Goodin D S
University of California, San Francisco 94143, USA.
Mult Scler. 1998 Oct;4(5):444-51. doi: 10.1177/135245859800400508.
This study assessed the feasibility of using a self-report questionnaire to measure neurological impairment in multiple sclerosis (MS). Thirty patients aged 21-67 years participated. Each patient was examined and scored on three commonly used impairment scales; the extended disability status scale (EDSS), the neurologic rating scale (NRS) and the ambulation index (A1). Two other scales were also determined; the sum of the EDSS functional scores (SFS), and a five point scale rating functional status (FS). The physician also filled out a copy of the questionnaire based on interview and examination of the patient. All of these scores were determined and the physical questionnaire filled out blind to the patient's answers on their self-report questionnaire. The first 15 consecutive patients served as the pilot group to develop a computer program to convert answers on the questionnaire into predicted scores on each of the five scales. The second 15 patients served as the independent test group to assess the validity of the computer program. Using this program, both patient and physician questionnaires accurately predicted (r > 0.87) the scores on each of the five scales measured manually. In addition, the scores on all five scales were highly cross-correlated (r > 0.85) suggesting that, in fact, each measured a similar attribute of MS (i.e., impairment). Therefore, the five scales were combined into a single measure, the mean disability score (MDS), which showed the highest correlations (r > 0.95) of any scale between the predicted scores and the actual scores determined by examination. The results of this study indicate that the self-report questionnaire is a valid measure of neurological impairment in MS and, thus, that it can be used to survey this health outcome in an MS population. Moreover, this questionnaire can be filled out by a physician (based directly on the neurological examination) and, together with the computer program for scoring each patient, can be used to provide consistent scoring in clinical trials.
本研究评估了使用自填式问卷来测量多发性硬化症（MS）神经功能缺损的可行性。30名年龄在21至67岁之间的患者参与了研究。每位患者均接受检查，并依据三个常用的功能缺损量表进行评分，即扩展残疾状态量表（EDSS）、神经功能评分量表（NRS）及步行指数（A1）。另外还确定了两个量表，即EDSS功能评分总和（SFS）以及一个评定功能状态的五点量表（FS）。医生也基于对患者的访谈及检查填写了一份问卷副本。所有这些评分均已确定，且在填写体格检查表时，对患者自填式问卷的答案保持盲态。前15名连续入组的患者作为试验组，用于开发一个计算机程序，将问卷答案转换为五个量表各自的预测评分。后15名患者作为独立测试组，以评估该计算机程序的有效性。使用此程序，患者和医生的问卷均能准确预测（r>0.87）手动测量的五个量表各自的评分。此外，所有五个量表的评分高度相互关联（r>0.85），这表明实际上每个量表测量的都是MS的相似属性（即功能缺损）。因此，将这五个量表合并为一个单一指标，即平均残疾评分（MDS），该指标在预测评分与检查确定的实际评分之间的相关性在所有量表中最高（r>0.95）。本研究结果表明，自填式问卷是MS神经功能缺损的有效测量工具，因此可用于在MS人群中调查这一健康结局。此外，该问卷可由医生填写（直接基于神经学检查），并且与为每位患者评分的计算机程序一起，可用于在临床试验中提供一致的评分。
