Comparison of the Kurtkze Expanded Disability Status Scale and the Functional Independence Measure: Measures of Multiple Sclerosis Related Disability

Abstract

This is a summary of an observational study we published in Disability and Rehabilitation in 2003[1], where we compared the Kurtkze expanded disability status scale (EDSS) and the Total functional independence measure (FIM) scale as measures of MSrelated disability. On retrospective electronic charts review of 76 veterans with MS regularly followed in our VA MS clinic, we found the EDSS score to accurately measure MS-related impairment at initial evaluation and on follow-up. However, the EDSS score did not change over time, compared to the FIM suggesting reduced sensitivity of the EDSS for detecting change in MS-related disability over time.Multiple sclerosis (MS) is a neurodegenerative condition that leads to cognitive and physical impairments resulting in disability with shortened life expectancy. It is the most common neurological cause of debilitation in young people and it is more common in women and in whites. According to the National Institute of Neurological Disorders and Stroke, about 250,000-350,000 people in the United States have been diagnosed with multiple sclerosis [2,3].MS is a disease with a variable clinical presentation and a variable clinical course. Therefore, accuracy of clinical rating scales to measure disability at initial clinical presentation and during follow-up visits is essential to accurately capture the variability inherent in this disease. This is particularly vital when attempting to identify the efficacy of interventions.At present expanded disability status scale (EDSS) is the most commonly used scale to record the neurological status of patients with MS, assesses disease progression, and monitor response to treatment. It is considered the "gold standard" in measuring MS-related disability in clinical research trials [4]. In 1955 Kurtkze JF first described a new scale to assess MS related-disability called the disability status scale (DSS) [5]. This scale was expanded in 1983 with the addition of 8 functional systems (FS), into what is now called the expanded disability status scale (EDSS) [4]. The EDSS score is based on a detailed neurological examination that combines impairment and disability in a 10-step ordinal scale, ranging from 0 (normal) to 10 (death). Thus, higher scores indicate increased levels of disability. The EDSS is scored in increments of 0.5 points, and includes the scores of eight FS items: pyramidal, cerebellar, brain-stem, sensory, bowel and bladder, visual, mental and other functions (Appendix 1A and 1B). The EDSS has a bi-modal distribution in valid cross-sectional studies [6], and has a fair to substantial inter-rater reliability (κ=0.32 to 0.76) [7,8], with a 2 point change considered a reliable indicator of the patient's response to treatment [9]. Though EDSS is an impairment scale it has been commonly used as an outcome measure of MS-related disability [10,11]. However, it has a number of limitations these include: i) lack of precision in defining FS grades due to its use of subjective terms (e.g., mild, moderate and severe); ii) inadequate...

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

“…Although pre-existing dementia can also affect outcome, we did not have sufficient data to measure its influence. Even though FIM scores comprise motor and cognitive components, we nonetheless chose to analyze total FIM scores as we judged that any correlation that we found would be more useful to clinicians and easier to understand [14,16]. LTCI classification [5] also includes items that would be expected to be impaired by dementia such as social interactions, problem solving, memory, and behavioral and psychological symptoms.…”

“…The Functional Independence Measure (FIM) is a functional assessment scale to assess self-care abilities, monitor the progress of rehabilitation and predict destination at discharge [9][10][11][12][13][14][15][16]. Numerous studies have demonstrated the usefulness and appropriateness of using FIM scores in the assessment of patients after acute stroke [4,[8][9][10][11][12].…”

Long-term worsening of different body functions in persons with progressive multiple sclerosis

“…1,2 Moreover, most instruments to measure impairments, including EDSS, were developed in persons with mild to moderate MS, and hence the understanding of disease progression in persons in advanced stages or with a more severe disease course is still partial. 3–10…”

The neuromyelitis optica spectrum disorders: approaches for problem resolution in medical rehabilitation

“…При сравнении шкал EDSS и TFIM у больных с РС показано, что шкала TFIM является более чувствитель ной для оценки степени инвалидизации, вызванной заболеванием. Она позволяет более оптимально оце нить и динамику функционального состояния паци ента в результате проводимой терапии [27]. По нашему мнению, использование шкалы TFIM у па циентов с заболеванием СОНМ могло бы быть высо коэффективным, особенно при выраженном невро логическом дефиците, когда чувствительность шка 14 лы EDSS заметно снижается.…”