This study assessed the feasibility of using a self-report questionnaire to measure Neurological Impairment in Multiple Sclerosis (MS). Thirty patients aged 21-67 years participated.

Each patient was examined and scored on three commonly used Impairment Scales; the Extended Disability Status Scale (EDSS), the Neurologic Rating Scale (NRS) and the Ambulation Index (A1).

Two other scales were also determined; the sum of the EDSS functional scores (SFS), and a five point scale rating Functional Status (FS).

The physician also filled out a copy of the questionnaire based on interview and examination of the patient. All of these scores were determined and the physical questionnaire filled out blind to the patient's answers on their self-report questionnaire.

The first 15 consecutive patients served as the pilot group to develop a computer program to convert answers on the questionnaire into predicted scores on each of the five scales.

The second 15 patients served as the independent test group to assess the validity of the computer program. Using this program, both patient and physician questionnaires accurately predicted (r > 0.87) the scores on each of the five scales measured manually.

In addition, the scores on all five scales were highly cross-correlated (r > 0.85) suggesting that, in fact, each measured a similar attribute of MS (i.e., Impairment).

Therefore, the five scales were combined into a single measure, the mean Disability score (MDS), which showed the highest correlations (r > 0.95) of any scale between the predicted scores and the actual scores determined by examination.

The results of this study indicate that the self-report questionnaire is a valid measure of Neurological Impairment in MS and, thus, that it can be used to survey this health outcome in an MS population.

Moreover, this questionnaire can be filled out by a physician (based directly on the Neurological examination) and, together with the computer program for scoring each patient, can be used to provide consistent scoring in clinical trials.

The purpose of this study was to investigate the extent to which objective (demographic) and subjective (self-reported health and role) domains predicted quality of life among 153 persons with Multiple Sclerosis (MS).

Subjects completed the Life Situation Survey, a measure of quality of life, a demographic from (sex, education, age, MS duration, employment status, marital status), the MS-Related Symptoms Scale (motor, BrainStem, Sensory, Mental/Emotions, Elimination subscales), and the 15-Item Activities of Daily Living (ADL) Self-Care Scale for MS Persons (Fine/Gross Motor, Communicating, Recreation/Socializing, Intimacy subscales).

Hierarchical multiple regression was used to enter three blocks of variables (demographic, symptom, and ADL domains), and stepwise was used to enter variables within each block.

The final model resulted in two health domains (Mental/Emotions and Sensory symptoms) and two role domains (Intimacy and Recreation/Socializing) that predicted 61% of the variance in quality of life of persons with MS.

Objective & Methods
To determine whether a newly developed Disability scale for patients with neck Pain demonstrated acceptable reliability and validity.

Testing was conducted using three different samples of patients with neck Pain (n = 162).

Test-retest reliability of the scale was carried out on the same day with one sample (n = 39), and between-day reliability was carried out with another (n = 21).

Differential item functioning with regard to the influence of gender and age was carried out with these two patient groups, as was construct validity.

Responsiveness was measured using patients participating in a clinical trial involving patients with chronic neck Pain (n = 102).

Additionally, scale scores were compared with a wide range of physical measurements using the patients in the clinical trial.

Results
Short-term, between-day and postal questionnaire reliability coefficients were all extremely high.

The Cronbach's alpha coefficient for internal consistency was 0.9 for the entire scale, and the coefficients for individual items were all greater than 0.88.

Disability scale scores correlated strongly to Pain scores as well as to doctor and patient global assessments, indicating good construct validity.

Relative changes in Disability scores demonstrated a moderately strong correlation to changes in Pain scores after treatment. Scale scores correlated weakly to all physical measurements.

Conclusions
The Disability Scale demonstrated excellent practicality and reliability.

The scale accurately reflects patient perceptions regarding functional status and Pain as well as doctor's global assessment and is responsive to change over long periods of time.

We feel that this scale can be a valuable tool for the assessment of patients in future clinical trials and quality of care studies.

One of the primary aims of rehabilitation for patients with Multiple Sclerosis (MS) is to reduce their levels of disability and handicap, yet little systematic research into the outcomes of this intervention has been undertaken.

This stratified, randomized, wait-list controlled study evaluated the effectiveness of a short period of multidisciplinary inpatient rehabilitation in people with MS.

Sixty-six patients in the progressive phase of the disease were assessed at 0 and 6 weeks with validated measures of Impairment (Expanded Disability Status Scale and Functional Systems), disability (Functional Independence Measure), and handicap (London Handicap Scale).

Both groups were comparable in terms of age, sex, disease duration and severity, Disability, and handicap.

At the end of 6 weeks, although the level of Impairment in both groups remained the same, those who participated in a short period of inpatient rehabilitation (average of 25 days) significantly improved their level of Disability and handicap compared with those in the wait-list control group.

Despite unchanging Impairment, inpatient rehabilitation resulted in reduced Disability and handicap in patients with Progressive MS.

Objectives
To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with Multiple Sclerosis with the opinions of patients themselves.

