- A total of 1,323 patients with MS underwent assessment using both the Disease Steps scale and the Expanded Disability Status Scale (EDSS), resulting in 2,755 assessments.
- The Disease Steps scale categorizes disability into distinct functional levels (0-6, U).
- Interrater reliability was assessed by comparing ratings from two neurologists for 60 patients.
Main Results:
- The Disease Steps scale demonstrated simple and rapid administration by raters.
- Disease Steps showed a uniform distribution of patient scores, unlike the bimodal distribution observed with the EDSS.
- Excellent interrater concordance (kappa = 0.8) was achieved with Disease Steps, significantly higher than the moderate concordance (kappa = 0.54) for the EDSS.
Conclusions:
- The Disease Steps scale is a simple, reproducible, and reliable measure for assessing functional disability in multiple sclerosis.
- Its ease of use and superior interrater reliability make it a valuable tool for guiding therapeutic decisions, monitoring treatment response, and evaluating disease progression in MS.