Integration of the Expanded Disability Status Scale with ambulation, visual and cognitive tests improves disability assessment
Francesco Sacca1, Antonio Carotenuto2, Marcello Moccia2, Roberta Lanzillo2, Maria Petracca3, Vincenzo Brescia Morra4, Cinzia Valeria Russo2
1NSRO, University Federico II, 2University Federico II, 3University of Rome Sapienza, 4Universita Federico II - Napoli
Objective:
Aim of our study was to estimate the difference between the Expanded Disability Status Scale (EDSS) obtained during routine visits, or after specific tests.
Background:
The EDSS is usually calculated through a neurological examination with self-reported performance. This may lead to incorrect assessment of Functional System scores (FSs).
Design/Methods:
We enrolled 670 MS patients that underwent a regular neurology consultation, and visual evaluation using optotype tables, ambulation evaluation with a rodometer, and cognitive assessment with the Brief International Cognitive assessment for MS (BICAMS). We calculated a new integrated EDSS (iEDSS) using the refined values of the FS and compared it to the standard EDSS.
Results:
Visual, cerebral and ambulation FSs were significantly higher compared with the self-reported counterpart [+1.169 (95%CI 1.077, 1.262; p<0.001), +0.727 (95%CI 0.653, 0.801; p<0.001) and +0.822 (95%CI 0.705, 0.939; p<0.001), respectively]. Mean iEDSS was higher than EDSS (+0.642; p<0.001). Visual acuity tests worsened the EDSS in 31% of cases, cognitive tests in 10%, ambulation measurement in 35%, all three measurements in 59% of cases.
Conclusions:
Objective measurement of FSs results in a more accurate EDSS score in almost two-thirds of cases. This could lead to a more thorough evaluation of patients in the transition or progressive phase.