VU University Medical Center, Amsterdam, The Netherlands.
Mult Scler. 2012 Mar;18(3):345-50. doi: 10.1177/1352458511419880. Epub 2011 Aug 25.
To determine which short-term changes on clinical scales including the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg test (9HPT) and Guy's Neurological Disability Scale (GNDS) are most predictive of long-term outcome of disability as rated by the EDSS in progressive multiple sclerosis (MS).
From a longitudinal database, all progressive patients, both primary (PP) and secondary (SP), were selected on the basis of at least two complete examinations being available within a time interval of 1-2 years (short-term change). All patients who fulfilled the selection criteria were invited for a third visit after an interval of at least 3 years (long-term outcome). We used ordinal logistic regression to see which early changes were most predictive of the long-term EDSS.
181 patients fulfilled the selection criteria. Early change on EDSS and T25FW were the best predictors of long-term EDSS; both were significant predictors in a 'single predictor' model. Early EDSS change was a slightly stronger single predictor (R(2) 0.38, Wald χ(2) 42.65, p < 0.001) compared with early T25FW change (R(2) 0.27, Wald χ(2) 12.35, p < 0.001). Adding early T25FW change to early EDSS change in a 'combined predictor' model improved prediction (p = 0.036).
Both early change on EDSS and T25FW predict long-term EDSS with comparable strength. Early change on T25FW adds significant independent information and improves the prediction model with early EDSS change only. Therefore we support the use of early T25FW examinations in future clinical trials in progressive MS.
为了确定扩展残疾状况量表（EDSS）、定时 25 英尺步行（T25FW）、9 孔钉测试（9HPT）和盖氏神经功能缺损量表（GNDS）等临床量表的短期变化中哪些最能预测进展性多发性硬化症（MS）患者的长期残疾结局（EDSS 评分）。
我们从纵向数据库中选择了所有符合条件的进展性患者，包括原发性进展型（PP）和继发性进展型（SP），其标准为在 1-2 年内至少有两次完整的检查（短期变化）。所有符合入选标准的患者均在至少 3 年后进行了第三次随访（长期结局）。我们使用有序逻辑回归来观察哪些早期变化最能预测长期 EDSS。
共有 181 例患者符合入选标准。EDSS 和 T25FW 的早期变化是长期 EDSS 的最佳预测指标；在“单一预测指标”模型中，这两个指标都是显著的预测指标。早期 EDSS 变化是一个稍强的单一预测指标（R（2）0.38，Wald χ（2）42.65，p < 0.001），而早期 T25FW 变化的预测能力稍弱（R（2）0.27，Wald χ（2）12.35，p < 0.001）。在“联合预测指标”模型中，将早期 T25FW 变化添加到早期 EDSS 变化中，可提高预测效果（p = 0.036）。
EDSS 和 T25FW 的早期变化都能以相当的强度预测长期 EDSS。T25FW 的早期变化可提供重要的独立信息，并可改善仅基于 EDSS 早期变化的预测模型。因此，我们支持在未来的进展性 MS 临床试验中使用早期 T25FW 检查。
