Highlights
- •The OMs aren’t responsive in patients with substantially impaired mobility.
- •OMs should be validated for patients with substantially impaired mobility.
- •There is dire need of feasible outcome measures for severe MS.
Abstract
Background
In multiple sclerosis (MS) rehabilitation, most currently used outcome measures were
validated in patients with a relapsing remitting MS and mild to moderate impairments.
We aimed to assess whether these measures were also adequate in more impaired patients,
frequently encountered in those with progressive MS (PMS).
Methods
Outcome measurements were extracted from medical records of 229 patients with PMS
undergoing 3 weeks of routine inpatient rehabilitation between 2011 and 2015. We assessed
the acceptability of Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW), 2-Minute
Walk Test (2MWT), Rivermead Mobility Index (RMI) and the Functional Independence Measure
(FIM) by analysing their statistical distributions, concurrent validity by comparing
Spearman correlations with pre-specified hypotheses, and responsiveness across impairment
status by calculating standardized response means.
Results
Our concurrent validity hypotheses were mainly satisfied. However, all outcome measures
had skewed distributions, showed low variability, and thus were inadequately discriminative.
Moreover, 9HPT was never responsive across the impairment states, whereas the T25FW
was responsive for mildly impaired patients, and the 2MWT for mild to moderate MS,
respectively. Generic multi-items measures such as RMI and FIM-motor were adequately
responsive for all severity levels.
Conclusions
Currently used outcome measures are inadequate for patients with impaired mobility,
and there is a dire need of specifically designed outcome measures for routine care
that are less burdensome and short-term responsive.
Abbreviations:
5STS (5 repetition Sit-to-Stand test), CI (confidence interval), FIM (Functional Independence Measure), FIST (Function in Sitting Test), MSEDGE (Multiple Sclerosis Evaluation Database to Guide Effectiveness), MSOAC (Multiple Sclerosis Outcome Assessments Consortium), MSTF (Multiple Sclerosis Task Force (MSTF)), OM (Outcome Measure), PMS (Progressive Multiple Sclerosis), RMI (Rivermead Mobility Index), SaGAS10 (Short and Graphic Ability Scale-10), SD (Standard Deviation), SRM (Standardized Response Mean)Keywords
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Article info
Publication history
Published online: April 03, 2018
Accepted:
April 2,
2018
Received in revised form:
March 29,
2018
Received:
December 18,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
