Abstract
The aim of the present study was to explore variations in functioning and disability – with regard to cognition, manual dexterity, walking, energy, mood, activities of daily living and social/ lifestyle activities – every six months during a 2-year period, in 200 people with MS (PwMS) at an outpatient MS specialist clinic. Symbol Digit Modalities Test, Nine Hole Peg Test, Timed 25 Foot Walk, Fatigue Severity Scale, Beck Depression Inventory, Katz ADL Index Extended and Frenchay Activities Index were used to collect data. For analyses of statistically significant changes in scores during the study period, repeated measures ANOVA was used for ratio data and Friedman ANOVA for ordinal data. In addition, effect size as well as the mean/median change in score during the study period were determined for each functioning. Nearly all functioning studied varied significantly but there was no general deterioration in the sample. Small effect sizes were mainly found for the Frenchay Activities Index and a plausible practice effect was detected for the Symbol Digit Modalities Test. As many as 63 % with regard to walking and 46 % with regard to manual dexterity demonstrated > 20 % mean change in scores which has proved to be a reliable and clinically meaningful change. This study illustrates the importance of systematic and regular multidimensional assessment of functioning and disability in PwMS aiming to identify disabilities that could be minimized through timely and appropriate evidence-based interventions. The fluctuation in functioning and the conceivable learning effect inherent in instruments used should be taken into consideration when designing studies and interpreting the results.
Similar content being viewed by others
References
Amato M, Ponziani G, Siracusa G, Sorbi S (2001) Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 58:1602–1606
Arnett P, Randolph J (2006) Longitudinal course of depression symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry 77:606–610
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Bever CT Jr, Grattan L, Panitch HS, Johnson KP (1995) The Brief Repeatable Battery of Neuropsychological Tests for Multiple Sclerosis: a preliminary serial study. Mult Scler 1:165–169
Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH (2002) Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 159:1862–1868
Cohen J (1992) A power primer. Psychol Bull 112:155–159
Confavreux C, Vukusic S, Moreau T, Adeleine P (2000) Relapses and progression of disability in multiple sclerosis. N Engl J Med 343:1430–1438
Dent A, Lincoln NB (2000) Screening for memory problems in multiple sclerosis. Br J Clin Psychol 39:311–315
Einarsson U, Gottberg K, Fredriksson S, von Koch L, Widén Holmqvist L (2006) Activities of daily living and social activities in people with multiple sclerosis in Stockholm County. Clin Rehabil 20:543–551
Einarsson U, Gottberg K, von Koch L, Fredrikson S, Ytterberg C, Jin YP, et al. (2006) Cognitive and motor function in people with multiple sclerosis in Stockholm County. Mult Scler 12:340–353
Goldman Consensus Group (2005) The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler 11:328–337
Goodkin DE, Hertsgaard D, Seminary J (1988) Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests. Arch Phys Med Rehabil 69:850–854
Gottberg K, Einarsson U, Fredrikson S, von Koch L, Widen Holmqvist L (2007) A population-based study of depressive symptoms in multiple sclerosis in Stockholm County. Association with functioning and sense of coherence. J Neurol Neurosurg Psychiatry 78:60–65
Gulick E (1998) Symptom and activities of daily living trajectory in multiple sclerosis: a 10-year study. Nurs Res 47:137–146
Huber SJ, Rammohan KW, Bornstein RA, Christy JA (1993) Depression symptoms are not influenced by severity of multiple sclerosis. Neuropsychiatry Neuropsychol Behav Neurol 6:177–180
Huijbregts S, Kalkers N, de Sonneville L, de Groot V, Polman C (2006) Cognitive impairment and decline in different subtypes. J Neurol Sci 245:187–194
Jenkinson C, Peto V, Jones G, Fitzpatrick R (2003) Interpreting change scores on the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40). Clin Rehabil 17:380–385
Johnson K, Brooks B, Cohen J, Ford C, Goldstein J, Lisak R, et al. (1998) Copolymer 1 Multiple Sclerosis Study Group (2001) Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability. Neurology 57:46–53
Kaufman M, Moyer D, Norton J (2000) The significant change for the Timed 25-foot Walk in the multiple sclerosis functional composite. Mult Scler 6:286–290
Kazis LE, Anderson JJ, Meenan R (1989) Effect sizes for interpreting changes in health status. Med Care 27(3 Suppl):178–189
