Gulde P, Hermsdörfer J, Rieckmann P
Centre for clinical neuroplasticity Medical Park Loipl, Germany.
Technical University of Munich, Germany.
Mult Scler Relat Disord. 2021 Feb;48:102674. doi: 10.1016/j.msard.2020.102674. Epub 2020 Dec 10.
Multiple sclerosis is an autoimmune disease with a plethora of potentially arising impairments and a coarse standard clinical estimation of severity, the expanded disability status scale (EDSS). In this study, we introduced the Watzmann Severity Scale (WSS), a sensorimotor function based statistical model of the EDSS of 113 patients. Using the WSS, we examined the rehabilitation course of 87 patients. The WSS revealed to be a reliable estimate of the EDSS with an R² of 0.81, although lower EDSS grades were systematically overestimated. Further, patients slightly improved during their inpatient stay of in average 17d by 0.21 on the WSS, with changes in gait performance being the driving factor (|β|-weight of 0.84). We were not able to reliably predict changes in the WSS and found no association with the duration of hospitalization. We conclude and advise that rehabilitation should start earlier, if lower EDSS grades were not overestimated, to emphasize gait less in rehabilitation, and to change from a perspective of impairment and disability to performance in order to maximize patient rehabilitation.
多发性硬化症是一种自身免疫性疾病，有大量潜在的功能障碍，且其严重程度的临床评估标准较为粗略，即扩展残疾状态量表（EDSS）。在本研究中，我们引入了瓦茨曼严重程度量表（WSS），这是一种基于113例患者EDSS的感觉运动功能统计模型。使用WSS，我们检查了87例患者的康复过程。WSS显示是对EDSS的可靠估计，R²为0.81，不过较低的EDSS等级被系统性高估。此外，患者在平均住院17天期间，WSS评分平均提高了0.21，步态表现的变化是驱动因素（|β|权重为0.84）。我们无法可靠地预测WSS的变化，且未发现其与住院时长有关联。我们得出结论并建议，如果较低的EDSS等级未被高估，康复应尽早开始，在康复中减少对步态的强调，并从功能障碍和残疾的角度转变为表现，以实现患者康复最大化。
