Oklahoma City VA Medical Center , Oklahoma City, OK , USA .
Disabil Rehabil. 2013;35(22):1877-84. doi: 10.3109/09638288.2013.766269. Epub 2013 Apr 19.
Multiple sclerosis (MS) is a disease which has a variable clinical presentation followed by 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.
This observational study in veterans with MS compared the Kurtkze Expanded Disability Status Scale (EDSS) and the Total Functional Independence Measure (TFIM) scale as measures of MS-related disability.
We retrospectively reviewed the electronic charts of 76 veterans with MS who are regularly followed in our VA MS clinic. Local Institutional Review Board approval was obtained for the protocol. Data were analyzed using SAS (SAS System for Windows, version 9.2, SAS Institute Inc., Cary, NC, USA). Chi-square and Fisher exact tests were used to assess categorical variables. Kruskal-Wallis tests evaluated the relationships between MS types [relapsing-remitting MS (RR), secondary progressive MS (SP), primary progressive MS (PP) and clinical isolated syndrome (CIS)] and the initial TFIM, EDSS and Impairment Index (II) scores.
The EDSS score accurately measured MS-related impairment at initial evaluation and follow-up relative to an II. However, the EDSS score did not change over time, compared to the TFIM suggesting reduced sensitivity of the EDSS for detecting change in MS-related disability over time.
This suggests TFIM scale is a more sensitive measure of MS-related disability than EDSS for use in future MS clinical trials.
This study highlights that given the paucity of scales to which EDSS has been compared, TFIM is a valuable adjunct to EDSS in measuring MS-related disability. TFIM is able to accurately measure the severity of MS-related disability and help provide for services patients with MS-related disability would need. TFIM is an easy to administer and a sensitive scale to measure the change in MS-related disability following interventions.
多发性硬化症（MS）是一种临床表现多样、病程多样的疾病。因此，在初始临床表现和随访期间，临床评分量表准确测量残疾的能力对于准确捕捉该疾病固有的变异性至关重要。当试图确定干预措施的疗效时，这一点尤为重要。
本项针对退伍军人多发性硬化症的观察性研究比较了 Kurtkze 扩展残疾状况量表（EDSS）和总功能独立性测量（TFIM）量表作为多发性硬化症相关残疾的测量方法。
我们回顾性地审查了在我们 VA 多发性硬化症诊所定期就诊的 76 名多发性硬化症退伍军人的电子病历。该方案获得了当地机构审查委员会的批准。使用 SAS（SAS 系统，Windows 版本 9.2，SAS 研究所，Cary，NC，USA）分析数据。使用卡方和 Fisher 精确检验评估分类变量。Kruskal-Wallis 检验评估 MS 类型[复发缓解型 MS（RR）、继发进展型 MS（SP）、原发进展型 MS（PP）和临床孤立综合征（CIS）]与初始 TFIM、EDSS 和损伤指数（II）评分之间的关系。
EDSS 评分在初始评估和随访时准确测量多发性硬化症相关损伤，而 II 则相对准确。然而，与 TFIM 相比，EDSS 评分在时间上没有变化，这表明 EDSS 对检测多发性硬化症相关残疾随时间变化的敏感性降低。
这表明 TFIM 量表是一种比 EDSS 更敏感的多发性硬化症相关残疾测量方法，可用于未来的多发性硬化症临床试验。
本研究强调，鉴于 EDSS 比较量表的缺乏，TFIM 是 EDSS 测量多发性硬化症相关残疾的有价值的补充。TFIM 能够准确测量多发性硬化症相关残疾的严重程度，并有助于为多发性硬化症相关残疾患者提供所需的服务。TFIM 是一种易于管理且敏感的量表，可用于测量干预后多发性硬化症相关残疾的变化。