Kragt JJ, van der Linden FA, Nielsen, JM, Uitdehaag BM, Polman CH (2006) Clinical impact of 20 % worsening on Timed 25 %-foot Walk and 9-hole Peg Test in multiple sclerosis. Mult Scler 12:594–598
Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123
Kujala P, Portin R, Ruutiainen J (1997) The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain 120:289–297
Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 77:1444–1452
Lerdal A, Celius EG, Moum T (2003) Fatigue and its association with sociodemographic variables among multiple sclerosis patients. Mult Scler 9:509–514
Mathiowetz V, Weber K, Kashman N, Volland G (1985) Adult norms for the Nine Hole Peg Test of finger dexterity. Occup Ther J Res 5:24–38
Myhr KM, Riise T, Vedeler C, Nortvedt MW, Gronning R, Midgard R, et al. (2001) Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension. Mult Scler 7:59–65
Noseworthy JS (1994) Clinical scoring methods for multiple sclerosis. Ann Neurol 36 (Suppl):80–85
Oberg T, Karsznia A, Oberg K (1993) Basic gait parameters: reference data for normal subjects, 10–79 years of age. J Rehabil Res Dev 30:210–223
Patten SB, Beck CA, Williams JVA, Barbui C, Metz LM (2003) Major depression in multiple sclerosis: a population-based perspective. Neurology 61:1524–1527
Peto V, Jenkinson C, Fitzpatrick R (2001) Determining minimally important differences for the PDQ-39 Parkinson’s disease questionnaire. Age Ageing 30:299–302
Pittock SJ, Mayr WT, McClelland RL, Jorgensen NW, Weigand SD, Noseworthy JH, et al. (2004) Change in MSrelated disability in a populationbased cohort: a 10-year follow-up study. Neurology 62:51–59
Polman CH, O’Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, et al. ; AFFIRM investigators (2006) A randomized placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 354:899–910
Poser C, Paty D, Scheinberg L, McDonald W, Davis F, Ebers G (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231
Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. Frequency, patterns, and prediction. Neurology 41:685–691
Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G (2004) Exercise therapy for multiple sclerosis. Cochrane Database of Systematic (Reviews), Issue 3
Rodriguez M, Siva A, Ward J, Stolp-Smith K, O’Brien P, Kurland L (1994) Impairment, disability, and handicap in multiple sclerosis: a populationbased study in Olmsted County, Minnesota. Neurology 44:28–33
Rudick R, Goodkin D, Jacobs L, Cookfair D, Herndon R, Richert J, et al. (1997) Multiple Sclerosis Collaborative Research Group (2001) Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis. Neurology 57:25–30
Rudick R, Antel J, Confavreux C, Cutter G, Ellison G, Fischer J, et al. (1997) Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force. Ann Neurol 42:379–382
Smith A (1982) Symbol Digit Modalities Test (SDMT). In: Lezak M (ed) Neuropsychological Assessment. 3rd ed. Oxford University Press, New York, pp 379–381
Sonn U, Asberg KH (1991) Assessment of activities of daily living in the elderly. Scand J Rehab Med 23:193–202
Swingler RJ, Compston DA (1992) The morbidity of multiple sclerosis. Q J Med 83:325–337
Tellez N, Rio J, Tintore M, Nos C, Galan I, Montalban X (2006) Fatigue in multiple sclerosis persists over time. A longitudinal study. J Neurol Nov 253:1466–1470
The Swedish MS Association (2005) Sundstrom P, Vrethem M, Wallentin F, Myr A (Editorial Committee). Metodboken. http://www. mssallskapet. se Accessed March 5, 2007
The Swedish MS-register http://www. msreg. net Accessed February 22, 2007
Thomas PW, Thomas S, Hillier C, Galvin K, Baker R (2006) Psychological interventions for multiple sclerosis. Cochrane Database of Systematic (Reviews), Issue 1
Tremlett H, Paty D, Devonshire V (2006) Disability progression in multiple sclerosis is slower than previously reported. Neurology 66:172–177
Turnbull JC, Kersten P, Habib M, McLellan L, Mullee MA, George S (2000) Validation of the Frenchay Activities Index in a general population aged 16 years and older. Arch Phys Med Rehabil 81:1034–1038
Wade DT, Legh-Smith J, Langton Hewer R (1985) Social activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med 7:176–181
World Health Organization (2001) International classification of functioning, disability and health www.who.int/classification/icf Accessed March 5, 2007
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ytterberg, C., Johansson, S., Andersson, M. et al. Variations in functioning and disability in multiple sclerosis. J Neurol 255, 967–973 (2008). https://doi.org/10.1007/s00415-008-0767-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-008-0767-0