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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.
Neurology
|February 1, 1995
Summary
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.