Introduction of the Watzmann Severity Scale: A sensorimotor approach to estimate the course of inpatient rehabilitation in multiple sclerosis

Inpatient Rehabilitation: Prediction of Changes in Sensorimotor Performance in Multiple Sclerosis: A Pilot Study

“…By the use of the WSS, we anticipated that we would be able to show even subtle changes in sensorimotor performance over the course of the rehabilitation. The nine-hole peg test (as part of the Multiple Sclerosis Functional Composite [ 3 ]), with reported minimal detectable changes of 19.4% (dominant upper-limb) and 29.1% (non-dominant upper limb) [ 4 ], is in line with a coarsely estimated necessary difference of 20.5% of the summed trial durations of the dominant and the non-dominant hand to achieve statistical significance from our previous study [ 1 ]. In comparison, other tests were revealed to be much more sensitive (e.g., finger tapping with a detected change of 4%).…”

“…In comparison, other tests were revealed to be much more sensitive (e.g., finger tapping with a detected change of 4%). However, the assessed parameters were only able to predict 4% of the variance of changes in the WSS and the duration of the rehabilitation was not a significant factor in the model in our prior study [ 1 ]. In 1999, Langdorn and Thompson [ 5 ] published a study explaining 57% of the variance of the motor scale of the Functional Independence Measure (FIM) [ 6 ] due to neurorehabilitation (3 weeks of multidisciplinary therapy at a neurorehabilitation facility; 97% of the sample were in the progressive phase of the disease).…”

“…Although inpatient rehabilitation is used frequently as a measure to improve function in multiple sclerosis (MS) patients, there is only little objective data on its success. In a recent study, we introduced the Watzmann Severity Scale (WSS) [ 1 ], a sensorimotor based statistical estimation of the Expanded Disability Status Scale (EDSS) [ 2 ], in order to sensitively examine the changes during inpatient rehabilitation in MS patients. The underlying idea was to have a sensitive surrogate of the EDSS, so that changes due to a rehabilitation intervention could be displayed based on a well-known and widely used clinical scale.…”

“…They identified three main factors, which were the verbal intelligence assessed by the Wechsler Adult Intelligence Scale-Revised Vocabulary [ 7 ] (positive impact), the FIM motor scale on admission (negative impact), and the cerebellar function score, which is a subset of the EDSS (negative impact of impairment). Interestingly, although in an extremely weak model, the only factor in our prediction model was a visuomotor control task with high demands on temporal resolution (a worse performance predicted worse rehabilitation outcomes [ 1 ]). This is in line with Langdorn’s findings on cerebellar function.…”

“…Many of the studies used measures that were susceptible to bias and the overall outcomes were only able to predict a minimal part of the variance (except Langdorn and Thompson [ 5 ]). So far, it appears that rehabilitation is most effective in patients with a lower disability [ 1 , 5 , 10 ] (excluding the FIM ceiling bias in [ 5 ]). In order to further examine potential predictive factors such as physical activity levels, we included behavioral data by actigraphy into our study.…”