Kaufmann Marco, Vaney Claude, Barin Laura, Liu Xinglu, von Wyl Viktor
Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Berner Klinik Montana, Crans-Montana, Switzerland.
Mult Scler J Exp Transl Clin. 2020 Oct 13;6(4):2055217320964514. doi: 10.1177/2055217320964514. eCollection 2020 Oct-Dec.
It is unclear whether EDSS is responsive to disability worsening in advanced MS.
To explore the dynamics of disability worsening in persons with advanced-stage MS (EDSS ≥5.5) using three disability worsening definitions (EDSS, Rivermead Mobility Index (RMI), 9-Hole Peg Test (9-HPT)).
EDSS-, RMI- and 9-HPT-based disability worsening were assessed over a minimum of two years in a cohort of 286 persons with advanced MS attending inpatient rehabilitation using Kaplan-Meier Curves and multivariable Cox regression. Furthermore, the correspondence between EDSS-, RMI- and 9-HPT-based disability worsening was analyzed.
Disability progression was observed in 49% (9-HPT), 52% (EDSS) and 53% (RMI), with 9-HPT-based worsening slightly lagging behind. The Multiple Sclerosis Severity Score (MSSS) was the only consistent factor predicting disability worsening based on all three definitions (EDSS: hazard ratio 1.48 [1.30;1.68]; RMI: 1.12 [0.99;1.27]; 9-HPT: 1.36 [1.18;1.57]). Correspondence between EDSS and the other definitions (9-HPT and RMI) was 44.3% and 55.7% at time of EDSS progression and 65.1% and 72.5% overall, respectively.
In persons with advanced-stage MS, half still developed disability worsening in different functional systems over a median of 6 years. MSSS seems a valid predictor for disability worsening in all three outcome measures in advanced MS.
尚不清楚扩展残疾状态量表（EDSS）是否能反映晚期多发性硬化症（MS）患者残疾状况的恶化。
使用三种残疾恶化定义（EDSS、Rivermead运动指数（RMI）、9孔插钉试验（9-HPT））来探究晚期MS患者（EDSS≥5.5）残疾状况恶化的动态变化。
在一个由286名晚期MS患者组成的队列中，这些患者正在接受住院康复治疗，使用Kaplan-Meier曲线和多变量Cox回归，对基于EDSS、RMI和9-HPT的残疾恶化情况进行了至少两年的评估。此外，还分析了基于EDSS、RMI和9-HPT的残疾恶化之间的对应关系。
观察到49%（9-HPT）、52%（EDSS）和53%（RMI）的患者出现残疾进展，基于9-HPT的恶化稍滞后。多发性硬化症严重程度评分（MSSS）是基于所有三种定义预测残疾恶化的唯一一致因素（EDSS：风险比1.48 [1.30；1.68]；RMI：1.12 [0.99；1.27]；9-HPT：1.36 [1.18；1.57]）。在EDSS进展时，EDSS与其他定义（9-HPT和RMI）之间的对应率分别为44.3%和55.7%，总体对应率分别为65.1%和72.5%。
在晚期MS患者中，中位时间为6年时，仍有一半患者在不同功能系统中出现残疾恶化。MSSS似乎是晚期MS所有三种结局指标中残疾恶化的有效预测指标。
