Assessing clinical correlates of self-rated disability in patients with multiple sclerosis

Abstract

BackgroundMultiple sclerosis (MS) is associated with significant impairment.ObjectiveThe objective of this article is to identify and compare clinical measures that can predict self-rated disability in patients with MS using the World Health Organization Disability Assessment Schedule II (WHODAS-II).MethodsPatients with MS and healthy controls were consecutively recruited at one center. Patients were evaluated for cognitive function assessment, neurological status, perceived disability, mood, fatigue and disease duration. Controls underwent neuropsychological evaluation only. Data were analyzed using multivariate regression.ResultsWHODAS-II total score was predicted by fatigue (p < 0.001) and neurological status (p < 0.05). Student’s t test comparisons between published WHODAS-II normative data and the enrolled cohort of patients with MS showed significantly worse (p < 0.05) scores for patients on mobility, self-care, life activities, participation and total score domains, but not in cognition. Group differences between patients with MS (n = 61) and controls (n = 61) were significant in all cognitive measures except one verbal memory test subscale. Memory function correlated best with the social participation domain of the WHODAS-II.ConclusionsSelf-reported disability in patients with MS was most strongly influenced by fatigue and to a lesser extent by physical disability. Although cognitive function does affect self-assessment of disability, this is not captured by patients on the WHODAS-II cognitive domain.

Mobile-phone-based e-diary derived patient reported outcomes: Association with clinical disease activity, psychological status and quality of life of patients with multiple sclerosis

“…This finding is in agreement with previous reports [ 48 ]. Both depression [ 49 ] and anxiety [ 50 ] have been identified as independent predictors of self-rated disability and QoL among patients with MS. Further work is needed to determine thresholds for change in eBF scores or eBF individual regression slopes that could reliably predict clinical disease activity on the individual level. Higher thresholds are expected for patients with clinically significant depression or anxiety.…”

Beyond cognitive dysfunction: Relevance of ecological validity of neuropsychological tests in multiple sclerosis

“…gait, hand skills), balance, fatigue, depression, disease course, disease duration, and demographic factors have demonstrated relationships with everyday functioning outcomes such as participation and activity limitations. 5,41,45,46,52–60 As described by Cattaneo et al, 54 walking disability reduces community participation, with 40% of individuals with lower EDSS scores (<4) experiencing significant participation restriction compared with 82% of those with higher EDSS scores (>5.5). As with NP testing, assessment of non-cognitive factors should also utilize ecologically valid techniques.…”

“…However, many of these studies show that self-report can be contaminated by various factors such as personal bias as well as emotional distress, and fatigue. 46 In fact, patient self-report is often unrelated to actual everyday functional activity. 47 To address potential bias of self-report instruments, several studies have utilized samples of everyday life behavior in an attempt to bring IADL assessment into the lab, by reconstructing these tasks in a controlled setting, in which success and errors can be coded (see Robertson and Schmitter-Edgecombe 48 for review).…”