To compare assessment of physical disability and to compare the scores of Multiple Sclerosis patients for each domain of the SF-36 with control data matched for age and sex.

A clinician using Kurtzke's Expanded Disability Status Scale and a non-clinically qualified assistant using the Office of Population Census and Surveys' (OPCS) Disability Scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire

Design & Setting
Cross sectional study. Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with Multiple Sclerosis attending a Neurology outpatient clinic for review or a neurology ward for rehabilitation.

Main Outcome Measures
Scores on the SF-36; EuroQol; Kurtzke's Expanded Disability Status Scale; the OPCS Disability Scale.

Results
Patients and clinicians disagreed on which domains of health status were most important (chi 2 = 21, df = 7, P = 0.003).

Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r = -0.87, P < 0.001) and the non-clinical assessment (r = -0.90, P < 0.001).

However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol, Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls.

Conclusions
Patients with Multiple Sclerosis and possibly those with Other Chronic Diseases are less concerned than their clinicians about physical disability in their illness.

Clinical trials in Multiple Sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment.

We examined the relations between quantitative volumetric estimates of Cerebral lesion load based on Magnetization Transfer Imaging (MTI), clinical data, and measures of NeuroPsychological function in 44 patients with clinically diagnosed MS.

In this population we assessed the correlation between several volumetric MTI measures, measures of Neurologic function (Kurtzke Expanded Disability Status Scale and Ambulation Index), and disease duration using Spearman's correlation coefficient.

Patients were classified on the basis of NeuroPsychological test performance as Severely Impaired, Moderately Impaired, and Normal. We assessed differences between these groups with respect to MTI results using the Kruskal-Wallis test.

MTI measures corrected for Brain Volume were found to correlate with disease duration (p < 0.01) and showed suggestive correlations with measures of Neurologic Impairment (p < 0.05).

Individual NeuroPsychological tests correlated with MTI measures corrected and not corrected for Brain Volume (p < 0.001). An MTI measure not corrected for Brain Volume differed (p < 0.05) between severely impaired, moderately impaired, and normal patients.

These preliminary results suggest that volumetric MTI analysis provides new measures that reflect more accurately the global lesion load in the Brain of MS patients, and they may serve as a method to study the natural course of the disease and as an outcome measure to evaluate the effect of drugs.

The feasibility and precision of clinical trials for the treatment of MS must be improved.

Subsequent to the approval by the Food and Drug Administration of the United States of Interferon-ß-Ib as a safe and effective, though not curative, treatment for Relapsing/Remitting MS, the testing of other agents in this disease has been undertaken or is anticipated.

This report summarises the discussions and recommendations of an international workshop held to review critically the elements of current MS therapeutic trials and to identify the most important aspects of clinical evaluation, study design and data analysis that would allow agents for MS to be tested as accurately, rapidly and economically as possible.

While acknowledging the many uncertainties about the pathophysiology and natural history of MS, the workshop participants made recommendations about the preferred components to be used in the design of trials which may be different depending on the treatment goal and agent studied.

It was concluded that the formulation of a useful clinical trial design must be based on specific guidelines for clinical scales and imaging for which task forces were recommended and subsequently appointed.

Many Neurological rating scales have been suggested to assess the impact of Multiple Sclerosis on patients, but none has been universally accepted.

The Kurtzke Extended Disability Status Scale has been the most widely used despite its imperfections. It combines disability and impairment, has moderate inter-rater reliability, and its overall score is heavily weighted toward ambulation.

The Scripps Neurological Rating Scale attempts to quantify impairment as measured by the traditional neurological examination. However, this and other impairment scales lack direct relevance to patients' functional health status.

The Ambulation Index and some of the quantitative upper limb dysfunction assessment methods are sensitive and reproducible, but they only measure limited aspects of the wide range of disabilities encountered in Multiple Sclerosis.

Current scales of disability and activities of daily living, such as the Incapacity Status Scale and the Functional Independent Measure, are not sensitive to the type of change which occurs in Multiple Sclerosis. The relationship between abnormalities on magnetic resonance images of the Brain and disability has been difficult to ascertain.

Although recently developed imaging acquisition methods may demonstrate abnormalities which are more closely correlated with disability, the demonstration of prevention, stabilization or recovery from disability using clinical scales will remain the final arbiter of success in clinical trials. We suggest guidelines for an improved disability scale.

Attempting to measure the impact of Multiple Sclerosis (MS) on the individuals patients has become a major issue stimulated by both the emergence of new therapeutic agents and the increasing demand to incorporate the patient's perspective.

Disability has been the main focus. Recently, new disability scales have been developed and generic scales evaluated in an attempt to replace or complement the constantly used and much criticized Expanded Disability Status Scale (EDSS).

There is, however, the growing realization that it is important to incorporate broader aspects of disease input such as are contained within the concepts of health-related quality of life.

Current scales in this area are limited in either their scientific soundness and/or clinical usefulness, and it may be appropriate to consider the development of a new MS-specific measure of disease impact for use in clinical trials.

This allows use of standards methods to assess treatment effects but sacrifices information on patterns over time as well as potential greater efficiency of analysis.