Multiple Sclerosis

Summary

Multiple Sclerosis is a progressive neurological disorder where the immune system attacks the myelin sheaths surrounding nerves in the body. Myelin acts as an insulator to nerves and allows messages to be conducted quickly throughout the body. As these sheaths get destroyed, systemic symptoms occur such as fatigue, weakness, difficulty walking, vision problems, depression, and many more. The Expanded Disability Status Scale (EDSS) is used to quantify and track disability over time in individuals with MS. Below are the EDSS range descriptions:

0.0-3.5
- Lower end: normal
- Upper end: moderate disability in 1 functional system (FS) or mild disability in 3-4 FS. Fully ambulatory.
4.0-5.5
- Lower end: fully ambulatory without aid or for at least 500 m. Self-sufficient but relatively severe disability.
- Upper end: ambulatory without aid for 100 m. Disability precludes full daily activities.
6.0-7.5
- Lower end: intermittent or unilateral assist for walking 100 m.
- Upper end: unable to take more than a few steps; restricted to a wheelchair. May need assist for transfers.
8.0-9.5
- Lower end: restricted to bed/wheelchair/chair. Retains self-care, effective upper extremity use.
- Upper end: restricted to bed. Dependent. Unable to communicate.

Recommendations for the outcome measures presented below were categorized by acuity level, disability level (EDSS), and those recommended for entry-level PT education. Recommendations for entry-level PT education include two sub-categories: students should learn to use and students should be exposed to. The following list explains the rating scale used by the MS Taskforce.

4: Highly recommend; Excellent psychometrics in MS population and excellent clinical utility in MS population.
3: Recommend; Good psychometrics in MS population and good clinical utility in the MS population.
2: Unable to recommend at this time; Insufficient information to support a recommendation for individuals with MS.
1: Do not recommend; Poor psychometrics and/or poor clinical utility in a MS population.

Outcome Measures

The Academy of Neurologic Physical Therapy (ANPT) has developed recommendations for the use of outcome measures in clinical practice and research for various neurological diagnoses. The Academy has also developed reference pages for the outcome measures that must be learned throughout a 3-year DPT program. Of the core outcome measures, five of the six will have MS specific psychometrics listed on their pages. These links can be found on the home page. No research has been done with the 10MWT in the MS population, so there will be no information on that tab. The outcome measures listed below are recommended tests that entry-level physical therapists should be able to administer. These were reviewed by NeuroPT EDGE and were found to be useful for the MS population. There are other outcome measures on this document that are supported for use with the MS population; however, they were not categorized as entry-level.