Ross Amy Perrin, Halper June, Harris Colleen J
Department of Neurosciences, Loyola University Chicago, Chicago, IL, USA (APR); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH); and Department of Clinical Neurosciences-Multiple Sclerosis Clinic, University of Calgary, Alberta, Canada (CJH).
Int J MS Care. 2012 Fall;14(3):148-59. doi: 10.7224/1537-2073-14.3.148.
There are currently no assessment tools that focus on evaluating patients with multiple sclerosis (MS) who are experiencing a relapse or that evaluate patients' response to acute relapse treatment. In practice, assessments are often subjective, potentially resulting in overlooked symptoms, unaddressed patient concerns, unnoticed or underrecognized side effects of therapies (both disease modifying and symptomatic), and suboptimal therapeutic response. Systematic evaluation of specific symptoms and potential side effects can minimize the likelihood of overlooking important information. However, given the number of potential symptoms and adverse events that patients may experience, an exhaustive evaluation can be time-consuming. Clinicians are thus challenged to balance thoroughness with brevity. A need exists for a brief but comprehensive objective assessment tool that can be used in practice to 1) help clinicians assess patients when they present with symptoms of a relapse, and 2) evaluate outcomes of acute management. A working group of expert nurses convened to discuss recognition and management of relapses. In this article, we review data related to recognition and management of relapses, discuss practical challenges, and describe the development of an assessment questionnaire that evaluates relapse symptoms, the impact of symptoms on the patient, and the effectiveness and tolerability of acute treatment. The questionnaire is designed to be appropriate for use in MS specialty clinics, general neurology practices, or other practice settings and can be administered by nurses, physicians, other clinicians, or patients (self-evaluation). The relapse assessment questionnaire is currently being piloted in a number of practice settings.
目前尚无专注于评估复发期多发性硬化症（MS）患者或评估患者对急性复发治疗反应的评估工具。在实际操作中，评估往往具有主观性，可能导致症状被忽视、患者担忧未得到解决、治疗（疾病修正治疗和对症治疗）的副作用未被注意到或未得到充分认识，以及治疗反应欠佳。对特定症状和潜在副作用进行系统评估可最大程度降低忽略重要信息的可能性。然而，鉴于患者可能经历的潜在症状和不良事件数量众多，详尽评估可能耗时良久。因此，临床医生面临着在全面性与简洁性之间取得平衡的挑战。需要一种简短但全面的客观评估工具，可在实际中用于：1）帮助临床医生在患者出现复发症状时进行评估；2）评估急性治疗的效果。一个专家护士工作小组召开会议讨论复发的识别与管理。在本文中，我们回顾了与复发识别和管理相关的数据，讨论了实际挑战，并描述了一种评估问卷的开发过程，该问卷用于评估复发症状、症状对患者的影响以及急性治疗的有效性和耐受性。该问卷设计适用于MS专科诊所、普通神经科诊所或其他医疗机构，可由护士、医生、其他临床医生或患者（自我评估）进行填写。复发评估问卷目前正在多个医疗机构进行试点。
