Highlights
- •The Expanded Disability Status Scale (EDSS) is dominated by ambulation.
- •Functional composite endpoints improve the sensitivity of measuring disability in MS.
- •The MS Functional Composite (MSFC) is a proven measure of disability in MS.
- •Including the Symbol Digit Modality test improves the utility of the MSFC.
- •Adding MS-specific measures of quality of life to the MSFC improves the test further.
Abstract
For decades, the Expanded Disability Status Scale (EDSS) has been the principal measure
of disability in clinical trials in patients with multiple sclerosis (MS) and in clinical
practice. However, this test is dominated by effects on ambulation. Composite endpoints
may provide a more sensitive measure of MS-related disability through the measurement
of additional neurological functions. The MS Functional Composite (MSFC) includes
a walking test (25-ft walk) plus tests of upper extremity dexterity (9-hole peg test)
and cognitive function (Paced Auditory serial Addition test [PASAT]). Replacing PASAT
with the Symbol Digit Modality test, a more sensitive test preferred by patients,
may improve the clinical utility of the MSFC. In addition, disease-specific measures
of QoL may be used alongside the MSFC (which does not include measurement of QoL).
Clinical data suggest that disease-modifying therapies may delay or prevent relapse,
and better composite measures will be valuable in the assessment of disease activity-free
status in people with MS.
Abbreviations:
BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis), BVMT-R (Brief Visuospatial Memory Test-Revised), CVLT-II (California Verbal Learning Test-Second Edition), DAF (disease activity-free status), EDSS (Expanded Disability Status Scale), MACFIMS (Minimal Assessment of Cognitive Function in MS), MSFC (MS Functional Composite), MusiQoL (MS International Quality of Life), PASAT (Paced Auditory serial Addition test), QoL (quality of life), SDMT (Symbol Digit Modalities Test)Keywords
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Article info
Publication history
Published online: March 24, 2015
Accepted:
March 14,
2015
Received in revised form:
February 23,
2015
Received:
December 12,
2014
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
